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med surg exam 3 Flashcards

1
Q

nasal canula

A

1-6 L/min
24-44%

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2
Q

simple facemask

A

minimun of 5 L/min
40-60%

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3
Q

non-rebreather

A

10-15 L/min
>90%
(has inflating bag)

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4
Q

high flow nasal canula

A

up to 60L/min
up to 100%

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5
Q

venturi mask

A

has different adapters for different flows of oxygen

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6
Q

most accurate O2 concentration without intubation

A

venturi mask

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7
Q

delivers highest flow of O2 from low flow systems

A

non-rebreather

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8
Q

what oxygen flow is used for pts who aren’t able to tolerate a tight fitting face mask bc of trauma

A

face tent

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9
Q

what oxygen flow is used for pts with a tracheostomy

A

trach collar

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10
Q

what oxygen flow is used for pts with a trach, laryngectomy, or an edncotracheal tube

A

t-piece

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11
Q

what are the 3 examples of NPPV (non-invasive positive pressure ventilation)

A

CPAP
BiPAP
volume or flow-limited

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12
Q

the volume of air the pt receives with each breath is called what

A

tidal volume

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13
Q

how does the gas exchange and perfusion systems of the body adjust to meet an increase in oxygen demand?

A

increase in heart rate and depth of respirations

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14
Q

when people with health problems experience an increase in oxygen demand, their body’s attempt to compensate may not be completely effective. how would you treat that?

A

1- increase the % of O2 youre giving them
2- reduce the oxygen need (rest)
3- treat underlying cause

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15
Q

what can a nurse do to improve a patient’s ventilation?

A

position, encourage TCDB, increase activity and ambulation, encourage hydration, promote vaccinations and immunizations, healthy lifestyle behaviors, avoid pollutants, humidification, nebs, CPT, NP suction

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16
Q

what is hypoxemia

A

low O2 in the blood

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17
Q

what is hypoxia

A

low O2 in the tissues

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18
Q

t/f hypoxemia happens then hypoxia can result

A

true

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19
Q

why is the normal O2 sat range 95-99%

A

bc 100% can mean O2 toxicity since the monitors dont read past 100

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20
Q

what are the symptoms of O2 toxicity

A

initially:
NP cough, chest pain, GI upset, dyspnea, crackles
prolonged:
pulmonary edema, hemorrhage, atelectasis

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21
Q

partial rebreather mask

A

6-11 L/min
60-75%
pt inhales 1/3 of the exhaled tidal volume

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22
Q

what is OSA? I how do you treat it?

A

obstructive sleep apnea
treated with a CPAP machine

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23
Q

what all is included in a respiratory health history

A

medical hx, family hx, risk factors, medications, surgeries, lifestyle questions, smoking, exposure to environmental substances, exercise, drug use

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24
Q

what is the most common upper respiratory infection?

A

rhinitis (aka cold)

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25
name the types of rhinitis
non-allergic, allergic, viral (common cold), bacterial
26
what is epistaxis
nosebleed
27
what are some causes of epistaxis
decreased humidity, sinusitis, rhinitis, HTN, blood dyscrasia (leukemia, clotting factors), tumor, trauma, picking or blowing nose, cocaine use, NG suction
28
what color is a 24 G needle and what is it used for?
yellow used for pediatrics and irritating meds
29
what color is a 22 G needle and what is it used for?
blue used for a majority of infusions
30
what color is a 20 G needle and what is it used for?
pink used for CT scans, preop pts, and blood transfusions
31
what color is a 18 G needle and what is it used for?
green used for trauma pts, surgery, L&D
32
what is extravasation
same as infiltration, but the infusing solution is an irritant or vesicant which can cause necrosis
33
what is infiltration
nonvesicant solution gets into surrounding tissue when the IV cannula dislodges & perforates the wall of the vein
34
what is phlebitis
inflammation of vein that can eventually lead to infection (whole vein up the arm is red and irritated)
35
what are the s/s of an air embolism
palpations dyspnea coughing JVD wheezing cyanosis hypotension weak-rapid pulse altered LOC
36
what are the s/s of sepsis
increased temp, RR, pulse h/a n/v/d shaking edema
37
why does blood come cold
to prevent clots and infections
38
what are s/s of a blood transfusion reaction
CV overload dyspnea pulmonary edema hypoxemia hypothermia
39
what are the 5 reasons to not stick someones veins
mastectomy axillary lymph node dissection lymphedema paralysis of extremity dialysis graft or fistula
40
how often do you change lipid tubing
every 24 hours
41
how often do you change blood tubing
within 4 hours
42
how often do you change Propofol (Diprovan) tubing
every 6-12 hours its an anesthetic
43
how often do you change IVF tubing
every 72 hours
44
how often do you change TPN tubing
every 24 hours
45
name the types of input (4) and output (4)
input- oral intake IVF infusion TPN tube feeding output- kidneys GI tract Lungs Skin
46
what 2 organs produce insensible fluid loss
lungs & skin
47
our body is made up of how many liters of water? (ICF? ECF?)
40 L (15L- ECF) (30%) (25L- ICF) (60%)
48
what types of fluid are in ECF
intravascular interstitial transcellular
49
what is intravascular fluid? Ex? L?
fluids within blood vessels blood & plasma 5 L
50
what is interstitial fluid? Ex? L?
fluids within interstitial spaces lymph, cerebrospinal fluid, GI secretions, pericardial fluid 11-12 L
51
what is transcellular fluid Ex
smallest part of ECF cerebralspinal fluid (CSF), synovial fluid, sweat
52
what % of total body water is ICF
60%
53
what is osmolarity vs osmolality
osmolarity = volume osmolality = mass
54
what are the s/s of hypervolemia
hypertension dyspnea/ SOB / crackles tachycardia abdominal ascites DJV peripheral edema
55
what are the s/s of hypovolemia
acute weight loss poor skin turgor decreased UOP hypotension tachycardia weakness/dizziness cramps & clammy skin
56
what are examples of hypertonic solutions
D5NS & D5LR
57
what are examples of isotonic solutions
0.9%NS, LR, D5W
58
what are examples of hypotonic solutions
0.25%NS 0.33%NS 0.45%NS D5W used to rehydrate pt. dont use with increased cranial pressure pts (like a head injury)
59
what is the normal BUN, Creatinine, & HCT
BUN= 10-20mg/dL Creatinine= 0.7-1.4mg/dL HCT= 42-53%men; 35-47%women
60
what will increase BUN
renal impairment GI bleeding dehydration increased protein intake fever sepsis
61
what will decrease BUN
low protein diet starvation liver disease expanded fluid volume situation
62
what is the end product of muscle metabolism
creatinine
63
what is the end product of protein metabolism of the liver
BUN - blood urea nitrogen
64
what is the most accurate indicator of renal function
creatinine
65
what increases HCT levels
dehydration and polycythemia
66
what decreases HCT levels
overhydration and anemia
67
what is polycythemia
increased concentration of RBC in blood makes blood thicker
68
what are the s/s of a cold (rhinitis)
sneezing runny nose sore throat mild cough normal temp maybe a h/a slight aches and pains
69
what are the s/s of the flu
prominent h/a sudden onset of a high fever severe aches and pains extreme fatigue and weakness severe cough chest discomfort
70
what is given prior to an endoscopy to dry up secretions to reduce the risk of aspiration
robinol
71
what are the 4 main causes of aspiration
GERD intoxication feeding tubes mechanical ventilation
72
community acquired pneumonia (CAP)
less than 48hrs after hospital admission
73
hospital acquired pneumonia (HAP)
48hrs or more after hospital admission
74
ventilator associated pneumonia (VAP)
48hrs or more after intubation
75
what are the VAP protocols
elevate HOB daily sedation vacations (taking a break and checking on status) PUD & DVT prophylaxis daily oral care with chlorhexidine
76
what are the s/s of pneumonia
h/a rash low grade fever pleuritic pain myalgia pharyngitis purulent sputum orthopnea poor appetite
77
what is essential to the diagnosis and treatment of pneumonia
CXR
78
what are the main s/s of pneumonia in an older pt
confusion fatigue hypoxia (in severe cases)
79
how do you treat pneumonia
hydrate rest give O2 PRN
80
what is atelectasis
the collapse of airless condition of the alveoli cause by hypoventilation, obstruction, or compressed lungs
81
what can lead to non-obstructive atelectasis
ineffective respirations positioning surgeries increased abdominal pressure
82
whats the difference between CPAP & BiPAP
CPAP- delivers a set of positive airway pressure throughout inspiration and expiration BiPAP- cycles different pressures during inspiration and expiration to help improve pt tidal volume
83
what are the s/s of micro-atelectasis
gradual onset increased dyspnea cough sputum production
84
what are the 3 kinds of macro-atelectasis
segmental, lobar, global
85
what are the s/s of macro-atelectasis
respiratory distress tachycardia tachypnea pleural pain central cyanosis (blue lips)
86
what is pleural effusion
The accumulation of fluid between the linings of the pleural space.
87
what are the indicators of malignant hyperthermia
tachycardia increases end-tidal CO2 level increased body temp
88
what is the most common skin disease from COVID
exanthematous (morbilliform) rash
89
what is called modeling of the legs
livedo reticularis
90
what are the 2 major intraoperative complications
malignant hyperthermia & disseminated intravascular coagulation
91
what is the reversal agent for malignant hyperthermia
dantrolene
92
what does the PACU nurse do
provides care for pt til they have recovered from the anesthesia (monitor status)(look at baseline assessment to compare)
93
what is hypovolemic shock
extreme blood loss
94
what are the s/s of hypovolemic shock
dilated pupils pallor slow cap refill cold increases RR tachycardia decreased BP decreased urine output cyanosis
95
what are the classes of hypovolemic shock
class 1: lost < 750ml of blood class 2: lost 750-100ml of blood class 3: lost 1500-2000ml of blood class 4: lost >2000ml of blood
96
how do you treat hypovolemic shock
replace volume rapidly administer blood products & colloids keep pt warm stop source of bleeding
97
what is dehiscence
edges of wound open
98
what is evisceration
wound opens and intestines protrude
99
what are the 6 main things the nurse focuses on with a pre-op patient
age medical hx allergies baseline vitals cardiovascular status previous medication use
100
what 2 things does the nurse need to prep the client with before surgery
skin - chlorhexidine bowels- enema or laxative
101
pre-op--> intra-op(pre-op holding) --> OR --> post-op
102
what is an autologous blood transfusion
reinfusing the patients own blood during a durgery
103
what are the 5 main post op goals
comfort cardiovascular function respiratory function fluid & electrolyte balance GI & nutrition

nursing (15 decks)

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