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Med Surg > Med Surg Exam 1 > Flashcards

Med Surg Exam 1 Flashcards

1
Q

intubation placement puts at risk for…

A

…R-sided aspiration (likely to put tube all way in R lung and not supply air to L)

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2
Q

3 components of respiration

A
  • ventilation
  • perfusion (blood flow)
  • diffusion of gas
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3
Q

components of air

A
  • 79% nitrogen
  • 21% oxygen
  • TRACE amounts of CO2, water vapor, helium, argon
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4
Q

stridor =

A

obstruction of upper airway

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5
Q

orthopnea

A

SOB when lying down

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6
Q

hemoptysis `

A

spitting/coughing up of blood

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7
Q

pulse oximetry parameters

A

94-99%

**SaO2 can’t read above 100% but you have unbound free-floating O2 (so you can OVERoxygenate)

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8
Q

percentage of unbound O2

A

2% (important for partial O2)

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9
Q

normal end tidal CO2

A

30-40

**continuous waveform capnography is diagnostic

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10
Q

CT for respiratory diagnostic imaging

A

** more specific

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11
Q

CT angiography

A
  • can show pulmonary embolism

- injection of contrast media into vein to show blood flow

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12
Q

MRI

A

-very detailed view of tissues (ex. carcinoma)

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13
Q

bronchoscopy

A

**direct inspection of airway and can also remove foreign bodies, mucus plug, secretions, or for diagnostics

-AEROSOL generating procedure

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14
Q

thoracentesis

A

**fluid can be sent for analysis

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15
Q

URI’s

A

Upper Respiratory Infections

**90% of these are viral

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16
Q

rhinitis=

A

common cold (inflammation and irritation of nasal mucus membrane

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17
Q

risk factors for rhinitis

A
  • more common in women

- most common in Sept, Jan, April

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18
Q

management rhinitis

A

-symptom management with NSAIDS, antihistamines, expectorants, antitussives

**colds are self limiting= only lasts so long and goes away on its own

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19
Q

topical nasal decongestants

A

*can result in rhinitis medicamentosa (chemical rhinitis) where overuse results in inflammation of mucosa membrane

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20
Q

rhinosinusitis is either…

A

…viral or bacterial and bacterial tends to last longer

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21
Q

rhinosinusitis definition

A

-inflammation of paranasal sinuses and nasal cavity

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22
Q

risk factors for rhinosinusitis

A
  • NG tube presence (HIGH risk)
  • environmental hazards
  • immunocompromised
  • foreign body
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23
Q

management of rhinosinusitis

A
  • decongestants
  • antihistamines
  • saline lavage (neti-pot)
  • ABx reserves for those with prolonged symptoms
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24
Q

patient education on rhinosinusitis

A
  • hydration (increase secretions)
  • steam inhalation
  • sleep with head of bed elevated
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25
Q

complications of rhinosinusitis

A
  • orbital cellulitis

- osteomyelitis

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26
Q

pharyngitis

A

-inflammation of pharynx

**typically VIRAL but can be streptococcal (bacterial, like strep throat)

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27
Q

risk factors pharyngitis

A

5-15 age

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28
Q

symptoms pharyngitis

A
  • red pharyngeal membrane
  • tonsillar exudate
  • enlarged lymph nodes
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29
Q

viral pharyngitis

A

-will typically resolve in 3-10 days

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30
Q

untreated bacterial pharyngitis

A
  • otitis media
  • peritonsillar abscesses
  • meningitis
  • rheumatic heart dz
  • glomerulonephritis
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31
Q

laryngitis risk factors

A
  • overuse
  • exposure to dust or chemicals
  • URI
  • GERD
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32
Q

symptoms laryngitis

A
  • hoarseness
  • aphonia (no voice)
  • dry cough
  • sore throat
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33
Q

management of laryngitis

A

**most pts. recover with conservative therapy (ex. if its from GERD, treat the GERD)

**more severe respiratory infections utilizes ABx

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34
Q

patient education on laryngitis

A
  • rest voice
  • avoid irritants like smoking
  • AVOID DECONGESTANTS (can dry out the throat which leads to greater irritation)
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35
Q

signs of airway compromise in URI

A
  • drooling

- inability to swallow

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36
Q

OSA (obstructive sleep apnea)

A

*recurrent episodes of upper airway obstruction that cause apnea during sleep

(relaxation of muscles + gravity)

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37
Q

patho of OSA

A

-airway recurrently gets obstructed as patient sleeps leading to periods of apnea (**AT LEAST 5x AN HOUR), hypoxia, and a strong sympathetic response (high HR and BP)

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38
Q

OSA risk factors

A
  • men
  • obesity
  • older age
  • more prevalent in those with CAD, HF, and T2DM
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39
Q

OSA symptoms

A
  • frequent, loud snoring
  • breathing cessation 10 seconds or longer
  • apnea following by waking abruptly w/ loud snort
  • hypoxia
  • daytime sleepiness/insomnia
  • morning headaches
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40
Q

OSA management (noninvasive)

A
  • CPAP (continuous positive airways pressure…one pressure throughout entire respiratory cycle)
  • BiPAP (bilevel positive airways pressure)
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41
Q

BiPAP specifically

A

-2 levels of pressure (change in pressure “pulling” air from lungs/uncomfortable)

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42
Q

surgical management of OSA

A
  • uvulopalatopharyngoplasty (surgical resection of uvula and pharyngeal soft tissue) LAST RESORT & effective in 50%
  • tonsillectomy
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43
Q

medications OSA

A

-modafinil (reduces daytime sleepiness)

***CNS stimulant

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44
Q

OSA pt. education

A
  • weight loss

- avoidance of alcohol and hypnotic meds (MELATONIN WORSENS SLEEP APNEA)

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45
Q

nasal cannula and OSA

A

-helps w/ hypoxia but not apnea

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46
Q

OSA complications

A
  • higher prevalence HTN (SNS activated)
  • increased risk of MI, stroke, and death
  • predisposed to arrhythmias
  • impacts metabolic changes such as insulin resistance
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47
Q

epistaxis

A

(nosebleeds)

- hemorrhage from nose caused by rupture of tiny vessels

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48
Q

risk factors epistaxis

A
  • local infections and inflammation
  • drying of mucus membranes (O2 pts)
  • trauma (nose-picking)
  • drug use
  • ANTICOAGULANTS
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49
Q

management of epistaxis

A
  • direct pressure
  • topical admin of vasoconstrictors
  • cauterization
  • nasal packing (Rhino-Rocket)
  • continually assess airway
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50
Q

pt. education epistaxis

A
  • sit with head tilted forward and pinch nose midline of septum (5-10 minutes)
  • avoid vigorous activity for few days
  • avoid tobacco and forceful nose blowing (this raises your BP so you are more likely to bleed)
  • humidify O2
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51
Q

nasal obstruction

A

-passage of air obstructed by foreign body, deviated septum, nasal polyps

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52
Q

nasal obstruction signs

A
  • congestion
  • frequent infections
  • sleep deprivation
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53
Q

management of nasal obstruction

A
  • nasal corticosteroids for polyps

- Abx underlying infection

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54
Q

pt. education national obstruction

A

-after surgery for removal of obstruction: elevate head of bed for drainage, sinus precautions (no straws, incentive spirometry, nose blowing), and ORAL hygiene

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55
Q

IMPORTANT to determine: nasal fractures

A
  • CLEAR FLUID from nostril suggest cribriform plate fracture and leakage of CSF
  • CSF has glucose and can be differentiated from nasal mucus with dipstick (Halo test)
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56
Q

management of nasal fractures

A
  • control bleeding utilizing packing
  • uncomplicated fractures can be tx with analgesia, ice, and ENT follow up and some can heal spontaneously but if misaligned you may need surgical intervention
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57
Q

pt education nasal fractures and CSF

A
  • educate pt. not to blow nose/cough
  • sneeze with open mouth
  • elevate head of the bed
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58
Q

complications with CSF leakage specifically

A

-meningitis

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59
Q

more complications nasal fracture

A
  • hematoma
  • infection
  • abscess
  • necrosis
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60
Q

facial fractures?

A

NOTHING in nose (no NG tube)

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61
Q

laryngeal obstruction

A
  • cause by edema and is SERIOUS (often fatal)

- can be caused by severe inflammation of throat such as scarlet fever, in anaphylaxis, or when laryngospasm occurs

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62
Q

risk factors for laryngeal obstruction

A
  • inhalation of foreign body
  • use of ACE inhibitors (-ilil)
  • previous tracheostomy
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63
Q

symptoms of laryngeal obstruction

A
  • stridor
  • hoarseness
  • use of accessory muscles/dyspnea
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64
Q

if unsuccessful in dislodging obstruction

A

-tracheotomy is necessary immediately

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65
Q

if obstruction due to anaphy…

A

-admin of epinephrine and corticosteroid

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66
Q

most common form of laryngeal cancer

A

-squamous cell carcinoma

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67
Q

risk factors laryngeal cancer

A
  • tobacco/alc
  • more common in men
  • 60-70 age
  • AA population
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68
Q

symptoms laryngeal cancer

A
  • hoarseness for more than 2 weeks

- persistent cough/sore throat

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69
Q

late symptoms laryngeal cancer

A
  • dysphagia
  • dyspnea
  • foul breath (halotosis)
  • persistent hoarseness
  • unintended weight loss
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70
Q

goals of tx laryngeal cancer

A
  • provide safe swallowing
  • preservation of voice
  • cure
  • avoidance of permanent tracheostomy
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71
Q

med management of laryngeal cancer

A
  • surgery (total laryngectomy, partial resection)
  • radiation (more effective early dx, preserves voice, can be used in combo with surgery)
  • chemotherapy (usually used for reoccurrence or metastatic dz, utilized to shrink tumor before surgery)
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72
Q

total laryngectomy

A

*permanent tracheal stoma

  • NO voice
  • pt. will have normal swallowing
  • speech therapy consulted preop.
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73
Q

nursing implications laryngeal cancer

A
  • post-op, raise head of bed to decrease surgical edema
  • monitor for hypoxia (SOB, restlessness, apprehension)
  • encourage TCDB
  • suction PRN (large amount mucus common)
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74
Q

possible complications from laryngectomy

A

respiratory distress/hypoxia

  • hemorrhage (notify surgeon IMMEDIATELY if active bleeding)
  • infection
  • wound breakdown
  • aspiration
  • tracheostoma stenosis
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75
Q

pt. education after laryngectomy

A
  • ORAL HYGEINE
  • carry medical ID (stoma ventilation)
  • hair spray, loose hair, and powder should not go near stoma
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76
Q

endotracheal intubation

A

**for those unable to maintain airway (ex. comatose or obstruction)

  • no more than 21 days (breaks down trachea) ***!!!!!
  • tube passed thru mouth or nose into trachea and once inserted cuff inflated to prevent air leakage around tube
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77
Q

ET tube nursing interventions

A
  • nurse should have bag valve mask device (Ambu bag) at bedside
  • suction and suction catheters should be set up at bedside
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78
Q

trach tubes cuffed vs uncuffed

A

-cuffed for mechanically ventilated patients

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79
Q

fenestrated

A

allows some air to move thru larynx so they can communicate

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80
Q

necessities at bedside for pt w/ trach

A

-spare tracheostomy tube (cuffed) and obturator (assists with putting in new trach)

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81
Q

thick secretions in trach

A

-thick secretions common because upper airway has been bypassed (hyper secretion because not dehumidifying same way)

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82
Q

trach pts. positioning

A

-semi fowlers

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83
Q

atelectasis commonly caused by

A

lack of deep breathing

*post-op pts. at increased risk

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84
Q

atelectasis symptoms

A
  • dyspnea, cough, leukocytosis (elevated WBC)
  • sputum production
  • diminished breath sounds
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85
Q

PREVENTING atelectasis

A
  • early ambulation
  • spirometry
  • DBCT
  • chest physiotherapy (percussion and vibration…i.e. hitting pts. backs help cough up secretions)
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86
Q

how often to you use spirometry

A

6-10x a session (every hour) while awake

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87
Q

pneumonia

A

-infection of lower respiratory tract

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88
Q

pneumonia risk factors

A
  • smoking
  • COPD or asthma
  • immunosuppression therapy
  • older than 65 yo
  • immobility
  • poor dental hygiene
  • artificial airways
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89
Q

VAP

A

-ventilator associated pneumonia

  • prevent:
  • suction
  • oral care
  • early mobility
  • elevating HOB
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90
Q

pneumonia symptoms

A
  • fever
  • cough CAN BE PRODUCTIVE OR NONPRODUCTIVE
  • hypoxia
  • headache
  • tachypnea
  • diminished breath sounds/crackles
  • altered mental status
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91
Q

O2 therapy

A

-titrate O2 to lowest level clinically indicated

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92
Q

cannula liters and percentage

A

1-6 L

*23-42%

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93
Q

simple mask liters and percentage

A

6-8 L

*40-60%

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94
Q

partial nonrebreather mask liter and percentage

A

8-11

*50-75%

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95
Q

nonrebreather mask liter and percentage

A

12-15L (can’t last long on this…start making backup plan)

***MUST BE INFLATED to deliver highest concentration of FIO2 (don’t let collapse on inspiration)

*80-100%

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96
Q

venturi mask

A

suggested flow rate is variable

*24%, 26%, 28%, 30%, 35%, 40%, 50%

***precise FIO2 (specific oxygen delivery)

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97
Q

incentive spirometer vs flutter valve

A
  • spirometer (breathe in, inflate alveoli)

- flutter valve (breathe out, loosens secretions and send vibrations thru bronchial tree)

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98
Q

pneumonia complications

A
  • septic shock
  • respiratory failure
  • atelectasis
  • pleural effusion
  • superinfection
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99
Q

TB affects…

A

…the lung parenchyma

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100
Q

risk factors TB

A
  • homelessness
  • poverty
  • overcrowding
  • immunocompromised
  • malnutrition
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101
Q

symptoms TB

A
  • hemoptysis (coughing blood)
  • dyspnea
  • chest pain
  • fever
  • night sweats
  • weight loss
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102
Q

symptoms of TB can last

A

weeks to months

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103
Q

pharm for TB

A
  • INH
  • rifampin
  • pyrazinamide
  • ethambutol
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104
Q

pleurisy

A

-inflammation of the membranes that cover the lungs

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105
Q

risk factors pleurisy (may develop with)

A
  • pneumonia
  • URI
  • trauma
  • PE
  • after thoracotomy
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106
Q

pleurisy symptoms

A

-severe sharp pain during inspiration

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107
Q

management of pleurisy

A

tx underlying condition and analgesics

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108
Q

pleural effusion

A

-collection of fluid in the pleural space

**usually secondary (to heart failure, TB, pneumonia)

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109
Q

empyema

A

collection of purulent fluid (pus) within the pleural space

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110
Q

symptoms of PE are…

A

…dependent on size and the underlying condition

**dyspnea is most common symptom of large pleural effusion

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111
Q

management of PE

A
  • tx of underlying condition
  • thoracentesis
  • chest tube insertion
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112
Q

PE and malignancy

A

-if caused by malignancy, reoccurrence is common

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113
Q

thoracentesis warning

A

-amounts removed that are greater than 1-1.5 L can result in re-expansion pulmonary edema

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114
Q

nursing interventions for thoracentesis

A
  • gather supplies
  • obtain specimen for testing
  • help position and monitor pt
  • documentation
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115
Q

ARF

A
  • acute respiratory failure
  • sudden life-threatening deterioration of gas exchange (differentiated between hypoxic {probs w/ oxygenation} or hypercapnic {probs w/ CO2})
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116
Q

causes of ARF

A

ex. injury to C-spine (above C4 or C3)

**numerous causes

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117
Q

ARF early symptoms

A
  • restlessness
  • fatigue
  • headache
  • dyspnea
  • air hunger
  • mild tachycardia/pnea
  • increased BP
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118
Q

ARF late symptoms

A
  • confusion and lethargy
  • tachycardia/tachypnea
  • central cyanosis
  • diaphoresis
  • respiratory arrest
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119
Q

settings for vent

A
  • rate (# of breaths machine gives each minute…breathing over vent=good)
  • FIO2 (inspired oxygen level…100% not good means pt not oxygenating well)
  • Tidal volume (amount of air given with each breath in mL)
  • positive end expiratory pressure (PEEP) (pressure used to keep alveoli open during expiration….5 is normal)
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120
Q

ARDS

A
  • acute respiratory distress syndrome
  • severe form of an acute lung injury (PROGRESSES QUICKLY TO SHOCK)
  • mortality 50-60%
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121
Q

risk factors ARDS

A
  • sepsis
  • aspiration
  • trauma
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122
Q

symptoms ARDS

A
  • sudden pulmonary edema
  • increasing bilateral infiltrates
  • hypoxemia refractory to supplemental oxygen
  • decreased lung compliance
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123
Q

management of ARDS

A
  • tx underlying condition
  • supportive care/intubation
  • circulatory support
  • proning
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124
Q

pulmonary artery hypertension is…

A

…usually secondary to cause such as COPD (hypercapnia and hypoxia causes vasoconstriction in pulm arteries) or L ventricular failure

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125
Q

as pressure in pulm artery rises…

A

…heart must work harder to compensate (often have R hypertrophy of R ventricle of heart)

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126
Q

symptoms of pulmonary artery hypertension

A
  • dyspnea and weakness
  • chest pain
  • symptoms of R sided HF (distended neck vein, ascites, peripheral edema)
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127
Q

management of pulmonary artery HTN

A
  • tx underlying condition
  • supplemental oxygen
  • vasodilators (sildenafil)
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128
Q

Pulmonary Embolism symptoms

A
  • SOB
  • pleuritic chest pain (sharp pain w/ inspiration)
  • cough
  • hemoptysis
  • crackles
  • tachypnea/tachycardia
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129
Q

diagnostics for pulmonary embolism

A
  • D-dimer (blood test for pt. w/ poss PE….lots of false + but rarely false -)
  • CT angio (BEST TEST FOR PE)
  • ABG
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130
Q

saddle pulmonary embolism

A

(blocks blood flow to L and R side of lungs)

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131
Q

pulmonary embolism risk factors

A
  • surgery/trauma
  • obesity
  • immobility
  • older than 40
  • pregnancy/oral contraceptives (more common in women)
  • hypercoagulable conditions
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132
Q

preventing a pulmonary embolism

A
  • prevent DVTs
  • active leg exercise/early ambulation
  • TED hose/SCDs
  • prophylactic anticoagulation
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133
Q

management of pulmonary embolism

A
  • anticoagulation (Heparin, Plavix)
  • thrombolytic therapy (clot-buster…Altepase, only for unstable pts)
  • surgical intervention (embolectomy)
  • O2 admin
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134
Q

pulmonary edema symptoms

A
  • PINK FROTHY SPUTUM
  • confusion
  • dyspnea/hypoxemia
  • anxiety
  • crackles
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135
Q

management of pulmonary edema

A
  • tx the cause
  • administer supplemental O2
  • intubation if needed (but it is hard to manage because of all the sputum)
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136
Q

occupational lung dz

A

exposure to: metal dust, mineral dust, toxic fumes, asbestos

*this exposure results in fibrinous lung changes that are irreversible

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137
Q

management of occupational lung dz

A

CANT REVERSE (supportive tx)

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138
Q

lung cancer (bronchogenic carcinoma)

A

**ALWAYS assess for metasasis (commonly spreads to other areas, usually the lymphs)

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139
Q

risk factors bronchogenic carcinoma

A
  • smoking
  • radon gas exposure
  • occupational exposure to carcinogens
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140
Q

airway clearance techniques for lung cancer pts

A
  • suctioning
  • directed cough
  • deep breathing exercises
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141
Q

tumors of mediastinum (malignant or benign) symptoms

A

-result of pressure put on intrathoracic organs (chest wall bulging, cough, wheezing, superior vena cava syndrome, neck distension), dysphagia, weight loss

142
Q

complications of mediastinum tumors

A
  • hemorrhage (eat thru lining of big vessel possibly)

- infection

143
Q

blunt trauma

A
  • most common cause is MVAs
  • falls
  • bicycle crashes
144
Q

penetrating trauma

A
  • gunshot wounds
  • stab wounds

**any penetrating trauma to head/neck/thorax/pelvis is a MEDICAL emergency

145
Q

trauma management

A
  • immediate life threats (hemorrhage)
  • airway
  • breathing
  • circulation
  • disability
  • exposure
146
Q

sternal fractures

A

most commonly due to MVAs

147
Q

rib fractures

A

*most common type of chest trauma (fractures of UPPER ribs usually from high impact trauma so less common)

148
Q

symptoms rib fractures

A

-pain that worsens when taking deep breath/coughing resulting in atelectasis

149
Q

management of rib fractures

A
  • pain relief

- incentive spirometer (cant get to 500? ICU.)

150
Q

surgical fixation of rib fractures

A

RARELY necessary (most rib fractures heal in 3-6 weeks)

*in old ppl: rib fx–> atelectasis –> pneumonia –> sepsis –> die

151
Q

flail chest

A

3 or more adjacent ribs are fractures in 2 or more spots resulting in free-floating rib segments

***result of HIGH impact trauma (almost always cardiac or pulmonary contusion w/ this)

152
Q

symptoms flail chest

A
  • paradoxical chest wall movement
  • SOB
  • hypoxia
153
Q

management of flail chest

A
  • ventilatory support
  • pain control
  • monitoring
154
Q

pulmonary contusion

A

-damage to lung that results in hemorrhage and localized edema (AKA a bruise)

**takes 24 for it to worsen and to really see it (delayed response)

155
Q

symptoms pulmonary contusion

A
  • crackles
  • decreased breath sounds
  • hypoxia
  • blood-tinged secretions
  • constant but ineffective cough
156
Q

management of pulmonary contusion

A
  • monitor pt
  • maintain airway
  • O2 therapy
  • pain control
157
Q

complications of pulmonary contusion

A

-pulmonary infections

158
Q

cardiac tamponade

A

-buildup of blood fluid in pericardial sac/compression of heart resulting from fluid or blood within pericardial sac

159
Q

subcutaneous emphysema

A

air passages injured and air enters tissue under skin

160
Q

subcutaneous emphysema symptoms

A
  • tissues crackle when palpated (crepitus)

- misshapen appearance in face, neck, body

161
Q

pneumothorax

A

-parietal or visceral pleura is punctures and pleural space exposed to positive atmospheric pressure resulting in air entering pleural space and causing lung to collapse

***MANAGE: chest tube insertion

162
Q

hemothorax

A

-blood enters pleural space and causes lung to collapse

***MANAGE: chest tube insertion

163
Q

tension pneumothorax

A

-air drawn into pleural space and is trapped (results in pressure on heart and trachea in addition to collapsed lung)

***EMERGENCY=cardiac arrest can occur

164
Q

symptoms tension pneumothorax

A
  • air hunger/SOB
  • anxiety/hypoxia
  • tracheal deviation (LATE sign)
165
Q

management tension pneumothorax

A
  • needle decompression

- followed by CT insertion

166
Q

water seal chamber

A

-tidaling normal but bubbling is NOT (air leak)

167
Q

drainage chamber

A

-more than 100 mL per hr or serosanguinous drainage all the sudden then be concerned

168
Q

chest tubes suction

A

set to continuous suction at 80-100 mmHg

169
Q

chest tube accidentally dislodged…..

A

cover site with occlusive dressing (taped on 3 sides)

170
Q

complications of aspiration

A
  • aspiration pneumonitis (inflammation of lungs from chemical burn from acid)
  • pneumonia
  • respiratory failure
171
Q

COPD

A

dz state characterized by chronic airflow limitation that is not fully reversible (usually progressive)

*combo of chronic bronchitis and emphysema

172
Q

ABG of COPD pt

A
  • elevated paCO2
  • normal PH (compensating)
  • elevated HCO3 (compensating)
  • low paO2

**respiratory acidosis

173
Q

3 primary symptoms COPD

A
  • dyspnea
  • chronic cough (more than 3 mo)
  • sputum production
174
Q

diagnostics for COPD

A

pulmonary function testing

175
Q

COPD med management

A

**stop progression of dz, improve QOL, and prevent exacerbation

  • smoking cessation
  • flu/pneum. vaccines
  • pulmonary rehab
  • pharmacotherapy
176
Q

COPD pharmacologic management

A
  • bronchodilators (metered dose inhaler, nebulized, or dry powder inhaler) to relieve bronchospasm and reduce airway obstruction
  • corticosteroids (oral, IV, inhaled)…NOT a rescue device {ex. fluticasone, beclomethasone}
177
Q

bronchodilators

A
  • short acting (ex albuterol) w/ asthma attack/rescue device
  • long acting (ex tiotropium) lasts 12-24 hrs maintenance.
178
Q

corticosteroids…be careful of…

A

…THRUSH

179
Q

symptoms COPD exacerbation

A
  • increased dyspnea
  • increased sputum production (often purulent)
  • respiratory failure
  • ABG abnormalities
180
Q

prevention of COPD exacerbation

A

helps preserve lung fxn

181
Q

COPD complications

A
  • pneumonia
  • exacerbation
  • pulmonary arterial HTN
  • heart failure/cardiac hypertrophy
  • pneumothorax
182
Q

goal of O2 therapy in pt w/ severe COPD

A

88-92% or at pt’s chronic baseline

**O2 usually titrated to O2 saturation of 90% in pts w/ COPD

**SHOULD NOT withhold O2 from a hypoxic pt, but should be titrated conservatively

183
Q

pursed lip breathing

A

-slowly inhale, exhale with pursed lips (helps w/ SOB)

184
Q

pt education in COPD

A
  • how to use nebulizer
  • how to use MDI
  • long term O2 therapy associated w/ increased survival
  • infection prevention
185
Q

using an MDI

A
  • inhale evenly and slowly and hold breath after inhalation

* space can help deliver more of med to lungs

186
Q

asthma

A

-chronic dz characterized by bronchial hyperresponsiveness and airflow obstruction

187
Q

asthma symptoms

A

-diffuse airway inflammation (chest tightness, wheezing, SOB)

188
Q

asthma complications

A
  • status asthmaticus
  • respiratory failure
  • total airway obstruction
189
Q

2 goals in asthma management

A
  1. limit need of inhaled SABA (albuterol) to 2 or fever times a week
  2. limit nighttime awakenings from asthma to 2 or fewer nights a month

**ALSO use peak flow meter

190
Q

pharmacologic management asthma

A
  • SABA or Inhaled Short Acting Beta-Agonist… rescue inhaler …ex. albuterol
  • ICS or Inhaled Corticosteroids …prevents exacervations as maintenance inhaler (Pulmicort) PREVENTS is key word here
  • LABA or Long-Acting Beta-Agonist …typically given in combo with ICS as maintenance (Advair)
  • Leukotriene Modifiers…oral anti-inflammatory meds (Singulair)
191
Q

status asthmaticus

A

-severe, continuous reaction resistant to initial tx

192
Q

management of status asthmaticus

A
  • ICU or ED monitoring
  • systemic corticosteroids
  • continuous nebs
  • ipratropium

*may need intubation/mechanical vent

193
Q

exercise and asthma

A

**use rescue inhaler prior to exercise for pts with exercise induced asthma

194
Q

inhaled corticosteroids

A

used daily to prevent acute asthma events (and spacer recommended with corticosteroids)

*rapid acting bronchodilator (albuterol) should be used for acute respiratory distress

195
Q

stomatitis (mucositis)

A

-inflamed, sore mouth (white patches, ulcer, redness)

196
Q

replacing toothbrush

A

every 2 months

197
Q

nursing management post op TMD

A
  • rigid fixation/rubber band fixation
  • no chew…liquid diet
  • wire cutters/scissors (need if begin to vomit)
198
Q

sialadenitis

A
  • *infection of salivary glands characterized by:
  • inflammation
  • pain
  • edema (often from dehydration)
  • purulent discharge
199
Q

sialadenitis common causes

A
  • dehydration
  • radiation therapy
  • stones
  • stress
  • malnutrition
200
Q

sialadenitis tx

A
  • ABx, corticosteroids
  • massage
  • hydration, warm compress
  • surgical drainage/excision
201
Q

parotitis

A

**most common form of sialadenitis

-often caused by staph

202
Q

mumps

A

epidemic parotitis

203
Q

parotitis risk factors

A
  • elderly
  • acutely ill
  • decreased salivary flow
204
Q

parotitis symptoms

A

-fever, edema, tender

205
Q

med management of parotitis

A
  • adequate nutrition and fluids
  • oral hygiene
  • discontinue meds (ESP diuretics)
  • Abx/analgesics
  • surgical drainage/excision OR parotidectomy
206
Q

most commonly affected oral and oropharyngeal cancers

A

-lips, tongue, floor of mouth

207
Q

manifestation of oral cancer

A

-non-healing painless sore or mass (doesn’t heal in 2x weeks)

208
Q

risk factors oral cancer

A
  • alc and tobacco
  • male
  • smoked meat ingestion
  • sun exposure (lips)
209
Q

oral and oropharyngeal cancer metastases

A

-frequently to lymph nodes, requiring neck dissection surgery `

210
Q

assessment neck dissection post op

A
  • respiratory status
  • wound infection
  • hemorrhage
211
Q

xerostomia

A

w/ both neck dissection and oral cancers

212
Q

common side effect of chemo/radiation (oral)

A
  • stomatitits

* prophylactic mouth care is important

213
Q

achalasia

A

-absent or ineffective peristalsis of distal esophagus and failure of esophageal sphincter to relax with swallowing (narrowing of sphincter proximal to stomach)

214
Q

achalasia symptoms

A
  • dysphagia (most common symptom of esoph. dz)
  • sensation of food being stuck
  • regurgitation (spontaneous or intentional)
  • chest pain/ pyrosis (heartburn)
215
Q

risk for achalasia

A

risk for aspiration

216
Q

what is used for dx in achalasia

A
  • manometry

* x-ray, CT endoscopy is supplemental

217
Q

tx for achalasia

A
  • aspiration precautions
  • calcium channel blockers/nitrates
  • botox to inhibit contractions of that smooth muscle
  • pneumatic dilation (balloon put in and stretches that area, monitor for PERF here)
  • esophagomyotomy
218
Q

hiatal hernia

A

-opening in diaphragm where esophagus passes is enlarged and part of stomach moves up into lower portion of thorax

219
Q

4 types hiatal hernias

A
  1. sliding (MOST COMMON) –upper stomach and gastroesophageal jxn displaced upward and slide in and out of thorax
  2. rolling (paraesophageal) – all or part of stomach pushes thru diaphragm beside esophagus
  3. sliding/rolling mix – cardia and fundus displaced upwards
  4. simultaneous w/ another organ
220
Q

hiatal hernia risk factors

A

**more common in women

221
Q

symptoms hiatal hernia

A
  • **50% are asymptomatic
  • pyrosis
  • regurgitation
  • dysphagia
222
Q

dx for hiatal hernia

A
  • xray

- barium swallow and fluoroscopy

223
Q

complications w/ hiatal hernias

A
  • hemorrhage
  • obstruction
  • strangulation
224
Q

tx hiatal hernia

A
  • frequent small meals w/ aspiration precautions
  • w/sliding hernia: sit up 1 hr after eating HOB
  • surgery
225
Q

diverticulum (esophageal)

A

-outpouching of mucosa and submucosa that protrudes thru weak portion of musculature at any location of esophagus

226
Q

clinical manifestations diverticulum

A
  • Zenker’s diverticulum (lots of fullness in neck, bulging, dysphagia, regurgitation, food in pouches)
  • Midesophageal diverticulum (lot of same symptoms just not as severe and could possibly have no symptoms)
227
Q

esophageal diverticulum tx

A

NPO until imaging shows no leaks or fistula development

liquids to solids as tolerated and NG tube may be placed

228
Q

esophageal perforation clinical manifestations

A
  • persistent pain
  • dysphagia
  • fever/leukocytosis
  • severe HTN
  • sepsis signs (spilling out)
229
Q

med/nursing management esophageal perf

A
  • broad spectrum ABx
  • NPO (enteral or parenteral nutrition)
  • surgery
  • repeat barium swallow
230
Q

esophageal dx: foreign bodies

A

MOST COMMON: food boluses

**identified in an XRAY or endoscopy to tx

231
Q

complications of foreign bodies

A

*may cause obstruction or trauma: perf or dyspnea

232
Q

meds for esophageal foreign bodies

A
  • glucagon (IM shot relaxes esophagus so food bolus can flow down)
  • sodium bicarb and Tartaric acid (nebulize)
233
Q

injury depends on what for chemical burn

A
  • strong alkaline substances
  • undissolved meds

**severity based on what chemical

234
Q

risk for chemical burns

A
  • dysphagia

- airway compromise

235
Q

evaluation of chemical burn

A

esophagoscopy

236
Q

tx in chemical burns

A

AIRWAYYYYYYY***

  • pain
  • vomiting/gastric lavage are AVOIDED (causes damage when comes back up and can perf)
  • NPO/NGT
237
Q

complication chemical burn

A
  • strictures may form from trauma and require dilation

- sometimes esophagectomy

238
Q

GERD

A

-incompetent lower esophageal sphincter, pyloric stenosis, or motility disorder

239
Q

clinical manifestation

A
  • pyrosis (heartburn)
  • dyspepsia
  • regurgitation
  • dysphagia
240
Q

nocturnal regurgitation

A

-often alcohol induced and comes up while sleeping and you can choke

241
Q

medical/nursing management Barrett’s esophagus

A
  • repeat EGD in 6-12 mo if cellular changes are mild
  • PDT (photodynamic therapy)
  • ablation
242
Q

risk factors cancer of esophagus

A
  • male
  • alcohol
  • tobacco use

**VERY treatable and curative if in early stages (but often asymptomatic)

243
Q

nursing priority cancer of esophagus

A

***airway directly after surgery

  • nutrition promotion
  • prevent aspiration pneumonia
  • NG tube maintenance
244
Q

priorities of care for any tube feedings

A
  • risk of aspiration ***

- prevent dumping syndrome (too much food too fast)

245
Q

labs and TPN

A

FLUSH before you draw labs

*and TWO NURSES check contents and order

246
Q

discontinuing TPN

A
  • *never just stop

- run D5 if line pulled out

247
Q

acute and chronic gastritis

A

acute: diet or NSAIDS or alc or reflux or radiation
chronic: benign or malignant ulcers of stomach or by H. pylori

248
Q

clinical manifestations gastritis

A
  • headache
  • anorexia
  • n/v stomach pain
  • hiccuping
  • achlorhydria/hypochlorhydria/hyperchlorhydria
249
Q

tx for gastritis

A
  • cause from acids? antacids will neutralize
  • cause from alkalis? diluted vinegar or lemon juice will neutralize

**LAVAGE and EMETICS avoided if danger of perf and/or esophageal damage

250
Q

chronic gastritis tx

A
  • diet
  • rest
  • avoid NSAIDS alc
251
Q

peptic ulcer dz can be…

A

…caused by GERD

*excavation that forms in mucosal wall of stomach, in pylorus, duodenum, or esophagus (erosion from increased HCl or activity of acid-pepsin)

252
Q

peptic ulcer complications

A

-can extend as deeply as muscle layers or thru peritoneum

253
Q

ZES

A

-Zollinger-Ellison syndrome

tumors that secrete HCl

254
Q

SRMD

A
  • Stress-related Mucosal dz
  • injury to lining of stomach and duodenum during physiologic stress

(can cause tumors)

255
Q

major manifestation of peptic ulcer dz

A

-dull, gnawing pain/burning sensation in midepigastrium in in back

256
Q

Zes-Gastric triangle

A

gallbladder, jxn of duodenum, jxn of head and neck of pancreas

257
Q

drug tx PUD

A
  • abx
  • PPI
  • histamine-2 (H2) receptor antagonists
  • bismuth salts
258
Q

vagotomy

A

-vagus nerve cut which decreases gastric secretions

259
Q

nursing interventions for PUD

A
  • hemorrhage risk
  • perf risk
  • penetration (from dx/surgery)
  • pyloric obstruction (GOO)
260
Q

perforation pain

A

-can be referred to shoulder, esp R shoulder because of irritation of phrenic nerve in diaphragm

261
Q

manifestations perf

A
  • vomiting
  • collapse (fainting) from change in vital signs
  • HTN and tachycardia (SHOCK indication)
262
Q

morbid obesity

A

more than 2x ideal body weight OR BMI exceeds 30 OR more than 100 lbs greater than ideal body weight

263
Q

morbid obesity puts at risk for

A

gallbladder dz and cancers (uterine, breast, colorectal, kidney, and gallbladder)

264
Q

diet for bariatric surgery

A
  • 6 small meals per day (w/ protein and fiber) and chew thoroughly (less than 1 cup total meal size)
265
Q

diet before bariatric surgery

A

-cl liquids 2-3 weeks before surgery to shrink liver and filled w/ gas to make sure nothing nicked

266
Q

hydration bariatric surgery

A
  • drink slowly

- 30 minutes (water) after each meal and 15 min before

267
Q

nutritional deficiency after bariatric surgery

A

**absorption issues (MUST take supplements)

268
Q

gastric cancer prognosis

A

POOR

-dx usually late because most pts. asymptomatic during early stages

**MOST are adenocarcinomas

269
Q

clinical manifestation gastric cancer

A
  • pain relieved by antacids resembling those of benign ulcers
  • N/V, dyspepsia, early satiety, weight loss, bloating after meals

**symptoms VERY similar to PUD

270
Q

duodenal tumors

A

**uncommon and usually benign and asymptomatic (vague nonspecific symptoms)

-if malignant, adenocarcinoma usually, may cause bleeding, pain, obstruction

271
Q

complications constipation

A
  • HTN
  • fecal impaction
  • hemorrhoids and fissures
  • megacolon
272
Q

types of diarrhea

A
  • secretory
  • osmotic
  • mixed
273
Q

monitor what w/ diarrhea

A

-serum electrolyte levels

274
Q

malabsorption

A

-inability of digestive system to absorb one or more of major vitamins, minerals, and nutrients

**typically causes diarrhea or frequent, loose and bulky and foul smelling stools

275
Q

tx for malabsorption

A

-avoid dietary substances that aggravate malabsorption and supplement nutrients that have been lost

276
Q

risk in malabsorption

A

refeeding syndrome

**potentially fatal shifts in fluid and electrolyte imbalances

277
Q

appendicitis clinical manifestation

A
  • vague epigastric or periumbilical pain

- fever, n/v, rigid abd, chills, anorexia, diarrhea/const, leukocytosis

278
Q

appendicitis indicators

A
  • RLQ pain improved w/ flexing right hip (this may suggest perforation)
  • rebound tenderness
  • Rovsing-sign (pain felt in RLQ upon palpation of L side of abd)
279
Q

appendicitis can cause

A

peritonitis (leakage of contents from abdominal organs into abd cavity)

**may have drain placed in this case because you are worried about a perf and can become septic real fast

280
Q

complications after appendectomy

A
  • peritonitis
  • abscess
  • ileus
281
Q

diverticulum

A

sac-like herniation of lining of bowel that extends thru defect in muscle layer

282
Q

diverticulosis

A
  • MULTIPLE diverticula are present w/out inflammatory symptoms
  • may be asymp., sometimes mild symptoms
283
Q

diverticulitis

A
  • food and bacteria retained in a diverticulum and produce infection and inflammation
  • at risk for perf and sepsis and abscesses
284
Q

peritonitis usually result of…

A

…bacterial infection

285
Q

tx for peritonitis

A
  • fluids
  • pain relief
  • abx
286
Q

peritonitis nursing interventions

A
  • frequent abd assessment
  • monitor vital signs
  • monitor septic signs
287
Q

IBD

A

-refers to two chronic inflammatory dx

  1. Crohn’s dz (regional enteritis)
  2. Ulcerative colitis

(exact causes unknown, AUTOimmune dx)

288
Q

IBD risk factors

A

men and women equally affected

289
Q

Crohn’s

A

subacute and chronic inflammation that extends thru all layers (ulcerations appear on inflamed areas)

290
Q

clinical manifestations Crohn’s

A
  • prominent RLQ pain unrelieved by defecation
  • diarrhea
  • fatigue, fever, cramping, anorexia, bloating after meals
  • tenesmus (feeling as tho you need to pass stools)
  • Borborygmi
291
Q

Crohn’s…what do you worry about

A

**worry about fistula (eats away at colon)

292
Q

complications

A
  • intestinal obstruction or stricture
  • perianal dz
  • fluid/electrolyte inbalance
  • malnutitrion
  • fistula/abscess
293
Q

UC

A

-recurrent ulcerative and inflammatory dz of mucosal and submucosal layers of colon/rectum

294
Q

complications UC

A
  • toxic megacolon
  • perf
  • blood loss
295
Q

med management IBD

A
  • reduce inflammation
  • rest for diseased bowel
  • improve QOL
296
Q

interventions for IBD

A
  • diet
  • lab monitoring and vital signs
  • abd assessment
  • bowel fxn / intake/output
297
Q

colorectal cancer

A

very tx-able earlt stages

  • prone to metastasize
  • often insidious signs, so late dx
298
Q

worry about w/ colorectal cancer

A

-anastomosis

299
Q

small bowel vs large bowel obstruction

A

small bowel: more rapid onset and treated w/ NG decompression

Large bowel: more gradual onset and may require creation of colostomy

300
Q

3 causes intestinal obstruction

A
  1. intussusception (movement of one segment of bowel into another)
  2. volvulus of sigmoid colon (counterclockwise twist and edematous bowel)
  3. hernia (inguinal) continuation of peritoneum of abd
301
Q

ileostomy, worry about…

A

fluid loss

302
Q

jaundice

A

-impairment of liver’s ability to metabolize and secrete bilirubin

303
Q

vitamin deficiencies in hepatic dysfunction

A
  • decreased secretion of bile salts into intestines may interfere with absorption of fat-soluble vitamins and dietary fats
  • liver cells have inability to use vitamin K to make prothrombin, GI tract unable to absorb
304
Q

ascites

A

-accumulation of fluid in peritoneal cavity

SYMPTOMS: increased abd girth, weight gain, swelling of lower extremities

305
Q

tx of ascites

A
  • sodium restriction
  • diuretics
  • paracentesis
  • TIPS (shunt)
306
Q

tx for active bleeding esophageal varices

A
  • meds
  • variceal banding
  • EIS
  • balloon tamponade
307
Q

nursing interventions esophageal varices

A
  • monitor bleeds
  • perf of esophagus
  • aspiration pneumonia
  • esophageal stricture
308
Q

hepatic encephalopathy

A

-results from accumulation of ammonia and other toxic metabolites in blood

309
Q

hepatic encephalopathy

A

-asterixis (flapping tremor of hands)

310
Q

tx hepatic encephalopathy

A

-lactulose (cephulac) give to reduce serum ammonia levels (laxative binds with ammonia) but be aware electrolyte/fluid imbalance

311
Q

nursing care hepatic enceph.

A

-prevent injury, bleeding, and infection

312
Q

viral hepatitis

A

-necrosis and inflammation of liver

A, B, C, D, E (acute or chronic liver dysfunction)

313
Q

vaccine hepatitis

A

vaccine for Hep. A and B

314
Q

hep a

A

fecal-oral route

*asymptomatic or acute symptoms (usually manage at home)

315
Q

hep b

A

**LONG incubation period (insidious signs and symptoms)

-NO cure but most adults who get it will recover fully

316
Q

hep b transmission

A

perinatal, percutaneous, sexual exposure, person-to-person

317
Q

leading cause of liver disease

A

-Hep C

**PRIMARY indication for liver transplantation

318
Q

Hep C

A

-injection of drugs and transfusion of blood products prior to 1992 is primary occurence

***MOST are asymptomatic

319
Q

hepatitis D

A

cant get if you didnt have B

320
Q

fulminant hepatic failure

A

-clinical syndrome of sudden severely impaired liver fxn in previously healthy person

***usually from Hep A, B, or E, OR acetaminophen

321
Q

w/ cirrhosis, monitor for…

A

…encephalopathy

322
Q

cirrhosis symptoms

A
  • abd distention and bloating
  • GI bleed
  • bruising
  • weight changes
323
Q

hepatocellular carcinoma

A
  • manifestations typically similar to cirrhosis

* surgery and liver transplant

324
Q

ESLD

A
  • end stage liver dz / acute liver failure

* tx of choice is transplantation

325
Q

complications liver transplantation

A
  • bleeding
  • infection
  • biliary leaks and obstruction
  • hepatic artery thrombosis
  • portal vein thrombosis
326
Q

what to monitor for pt undergoing liver transplant

A
  • infection
  • bleeding prevention
  • monitor protein and clotting factors
  • monitor signs of liver dysfunction
  • monitor s/s rejection
327
Q

cholelithiasis

A
  • gallstones

- symptoms results from dz of gallbladder itself and obstruction of bile passages by gallstone

328
Q

cholecystitis

A
  • inflammation of gallbladder

* upper right abdominal pain, n/v

329
Q

tx cholecystitis

A
  • medication
  • cholecystectomy
  • laproscopic procedure
330
Q

risk factors for cholelithiasis

A

4 F’s

  • fat
  • forty
  • female
  • fertile
331
Q

pancreatitis labs

A

HIGH lipase

332
Q

pancreatitis

A

autodigestion of pancreas from temporary pancreatic duct obstruction accompanied by hypersecretion of exocrine enzymes

333
Q

ERCP

A

-endoscopic retrograde cholangiopancreatography

***can cause pancreatitis

334
Q

tx pancreatitis

A
  • NPO
  • pain management
  • fluids (worry about fluid overload)
335
Q

4th leading cause cancer death US

A

-pancreatic cancer (low survival rates both w. and w/out surgery)

336
Q

risk factors pancreatitis

A
  • tobacco
  • obesity
  • chronic pancreatitis
337
Q

whipple procedure

A

-remove part of small intestine, gallbladder, and bile duct

**major surgery

338
Q

geriatrics and surgery

A
  • less physiologic reserve
  • less ability to respond to stress
  • underreported pain
  • HIGH delirium risk
  • HIGH hypoxia risk
  • HIGH hypothermia risk
339
Q

IV solutions and geriatrics

A

-decreased cardiac output (so pulmonary effusion risk)

340
Q

anesthesia and geriatrics

A

-less plasma proteins so more unbound anesthesia and stays in system longer

341
Q

fatty tissue

A

higher risk for infection (obese pts.)

342
Q

obese surgical pts.

A
  • higher risk for dehiscence
  • difficulty ambulating
  • shallow breathing when supine
343
Q

state of narcosis

A

-severe CNS depression

344
Q

anesthesia hasn’t worn off until

A
  • motor
  • sensory
  • autonomic

no longer affected

345
Q

shivering

A

increases O2 demand by 300% to 400% thus supplemental O2 should be administered

346
Q

malignant hyperthermia early sign

A

tachycardia

altered mechanism of Ca fxn in skeletal muscle cells

347
Q

MH other signs

A
  • hypotension, ventircular arrythmias, hyperthermia, tachypnea
  • rigidity (often in jaw)

**CARDIAC ARREST IF NOT CORRECTED

348
Q

late sign MH

A
  • hyperthermia

- core body temp rise rapidly, 2-4 degrees every 5 min

349
Q

admin to tx MH

A

dantrolene

  • discontinue triggering agent
  • hyperventilation of pt. w/ 100% O2
350
Q

DIC

A
  • disseminated intravascular coagulation
  • widespread hemorrhage and microthrombosis all over with ischemia
  • can be precursor or caused by MH/ HIGH mortality rate
351
Q

bleeding in DIC

A
  • venipuncture sites
  • mucous membranes
  • GI and urinary tracts
352
Q

hypopharnygeal occlusion

A

lower jaw and tongue fall backwards

Med Surg (4 decks)

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