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med surg exam 3 Flashcards

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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
Q

name the types of rhinitis

A

non-allergic, allergic, viral (common cold), bacterial

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26
Q

what is epistaxis

A

nosebleed

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27
Q

what are some causes of epistaxis

A

decreased humidity, sinusitis, rhinitis, HTN, blood dyscrasia (leukemia, clotting factors), tumor, trauma, picking or blowing nose, cocaine use, NG suction

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28
Q

what color is a 24 G needle and what is it used for?

A

yellow
used for pediatrics and irritating meds

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29
Q

what color is a 22 G needle and what is it used for?

A

blue
used for a majority of infusions

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30
Q

what color is a 20 G needle and what is it used for?

A

pink
used for CT scans, preop pts, and blood transfusions

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31
Q

what color is a 18 G needle and what is it used for?

A

green
used for trauma pts, surgery, L&D

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32
Q

what is extravasation

A

same as infiltration, but the infusing solution is an irritant or vesicant which can cause necrosis

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33
Q

what is infiltration

A

nonvesicant solution gets into surrounding tissue
when the IV cannula dislodges & perforates the wall of the vein

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34
Q

what is phlebitis

A

inflammation of vein that can eventually lead to infection
(whole vein up the arm is red and irritated)

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35
Q

what are the s/s of an air embolism

A

palpations
dyspnea
coughing
JVD
wheezing
cyanosis
hypotension
weak-rapid pulse
altered LOC

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36
Q

what are the s/s of sepsis

A

increased temp, RR, pulse
h/a
n/v/d
shaking
edema

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37
Q

why does blood come cold

A

to prevent clots and infections

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38
Q

what are s/s of a blood transfusion reaction

A

CV overload
dyspnea
pulmonary edema
hypoxemia
hypothermia

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39
Q

what are the 5 reasons to not stick someones veins

A

mastectomy
axillary lymph node dissection
lymphedema
paralysis of extremity
dialysis graft or fistula

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40
Q

how often do you change lipid tubing

A

every 24 hours

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41
Q

how often do you change blood tubing

A

within 4 hours

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42
Q

how often do you change Propofol (Diprovan) tubing

A

every 6-12 hours
its an anesthetic

43
Q

how often do you change IVF tubing

A

every 72 hours

44
Q

how often do you change TPN tubing

A

every 24 hours

45
Q

name the types of input (4) and output (4)

A

input-
oral intake
IVF infusion
TPN
tube feeding
output-
kidneys
GI tract
Lungs
Skin

46
Q

what 2 organs produce insensible fluid loss

A

lungs & skin

47
Q

our body is made up of how many liters of water? (ICF? ECF?)

A

40 L
(15L- ECF) (30%)
(25L- ICF) (60%)

48
Q

what types of fluid are in ECF

A

intravascular
interstitial
transcellular

49
Q

what is intravascular fluid? Ex? L?

A

fluids within blood vessels
blood & plasma
5 L

50
Q

what is interstitial fluid? Ex? L?

A

fluids within interstitial spaces
lymph, cerebrospinal fluid, GI secretions, pericardial fluid
11-12 L

51
Q

what is transcellular fluid Ex

A

smallest part of ECF
cerebralspinal fluid (CSF), synovial fluid, sweat

52
Q

what % of total body water is ICF

A

60%

53
Q

what is osmolarity vs osmolality

A

osmolarity = volume
osmolality = mass

54
Q

what are the s/s of hypervolemia

A

hypertension
dyspnea/ SOB / crackles
tachycardia
abdominal ascites
DJV
peripheral edema

55
Q

what are the s/s of hypovolemia

A

acute weight loss
poor skin turgor
decreased UOP
hypotension
tachycardia
weakness/dizziness
cramps & clammy skin

56
Q

what are examples of hypertonic solutions

A

D5NS & D5LR

57
Q

what are examples of isotonic solutions

A

0.9%NS, LR, D5W

58
Q

what are examples of hypotonic solutions

A

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
Q

what is the normal BUN, Creatinine, & HCT

A

BUN= 10-20mg/dL
Creatinine= 0.7-1.4mg/dL
HCT= 42-53%men; 35-47%women

60
Q

what will increase BUN

A

renal impairment
GI bleeding
dehydration
increased protein intake
fever
sepsis

61
Q

what will decrease BUN

A

low protein diet
starvation
liver disease
expanded fluid volume situation

62
Q

what is the end product of muscle metabolism

A

creatinine

63
Q

what is the end product of protein metabolism of the liver

A

BUN - blood urea nitrogen

64
Q

what is the most accurate indicator of renal function

A

creatinine

65
Q

what increases HCT levels

A

dehydration and polycythemia

66
Q

what decreases HCT levels

A

overhydration and anemia

67
Q

what is polycythemia

A

increased concentration of RBC in blood
makes blood thicker

68
Q

what are the s/s of a cold (rhinitis)

A

sneezing
runny nose
sore throat
mild cough
normal temp
maybe a h/a
slight aches and pains

69
Q

what are the s/s of the flu

A

prominent h/a
sudden onset of a high fever
severe aches and pains
extreme fatigue and weakness
severe cough
chest discomfort

70
Q

what is given prior to an endoscopy to dry up secretions to reduce the risk of aspiration

A

robinol

71
Q

what are the 4 main causes of aspiration

A

GERD
intoxication
feeding tubes
mechanical ventilation

72
Q

community acquired pneumonia (CAP)

A

less than 48hrs after hospital admission

73
Q

hospital acquired pneumonia (HAP)

A

48hrs or more after hospital admission

74
Q

ventilator associated pneumonia (VAP)

A

48hrs or more after intubation

75
Q

what are the VAP protocols

A

elevate HOB
daily sedation vacations (taking a break and checking on status)
PUD & DVT prophylaxis
daily oral care with chlorhexidine

76
Q

what are the s/s of pneumonia

A

h/a
rash
low grade fever
pleuritic pain
myalgia
pharyngitis
purulent sputum
orthopnea
poor appetite

77
Q

what is essential to the diagnosis and treatment of pneumonia

A

CXR

78
Q

what are the main s/s of pneumonia in an older pt

A

confusion
fatigue
hypoxia (in severe cases)

79
Q

how do you treat pneumonia

A

hydrate
rest
give O2 PRN

80
Q

what is atelectasis

A

the collapse of airless condition of the alveoli cause by hypoventilation, obstruction, or compressed lungs

81
Q

what can lead to non-obstructive atelectasis

A

ineffective respirations
positioning
surgeries
increased abdominal pressure

82
Q

whats the difference between CPAP & BiPAP

A

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
Q

what are the s/s of micro-atelectasis

A

gradual onset
increased dyspnea
cough
sputum production

84
Q

what are the 3 kinds of macro-atelectasis

A

segmental, lobar, global

85
Q

what are the s/s of macro-atelectasis

A

respiratory distress
tachycardia
tachypnea
pleural pain
central cyanosis (blue lips)

86
Q

what is pleural effusion

A

The accumulation of fluid between the linings of the pleural space.

87
Q

what are the indicators of malignant hyperthermia

A

tachycardia
increases end-tidal CO2 level
increased body temp

88
Q

what is the most common skin disease from COVID

A

exanthematous (morbilliform) rash

89
Q

what is called modeling of the legs

A

livedo reticularis

90
Q

what are the 2 major intraoperative complications

A

malignant hyperthermia & disseminated intravascular coagulation

91
Q

what is the reversal agent for malignant hyperthermia

A

dantrolene

92
Q

what does the PACU nurse do

A

provides care for pt til they have recovered from the anesthesia (monitor status)(look at baseline assessment to compare)

93
Q

what is hypovolemic shock

A

extreme blood loss

94
Q

what are the s/s of hypovolemic shock

A

dilated pupils
pallor
slow cap refill
cold
increases RR
tachycardia
decreased BP
decreased urine output
cyanosis

95
Q

what are the classes of hypovolemic shock

A

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
Q

how do you treat hypovolemic shock

A

replace volume rapidly
administer blood products & colloids
keep pt warm
stop source of bleeding

97
Q

what is dehiscence

A

edges of wound open

98
Q

what is evisceration

A

wound opens and intestines protrude

99
Q

what are the 6 main things the nurse focuses on with a pre-op patient

A

age
medical hx
allergies
baseline vitals
cardiovascular status
previous medication use

100
Q

what 2 things does the nurse need to prep the client with before surgery

A

skin - chlorhexidine
bowels- enema or laxative

101
Q

pre-op–> intra-op(pre-op holding) –> OR –> post-op

A
102
Q

what is an autologous blood transfusion

A

reinfusing the patients own blood during a durgery

103
Q

what are the 5 main post op goals

A

comfort
cardiovascular function
respiratory function
fluid & electrolyte balance
GI & nutrition

nursing (15 decks)

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