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BSN: 3rd Quarter > MED/SURG EXAM #3 > Flashcards

MED/SURG EXAM #3 Flashcards

1
Q

Go over gag reflex, acid-base

A
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2
Q

Difference between upper respiratory problems vs. lower respiratory problems

A

UPPER respiratory tract problems occur in the structures in the larynx or above. (Anaphylaxis)
LOWER respiratory tract problems involve the airways below the larynx (e.g. COPD)

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3
Q

Active TB + wher to place patient

A

Room with exhaust directly to outside environment
– (+) pressure room

NOTE: question stating that there aren’t anymore (-) pressure rooms

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4
Q

How to check for cyanosis on the body

A

oral mucosa

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5
Q

Interventions for COPD patients

A

— Position in high-Fowler’s to maximize ventilation
— Increase fluid intake and drink 2-3L/day to liquefy mucus
— Take walks 20 minutes daily 2-3x/wk
— O2 2-4L/min (nasal cannula) OR up to 40% Venturi mask
— Chronically increased PaO2 levels will usually need 1-2L/min O2 via nasal cannula
— O2 maintained b/w 88-92%

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6
Q

Determinants of when to eat and how medication will make you feel

A

— Medication may make you feel jittery after taking (e.g. Albuterol) b/c steroid within, so give food before administration

NOTE: S/Sx after administration: nervousness, HR palpitations, dysrhythmias, tremors, insomnia, increased BP

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7
Q

Diagnostic studies for lower RR problems

A

— Hx + physical examination
— Chest XRAY
— Thoracentesis/bronchoscopy
— Pulse oximetry
— Arterial blood gases (ABGs)
— Sputum gram stain, culture, and sensitivity (ideally before antibiotics have been started)
— Blood cultures
— CBC w/ differentials

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8
Q

Position placement of patient during thoracentesis + Why?

A

Sitting while leaning forward over the side table

WHY?
— When preparing a client for a thoracentesis, the nurse should have the client sit on the edge of the bed and lean forward over the bedside table because this position maximizes the space between the client’s ribs and allows for aspiration of accumulated fluid and air.

NOTE: Increased HR = complications; serosanguinous fluids = normal

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9
Q

How to use inhaler w/ spacer (IN ORDER)

A

1st press down on inhaler then within 5 seconds SLOWLY breathe in
Hold breath for 10 seconds
Wait ~1min b/w puffs

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10
Q

Client COPD + difficulty breathing + what to do?

A

Assess (RN intervention r/t process)

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11
Q
A

Gag reflex

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12
Q

What are Cheyenne-Stokes?

A

Periods of apnea and ventilation —> about to DIE
alternating periods of

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13
Q

Pneumothorax intervention

A

Chest tube is BELOW the chest

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14
Q

Pneumothorax w/ chest tube in place + trachea has moved to the other side + what to do?

A

problem of tension pneumonia —> notify MD

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15
Q

What to do if chest tube comes OUT of body?

A

Place in sterile water

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16
Q

ABGs + Respiratory drugs, what to look out for

A

— ABGs (sedating and opioid drugs, respiratory drugs; respiratory acidosis)

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17
Q

What does constant bubbling indicate for a chest tube? Continuous bubbling in water-seal chamber?

A

—Continuous bubbling in H2O seal chamber = BAD = air leak (bloody fluid level fluctuation and cannot tell b/c chest tube has been dislodged somewhere)

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18
Q

Hyperventilation: when would you do this?

A

When providing suction care to clear mucus from airway
–hyperventilate for 2-3 minutes prior to suctioning

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19
Q

Chest tube: how to know if lung has re-expanded

A

No fluctuation noticed

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20
Q

MEDICATIONS: Check for allergic rxns
Patient has IV + client states they are itchy and cannot breathe + what to do?

A

STOP INFUSION
— S/Sx = N/V, wheezing

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21
Q

Atelectasis + how do we get it?

A

Loss of lung volume (atelectasis)
Will hear decreased lung sounds
PNA will hear crackles

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22
Q

When to use rescue inhaler vs. maintenance

A

Albuterol = rescue = given first
Maintenance = Trelegy (COPD)
Rescue/reliever –> corticosteroid

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23
Q

Central cyanosis + what to look for?

A

Look at the fingers and toes for pale/blue color

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24
Q

Viral pharyngitis + elevated WBC?

A

No b/c its bacterial, will not see, so do a throat culture to determine

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25
Q

Drug therapy

A

— Rifampin, Ethambutol (TB)
— Ecyclivir (herpes)
— Montalukast (Singulair for asthma, COPD)

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26
Q

Treatment for active TB disease

A

2 phases of Tx
— Initial: 8wks to 3 mos = 4 drugs
— Continuation: 18wks = 2 drugs (Isoniazid, Rifampin)

4-Drug regimen:
— Isoniazid
— Rifampin
— Pyrazinamide
— Ethambutol

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27
Q

What to monitor with Active TB drug therapy

A

— Isoniazid: hepatitis
— Rifampin: hepatitis; orange body fluids
— Pyrazinamide: hepatitis
— Ethambutol: ocular toxicity

NOTE: Monitor LFTs = sclera of eyes/skin, tenderness in RUQ (enlargement), clay-colored stool

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28
Q

ARDS complications of pneumonia

A

— Manifestations = on O2 or vent? VENT b/c cannot tolerate O2 (it is not helping)

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29
Q

Watch out for Veceronium and Panceronium

A

Vecuronium — nondepolarizing agent that achieves skeletal muscle paralysis; it works by blocking the signals between your nerves and your muscles.
Panceronium — used to suppress/paralyze respiratory effort
– Facilitate mechanical ventilation

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30
Q

Therapeutic effect for a medication Sleepiness medication

A
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31
Q

ALBUTEROL inhalation process

A

— Hold for 10 seconds

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32
Q

Diuretics to get off ; ARDS needs supplemental foods, but is BETTER in prone position (when on vent, otherwise in HIGH Fowler’s)

A
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33
Q

Fatty embolism syndrome can cause what?

A

A pulmonary embolism

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34
Q

Indications of a fatty embolism

A

Ca2+ serum level decreased

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35
Q

Drop down dyad of ABGs + what to do 1st, 2nd, etc

A
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36
Q

Bow tie bronchodilators, asthma, PFT

A
37
Q

Diphenhydramine given when

A

anaphylactic allergic reaction

38
Q

Pneumonia (PNA) etiology

A

— Acute infection of lung parenchyma
— Associated with significant morbidity and mortality

Normal defense mechanisms: air filtration, epiglottis closure over trachea, cough reflex, mucociliary escalator, and reflex bronchoconstriction; IgA, IgG, alveolar macrophages
— Defense mechanisms become incompetent or overwhelmed: aspiration, tracheal intubation, air pollution, smoking, viral URI, aging, chronic diseases

39
Q

Pneumonia (PNA) etiology

A

— Acute infection of lung parenchyma
— Associated with significant morbidity and mortality
— Normal defense mechanisms: air filtration, epiglottis closure over trachea, cough reflex, mucociliary escalator, and reflex bronchoconstriction; IgA, IgG, alveolar macrophages
— Defense mechanisms become incompetent or overwhelmed: aspiration, tracheal intubation, air pollution, smoking, viral URI, aging, chronic diseases

40
Q

3 ways organisms reach lungs in patients with pneumonia

A
  1. Aspiration of normal flora from nasopharyngeal or oropharynx
  2. Inhalation of microbes present in air
  3. Hematogenous spread from primary infection elsewhere in the body
41
Q

Incentive spirometry purpose + steps

A

Purpose: monitor optimal lung expansion to reduce risk of PNA

STEPS
1. Keep tight mouth seal around mouthpiece
2. Inhale and hold for 3-5sec
3. During inhalation, the needle of the spirometry machine will rise.

42
Q

Respiratory Failure medication options

A

NOTE: driven by the cause/reason

— Rescue drug inhalers/nebulizers
— Maintenance inhalers
— Beta agonists (e.g. AlbuTEROL, LevalbuTEROL, FomoTEROL)
— Anticholinergics (e.g. IpaTROPIUM, TriaTORPIUM)
— Diuretics
— Antibiotics
— Methyxanthines (e.g. AminoPHYLINE)
— Steroids (e.g. FluticaSONE, BudeSONide, PredniSONE)

43
Q

Cause of metabolic acidosis + examples

A

Cause = An overproduction of hydrogen ions
— XS oxidation of fatty acids
— Starvation
— Diabetic ketoacidosis
— Hypermetabolism: heavy exercise, seizure activity, fever, hypoxia, ischemia
— XS ingestion of acids: ethanol/methanol intoxication,

44
Q

Cause of metabolic acidosis + examples

A

Cause = An overproduction of hydrogen ions
— XS oxidation of fatty acids
— Starvation
— Diabetic ketoacidosis
— Hypermetabolism: heavy exercise, seizure activity, fever, hypoxia, ischemia
— XS ingestion of acids: ethanol/methanol/salicylate intoxication
— Overproduction of bicarbonate: kidney/liver failure, pancreatitis, dehydration
— Overelimination of bicarbonate: diarrhea

45
Q

Respiratory acidosis examples

A

Under elimination of H+ ions:
— RR depression: anesthetics, opioids, electrolyte imbalance
— Inadequate chest expansion: muscle weakness, airway obstruction, alveolar-capillary block

46
Q

METABOLIC ACIDOSIS EXAMPLES

A

Increase of base components:
— Oral ingestion of bases: antacids
— Parenteral base administration: blood transfusions, NaHCO3, total parenteral nutrition (TPN)
— Decrease of acid components: prolonged vomiting, nasogastric suctioning, HYPERcortisolism, HYPERaldosteronism, thiazide diuretics

47
Q

RESPIRATORY ALKALOSIS EXAMPLES

A

NOT producing enough CO2, so not producing NaHCO3, therefore not enough H+ but excessive HCO3 in body —> increasing pH

XS loss of CO2:
— Hyperventilation
— Fear/anxiety
— Mechanical ventilation
— Salicylate toxicity
— High altitudes
— Shock
— Early-stage acute pulmonary problems

48
Q

OPEN vs. CLOSED pneumothorax

A

OPEN: brought on by an external source, causing internal trauma; penetrates integrity of body
— e.g. knife/gun wound, arrow/spear

CLOSED: may originate externally or internally
— e.g. pneumothorax (chest tube now needed d/t unequal chest expansion after insertion); complication from central line

49
Q

What is the purpose of a chest tube? Where?

A

To reestablish ventilation and oxygenation in the pleural cavity/space which allows an avenue for air/fluid to exit = reexpansion of lungs results in increased O2’ation by ventilation capabilities improvement

pleural space is b/w parietal + visceral

50
Q

Anatomy of lung

A

Lung —> Visceral pleura —> Pleural cavity —> Parietal pleura —> Endothoracic fascia —> Innermost intercostal muscle

51
Q

Chest tube insertion location: AIR vs. FLUID

A

AIR = b/w 3rd-4th intercostal space
— “air rises,” so want removal of air (e.g. pneumothorax)
FLUID = 5th intercostal space or further below
— “fluid settles below in a cavity” (e.g. emphysema, hemothorax)

52
Q

Egophony

A

Spoken “E” similar to “A” on auscultation because of altered transmission of voice sounds
— Increased resonance of voice sounds heard when auscultating the lungs.

WHY? PNA, pleural effusion

53
Q

Fine crackles

A

Short, discontinuous, high-pitched sounds heard just before the end of inspiration.
— Result of rapid equalization of gas pressure when collapsed alveoli or terminal bronchioles suddenly snap open.
— Similar sound to that made by rolling hair between fingers

WHY? Interstitial edema (early pulmonary edema), alveolar filling (PNA), loss of lung volume (atelectasis), early phase of heart failure, idiopathic pulmonary fibrosis

54
Q

Course crackles

A

Louder, discontinuous, low-pitched sounds caused by air passing through airway intermittently occluded by mucus, unstable bronchial wall
— May be heard on inspiration/expiration/both
— Similar to sounds of blowing through straw underwater

WHY? XS fluid w/in lungs, heart failure, pulmonary edema, PNA w/ severe congestion, COPD

55
Q

Stridor

A

Continuous musical/crowning sound of constant pitch resulting of partial obstruction of larynx/trachea
— e.g. Croup, epiglottitis, vocal cord edema after exhumation, foreign body object stuck

56
Q

Wheezing

A

Continuous high-pitched squeaking or musical sound caused by rapid vibration of bronchial walls. First evident on expiration but possibly evident on inspiration as obstruction of airway increases. May be audible without stethoscope
— e.g. Bronchospams (caused by asthma), airway obstruction (caused by FBO), COPD

57
Q

What is a pleural friction rub?

A

Creaking or grating sound from roughened, inflamed pleural surfaces rubbing together. Evident during inspiration, expiration, or both. No change with coughing. Often uncomfortable, especially on deep inspiration

WHY? Pleurisy, PNA, pulmonary infarct

58
Q

Bronchophony

A

Spoken or whispered syllable more distinct than normal on auscultation
WHY? Pneumonia

59
Q

Whispered pectoriloquy

A

Spoken or whispered syllable more distinct than normal on auscultation

60
Q

ICS/LABA

A

— BudeSONide/Formoterol (Symbicort) — MDI
— FluticaSONE/Salmeterol (Advair Diskus or HFA) — DPI, MDI
— FluticaSONE/Vilanterol (Breo Ellipta) — MDI
— Mometasone furoate/formoterol fumarate (Dulera) — MDI (not for relief of acute bronchospasm)

61
Q

LAMA/LABA

A

Umeclidinium/vilanterol (Anoro Ellipta) — DPI (for COPD, but not for relief of acute bronchospasms)

62
Q

SAMA/SABA

A

Ipratropium/albuterol (Combivent Respimat, DuoNeb) — Nebulizer, inhalation spray

63
Q

Methylxanthines

A

IV agent: Aminophylline (2nd line therapy)
PO: Theophylline
MOA:
NOTE: 1/2 life is reduced by smoking and increased by heart failure + liver disease

64
Q

RF for impaired gas exchange

A

— Age
— Smoking: modifiable
— Immunosuppresion
— Reduced state of cognition: CF and CE
— Brain injury: increased risk of aspiration
— Prolonged immobility: fluid builds up, pts. not taking deep breaths
— Chronic conditions: COPD, CF

65
Q

Populations with the greatest for impaired gas exchange

A

— Infants have anemia for first 2-3 months
— Young children = less alveolar surface area + narrow branching of airways (easily obstructed)
— Older adults = stiffer chest wall, less effective cough, weakened chest muscles, loss of elasticity

66
Q

TB is a highly communicable disease caused by what organism

A

Microbacterium tuberculosis, rod-shaped bacteria; slow-growing

67
Q

RF for TB disease

A

— Environmental exposure: homeless, crowded places, poor ventilation, contact w/ untreated people
— Travel: Asia, Africa, Russia
— SES: lower income (b/c medically underserved)

68
Q

S/Sx of TB

A

— hemoptisis + cough lasting 3+ weeks
— night sweats/chills
— fatigue/malaise

NOTE: TB = droplet precautions.

69
Q

Patient education on reduction of TB transmission in home environment

A

— Medication compliance
— Cover mouth + nose w/ cough/sneeze
— HH
— Sleep alone
— No visitors until non-infectious
— Open windows to allow ventilation
— Avoid public places (wear surgical mask if you do go out)
— Family should get tested

70
Q

Criteria for TB patients to be considered non-infectious?

A

ALL 3 must be met:
1) Drug tx >/2 weeks
2) Symptoms improved
3) 3 consecutive negative sputum cultures/smears (must be 8 hrs apart, one must be in the AM)

71
Q

What vaccine is used to treat tuberculosis?

A
72
Q

Medical term for “raccoon eyes?” Why?

A

Periorbital ecchymosis
WHY? To evaluate for basilar skull fractures

73
Q

RN Interventions for INH-Isoniazid

A

— Take on empty stomach to increase absorption
— Avoid antacids
— Take daily multivitamin b/c depletes Vitamin B
— Report yellow appearance (jaundice), easily bruising, bleeding
— Take at night b/c can cause severe nausea

74
Q

RN interventions for Rifampin

A

— Reddish- orange tinge (urine, secretions- NORMAL)
— Oral contraceptives- decreases effectiveness, 2nd BC method while on and a month after
— Avoid alcohol: S/S liver failure
— Take a bedtime

75
Q
A

— Ask if they have had gout
8 oz of water, increase fluid intake (uric acid increase)
Wear protective stuff in the sun (sunburn)
Avoid alcohol
Report yellow appearance to skin or whites of eyes, darkening urine, bruising or bleeding
— S/S liver failure
— Take at bedtime b/c of severe nausea

76
Q

RN Interventions for PZA (Pyrazinamide)

A

P = photosensitivity
— Ask if they have had gout
— 8 oz of water, increase fluid intake (uric acid increase)
— Wear protective stuff in the sun (sunburn)
— Avoid alcohol
— Report yellow appearance to skin or whites of eyes, darkening urine, bruising or bleeding
— S/S liver failure
— Take at bedtime b/c of severe nausea

77
Q

RN Interventions for EMB (Ethambutol)

A

E = eyes
— Ask about gout
— Take with 8oz of water
— REPORT VISION CHANGES (can cause blindness) optic neuritis
— Avoid alcohol
— Take at bedtime

78
Q

Differences in symptoms of allergic rhinitis

A

— Episodic—sporadic exposure
— Intermittent—less than 4 days/week or less than 4 weeks/year
— Persistent—greater than 4 days/week or greater than 4 weeks/year

79
Q

Chest tube insertion

A
80
Q

3 Basic compartments of pleural drainage

A

Purpose: collect fluid, air, or blood in chest cavity

1st — collection chamber | fluid stays IN; air vents to 2nd compartment
2nd — H20 -seal chamber | contains 2cm of H2O; acts as one-way valve; air goes IN, bubbles OUT, but can’t go back to patient
3rd — suction control chamber | Uses column of H2O to control suction from regulator

81
Q

Bubbling in H2O-seal chamber in pleural drainage

A

— Brisk at first, eventually disappears as lung expands
— Intermittent with exhalation, coughing, or sneezing

82
Q

Tidaling in H2O-seal chamber in pleural drainage

A

— Fluctuation of water with pressure changes during respiration
— Disappears as lung re-expands
— If stops suddenly, check for occlusion

83
Q

Management for chest drainage

A

Keep below chest
— Mark and measure drainage
— Report greater than 200 mL/hr in first hour and 100 mL/hr thereafter; replace unit when full
— Avoid overturning unit
— Breakage of unit: place distal end of chest tube in 2 cm water in sterile container; replace unit
— No milking or stripping chest tube

84
Q

Management for wet suction chest drainage

A

Monitor:
Water levels
Suction at—20 cm H2O
Gentle bubbling

85
Q

Management for DRY suction chest drainage

A

— Turn dial to ordered amount
— If decrease suction; depress high-negativity vent and check water level in water-seal chamber

86
Q

Chest tube dressings management

A

Change according to agency policy and procedure
Petroleum gauze
Aseptic technique
Monitor for infection
Document

87
Q

Which test measures volume of the air the lungs can hold after maximum inhalation?

A

Pulmonary function tests
— used to examine the effectiveness of the lungs and identify lung problems. Total lung capacity measures the amount of air the lungs can hold after maximum inhalation.

88
Q

Expected finding for chest tube placement postprocedure

A

– H2O seal chamber: tidaling
– Suction chamber: continuous bubbling only

BSN: 3rd Quarter (13 decks)

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