Med Surg Final Flashcards

Question

adrenal Crisis ( acute adrenal insufficiency)

Answer 1

RAPID onset due to Sudden drop in corticosteroids is due t sudden tumor removal, stress of illness, trauma, surgery or dehydration, or abrupt withdrawal of steroid medications if not quickly diagnosed and treated- prognosis is poor. S/S: - hypotension - hypoglycemia - hyperkalemia - abdominal pain - weakness - weight loss Nursing Actions: - start IV line and administer rapid infusion of Normal saline - administer glucocorticoids to treat acute insufficiency - administer insulin with dextrose or loop diuretic to treat the hyperkalemia ( move potassium into cells) - give calcium to counteract the effects of hyperkalemia and protect the heart - if acidosis occurs, give bicarb - administer glucagone or iv glucose for the hypoglycemia - monitor vitals and gluose levels - monitor for ECG changes

Answer 2

RAPID onset due to Sudden drop in corticosteroids is due t sudden tumor removal, stress of illness, trauma, surgery or dehydration, or abrupt withdrawal of steroid medications if not quickly diagnosed and treated- prognosis is poor. S/S: - hypotension - hypoglycemia - hyperkalemia - abdominal pain - weakness - weight loss Nursing Actions: - start IV line and administer rapid infusion of Normal saline - administer glucocorticoids to treat acute insufficiency - administer insulin with dextrose or loop diuretic to treat the hyperkalemia ( move potassium into cells) - give calcium to counteract the effects of hyperkalemia and protect the heart - if acidosis occurs, give bicarb - administer glucagon or iv glucose for the hypoglycemia - monitor vitals and glucose levels - monitor for ECG changes

Answer 3

Balanced Nutrient intake Balanced Hormonal signaling Balanced Glucose uptake by the cell

Answer 4

State of insufficient or low blood levels, defined as less than 70 mg/dL Possible Causes: - Insufficient Nutritional Intake - Adverse Reaction to Medication - Excessive Exercise S/S: - irritability - fatigue - mental confusion - seizures - unconsciousness - potentially leads to cellular death TREATMENT: Rule of 15s 1. eat/drink 15g carbs 2. wait 15 min 3. check blood glucose 4. less than 70mb- repeat steps 1-5 Once BG >70 mg/dL – give complex CHO with protein or fat If pt is crashing or unconscious- give glucagon 1 mg, sub Q or IM OR 50% Dextrose (D50) 25-50ml IV push

Answer 5

State of elevated blood glucose levels, defined as more than 100 mg/dL in a fasting state or 140 mg/dL when not fasting - Insufficient Insulin -Production/Secretion - Deficient Hormone Signaling - Excessive Counter-regulatory Hormone Secretion Short-term consequences : Inadequate glucose reaching the cells Dehydration ``` Long-term consequences: End-organ disease due to microvascular damage Retinopathy Nephropathy Peripheral neuropathy ``` Macrovascular angiopathy: Hypertension Cardiovascular and peripheral vascular disease Collaborative Care: - Education about glucose regulation - Nutrition therapy - Pattern management: monitoring meal-related blood glucose values - Pharmacological agents - Oral hypoglycemic agents - Insulin ketones in urine associated with hyperglycemia- greater than 300mg=medical emergency

Answer 6

1. Fasting Plasma glucose - No caloric intake for at least 8 hrs. -Impaired Fasting Glucose = 100-126 Critical Values : <60 mg/dl or >500 mg/dl 2.Random Glucose test -Can be drawn any time -Meals, drugs, stress can cause increase -Critical values >180 mg/dl on two occasions >200 mg/dl with s/s hyperglycemia 3. Two-Hour Glucose Tolerance Test ( OGTT) -Multiple blood draws over 2 hrs. after a glucose load of 75 g -200 mg/dl or more = diabetes >140 and <199 = pre-diabetes

Answer 7

A blood test that measures the amount of glycosylated hemoglobin in the blood (Hemoglobin is a protein found in the blood) Glycosylated hemoglobin means that glucose (sugar) has attached to the hemoglobin protein The higher the blood sugar, the more that glucose gets attached to the hemoglobin Glucose attaches to Hgb and remains attached to the RBC for it’s lifespan (90 days) - Indicates overall long term average glucose control for previous 60-90 days - Near-normal levels over time markedly reduce risk of complications Conditions that affect RBC turnover may alter HbA1c (sickle cell, anemia, hemolysis, etc.) Normal range: 4 to 5.6 % Prediabetes: 5.7-6.4% Goal: 6.5% or less

Answer 8

Urine- checking for protein and/or ketones Kidney function tests people with a BMI of >25 at risk for glucose regulation issues

Answer 9

- Multi-system disease related to abnormal insulin production, impaired insulin utilization or both - Disturbance in carbohydrate, protein and fat metabolism - heart disease, cerebral vascular accidents, renal failure, blindness, and non traumatic limb amputation Glycemic control reduces complications of diabetes Treatment of hypertension and hyperlipidemia is essential

Answer 10

- Pre-diabetes (Impaired Glucose Tolerance) - Type 1 - Type 1.5 - Latent autoimmune diabetes in adults (LADA) - Type 2 - Type 3 - MODY (maturity onset diabetes of the young) - Gestational -Secondary diabetes: Chemical induced Disease induced Hormonal

Answer 11

- Slow progressing form of autoimmune diabetes - Occurs because your pancreas stops producing adequate insulin, most likely from some "insult" that slowly damages the insulin-producing cells in the pancreas. - Often won't need insulin for several months up to years after being diagnosed. - Usually diagnosed over 30 years - At first, LADA can be managed by controlling blood glucose with diet, weight reduction if appropriate, exercise and, possibly, oral medications. - As the body gradually loses its ability to produce insulin, insulin injections will eventually be needed.

Answer 12

alzheimers related DM - Evidence suggests that AD represents a form of diabetes that selectively involves the brain and has molecular and biochemical features - Rapid growth in the literature pointing toward insulin deficiency and insulin resistance as mediators of AD - People with type 2 diabetes have an increased risk of suffering from AD disease estimated to be between 50% and 65% higher.

Answer 13

- 1-5% of DM cases - Autosomal dominant - Leads to Beta cell dysfunction - Usually before age of 25 - Not associated with obesity or hypertension - Treatment depends on the genetic mutation

Answer 14

Prediabetes/Impaired Glucose Tolerance (IGT)/Impaired Fasting Glucose (IFG) - Beta cells become fatigued from overproduction - Beta cell dysfunction is mild (with slight increase in glucose) - Patients with IGT are increased risk for DM II (usually within 10 years) Fasting glucose levels above 100 - pre-diabetes can prevent or delay the development of Type 2 diabetes through changes to their lifestyle that include modest weight loss and regular exercise - long-term damage, especially the cardiovascular system, already may be occurring during pre-diabetes

Answer 15

-Failure of the pancreas -May be genetic – recessive -Can be caused by toxins or virus 5-10 % of all diabetics -Usually under age of 40 -Peaks before 20 years of age - same incidence in males and females - Patients are usually thin/lean but may be obese - Progressive destruction of Pancreatic B cells - Requires exogenous Insulin - Diabetic Ketoacidosis (DKA) Acute onset- 3Ps - polydipsia - polyphagia - polyuria - weight loss

Answer 16

- Most prevalent (90% of patients) - Genetics – dominant and multifactorial ( - Insulin resistance - Highest among Native Americans and Hispanics followed by African Americans correlated with obesity - over the age of 35 - also identified in young people- especially with the increase of childhood obesity - pancreas still manufactures SOME insulin - but its usually insufficient to meet the needs of the body and/or poorly utilized by tissues - body tissues do not respond to insulin - insufficient number of receptors or the receptors are unresponsive - hyperglycemia - hyperinsulinemia can result in HHNK ( hyperosmolar hyperglycemic nonKetotic state) ``` s/s: non specific manifestations Can be 3 P's -fatigue -recurrent infections -visual changes -prolonged healing ```

Answer 17

-primarily occurs in Type 2 Diabetes Metabolic Syndrome - cluster of abnormalities working synergistically to greatly ↑ risk for CV disease and diabetes - Elevated insulin levels (insulin resistance) - High triglycerides - Decreased HDL - Increase LDL - Hypertension - Obesity (esp. central obesity) - Sedentary Lifestyle - Estimated 34% of Americans fit the criteria - Can be treated with weight loss and exercise

Answer 18

Drug Therapy- Exogenous Insulin Why can’t exogenous insulin be taken orally?- destroyed by gastric enzymes before it can reach the cells Onset-Peak-Duration Sliding Scale insulin pumps, ports, pens, Omnipods, insulin jets

Answer 19

Nutritional Therapy – Individualized to patient (Table 44.6) CHO: include fruits, vegetables whole grains and low-fat milk Fiber intake 25-30 g/day Protein: High protein diets for weight loss not recommended 15-20% of daily intake Fats: Minimize trans fats Dietary cholesterol <200mg/day At least 2 servings/week of fish Alcohol: Limit to moderate amounts Effect of Alcohol on sugar? alcohol decreases serum blood glucose and can cause hypoglycemia

Answer 20

*Lowers blood glucose by increasing CHO metabolism Fosters weight reduction & maintenance Increases insulin sensitivity Increases high-density lipoprotein (HDL) levels Decreases triglyceride levels Lowers blood pressure Reduces stress & tension Monitor blood sugars before and after exercise Best done after meals Moderate activity level such as brisk walking or active housework If BS <100 mg/dL – delay exercise If BS >250mg/dL and with ketones in urine– postpone exercising Monitor by healthcare providers – adjustment of medications

Answer 21

``` Illness causes increased BS… Eat regular diabetic diet Increase non-caloric fluids Continue with oral agents and/or insulin Monitor BS every 4 hrs. If > 240 check urine for ketones and report + ketones to physician ``` If Illness leads to decreased PO intake… Supplement CHO food intake with CHO-containing fluids while continuing with oral agents and/or insulin Notify physician immediately if unable to keep any food or fluids down

Answer 22

Risk of amputation 15X higher in diabetics Foot care/assessment Proper footwear Podiatrist

Answer 23

Somogyi Effect: A rebound effect in which an overdose of insulin induces morning hyperglycemia Results in ↓ B.S. in middle of night as a response to ↑ insulin Compensatory mechanisms occur to raise glucose (release of counter-regulatory hormones → gluconeogenesis etc.) Results in overcompensation, leading to rebound hyperglycemia and ketosis noted in the AM. Problem: Possible undetected hypoglycemia during the night Treatment Check B.S. between 2 AM and 4 AM If this AM B.S. is low …then reduce PM dose of insulin OR eat a more substantial bedtime snack

Answer 24

Hyperglycemia noted on awakening in AM due to release of hormones in predawn hours - Growth hormone is possible factor - Affects majority of those with diabetes but most severe in adolescence and young adulthood Problem: high B.S. usually after 3 AM Treatment Check B.S. between 2 AM and 4 AM If high, then increase insulin and eat bedtime snack Change timing of evening intermediate acting from dinnertime to bedtime

Answer 25

Onset Over 4-10 hours - Medical EMERGENCY- Type 1 only SERUM GLUCOSE GREATER THAN 300 serum sodium - normal, low or high sodium potassium depends on how long DKA existed prior to treatment- decreases with treatment Increase in BUN (>30) and Creatinine (>1.5) ketones present in serum and urine metabolic acidosis with respiratory compensation PH less than 7.3 Causes: - lack of sufficient insulin related to undiagnosed type 1 or nonadhearance to medication regimen - reduced or missed dose of insulin - any condition that increases carbohydrate metabolism (physical or emotional stress, illness, infection (#1 cause of DKA), surgery or trauma) - increased hormone production( cortisol, glucagon, epinephrine), stimulates the liver to produce glucose and decreases the effects of insulin Expected findings: - polyuria - polydipsia - polyphagia - weight loss - GI effects ( N/V/Abdominal pain) - blurred vision - orthostatic hypotension - fruity odor of breath - kussmaul respirations ( deep labored breathing) - metabolic acidosis - mental status changes

Answer 26

MEDICAL EMERGENCY -Occurs in patients who produce enough insulin to prevent DKA- Type 2 only SERUM GLUCOSE GREATER THAN 600 serum sodium- normal or low serum potassium- normal to high as a result of dehydration Increase in BUN (>30) and Creatinine (>1.5) ketones NOT present in urine or serum - Not enough insulin to prevent osmotic diuresis, hyperglycemia or ECF depletion - Increase in serum osmolarity - BS >400mg/dl - Ketones are absent absence of acidosis PH :greater than 7.4 Causes: lack of insulin related to undiagnosed DM, enough to prevent ketosis, but not enough to prevent hypoglycemia. -inadequate fluid intake or poor kidney function -most common in elder adults 50-70 -mortality rates in elders are between 40-70%, due to late treatment and overall poorer health -medical conditions such as MI, Stroke or sepsis can cause HHNK - can be caused by some medication such as : glucocorticoids, thiazide diuretics, phenytoin, beta blockers, calcium channel blockers -infection and stress Expected findings: - polyuria - polydipsia - polyphagia - weight loss - blurred vision - orthostatic hypotension - mental status changes - seizures, myoclonic jerking - reversible paralysis

Answer 27

Medical emergency -IV administration of NSS the hypotonic- ½ NSS -Regular insulin IV -When glucose falls < 250 add IV glucose (D5 ½) -monitor serum potassium - initially they will be increased but with iv insulin potassium will shift back into the cell and pt is at risk for hypokalemia -Electrolyte replacement -Bicarbonate for pH<7.10 -Treat underlying cause and complications -cardiac monitoring- why? pts with known DM should monitor blood glucose every 1-4 hours when ill -wear medical alert bracelet

Answer 28

biguanides- metformin -reduces the production of glucose in the liver ( glycogenesis) -take with food STOP taking it 48 hours before/after any tyoe of radigraphic test with iodinated contrast dye- can cause lactic acidosis and kidney failure second gen. sulfonylureas - glipizides, glyburide -stimulates insulin release from pancreas causing decrease blood glucose -take 30 min before meals

Answer 29

Conceptually: process by which oxygen is transported to cells and carbon dioxide is transported from cells. Process: interaction among the following systems… Neurologic Respiratory Cardiovascular Impairment of gas exchange occurs when the diffusion of gases (oxygen and carbon dioxide) becomes impaired because of - Ineffective ventilation - Reduced capacity for gas transportation (reduced hemoglobin and/or red blood cells) - Inadequate perfusion Consequences of impaired gas exchange include: - reduced oxygen in blood( hypoxia) - absence of oxygen in blood ( anoxia) - oxygen-deprived tissues - CELL DEATH

Answer 30

- Age - Smoking - Chronic medical conditions, - Immunosuppression - Reduced state of cognition - Brain injury - Prolonged immobility

Answer 31

-Infection control -Smoking cessation -Immunizations -Influenza – Given Yearly - Check for egg allergies prior to flu shot -Pneumococcal -PCV13 (Pneumococcal Conjugate) -recommended @65 yrs. or younger who are high risk -PPSV23 (Pneumococcal Polysaccharide) – recommend @65 yrs. or younger if smoker or have asthma -Preventing postoperative complications

Answer 32

Screening Tests: Mantoux skin test Interferon-gamma release assays (IGRAs). ``` Laboratory tests: Throat culture Arterial blood gases Complete blood count D-Dimer test Sputum Biopsy ``` -Pulse Oximetry -Radiologic studies (Chest x-ray, CT scan and Spiral CT scan MRI scans, ventilation/perfusion (V/Q) scan, positron emission tomography (PET) scan) -Pulmonary function studies/Peak Flow Bronchoscopy -transbronchial needle biopsy Thoracentesis

Answer 33

``` Pharmacotherapy: β-adrenergic Agents (short and long acting) Corticosteroids Anticholinergic Agents Methylxanthines Mucolytics Antibiotics Decongestants/Expectorants/Antitussives ```

Answer 34

Alveolar hypoxia-->pulmonary capillary vasoconstriction-->increased pulmonary artery pressure (pulmonary hypertension)--> hypertrophy of right ventricle--> right-sided heart failure

Answer 35

- Physiologic compensation for hypoxemia. | - Increased RBC’s but not able to carry increased O2 as oxygen not available -->cyanosis.

Answer 36

- Deficiency in # of RBC or a deficiency in the quantity of hemoglobin concentration OR both - Not a specific disease but rather a manifestation of a pathologic process - Manifestations stem from hypoxia ``` S/S variable: Mild, Moderate, Severe -possibly asymptomatic in mild cases -pallor -irritability -numbness or tingling of extremities -dyspnea on exertion -yellowing of eyes -pale, cold yellow skin -shortness of breath -muscle weakness - changes in stool color -fatigue -dizziness -fainting ( severe) -low BP -heart palpitations -Tachycardia -chest pain (severe) -angina (severe) -heart attack ( severe) -enlarge spleen -orthostatic hypotension -nail bed deformities( spoon-shaped nails) -smooth, sore, bright-red tongue ( b12 deficiency) ``` ``` *Collaborative Care: Administer oxygen as needed Alternate rest/activity Monitor blood H/H Medication teaching Diet teaching- b12, folate, iron ``` A causes of Anemia: - bood loss - inadequate RBC production (hypoproliferative anemia) - Increased RBC destruction ( Hemolytic) - deficiency of necessary components such as folic acid, iron, erythpoietin, and/or vitamin b-12 Risk Factors for Anemia: * Acute or chronic blood loss - trauma - menorrhagia - GI bleeds ( ulcers, tumor) - Intra or post-surgical blood loss or hemorrhage - Chemical or radiation exposures * Increased Hemolysis - defective Hgb ( sickle-cell disease) RBCs become malformed during periods of hypoxia and obstruct capillaries in joins and organs - immune disorders or destruction (transfusion reactions, auto immune diseases) - mechanical destruction of RBCs (mechanical heart valve, cardiopulmonary bypass) * inadequate dietary intake or malabsorption - iron deficiency - vitamin b-12 deficiency - folic acid deficiency - pica * bone-marrow suppression - exposure to radiation or chemo - aplastic anemia * age - older clients are at risk for nutrition-deficient anemia - anemia can be misdiagnosed as depression or debilitation in older adult clients - gastrointestinal bleeding is a common cause of anemia in older adult clients. check stools for occult blood

Answer 37

anemia due to deficiency of intrinsic factor produced by gastric mucosa, which is necessary for absorption of b-12 -dietary intake of b12 would do nothing Collaborative Care: Supplemental B-12 ( cobalamin) injections for pernicious anemia Cobalamin= B-12

Answer 38

Epistaxis ( nose bleed) Rhinitis Sinusitis NOTE: These conditions typically do not interfere with a person’s ability to maintain oxygenation or adequate tissue perfusion unless complications (such as Bronchitis, Pneumonia etc.) develops

Answer 39

``` Etiology: Trauma Foreign bodies Nasal sprays Street drug use Anatomic malformation Allergic rhinitis Tumors Medications Hypertension (doesn’t increase risk but makes bleeding more difficult to control) ``` Anterior ( most common): Keep patient quiet Place in sitting position, lean forward Pinch entire soft portion of nose 10 minutes Apply ice to nose Partially insert gauze into bleeding nostril Obtain medical assistance if bleeding continues ``` Posterior ( More serious): If tubes are used to control bleeding… Observe for respiratory distress Humidified oxygen Bedrest Pain management Hydration and oral care ```

Answer 40

Viral (“Common Cold”): Viruses invade the upper respiratory system Spread by droplet Increased in winter months Risk factors: Overcrowding/staying indoors Compromised immune system Stress Allergic: Triggered by a sensitivity reaction to airborne allergens “Seasonal” or “chronic” Nursing considerations: - Rest, fluids, diet, analgesics - Antihistamine and decongestant therapy - Recognize symptoms of secondary bacterial infection - Prevention – avoid crowded areas, good hand washing, etc.

Answer 41

Exit (ostia) from sinus is narrowed or blocked by inflammation or hypertrophy (swelling) of the mucosa - Secretions build up behind the obstruction - Excellent medium for organism growth leading to infection ``` Clinical Manifestations: Pain over affected sinus Purulent nasal drainage Nasal obstruction Congestion Fever Malaise Dental pain Headaches ``` ``` Collaborative Care: Control underlying cause (i.e. allergies etc.) Antibiotics Decongestants Nasal Corticosteroids Increase fluids Nasal Clearing/Cleaning Techniques (hot showers nasal rinse, etc.) Avoid smoking or exposure to smoke Increase HOB ```

Answer 42

Partial or complete airway obstruction during sleep Apnea is cessation of airflow >10 seconds (adults) Narrowing of passages – reduction of muscle tone during sleep Tongue falling back to obstruct airway Decreased O2 and increased CO2 Long term effect: Hypertension, Cardiac dysrhythmias, heart failure, CAD etc. Chronic OSA: impaired memory, inability to concentrate, failure to accomplish task, interpersonal difficulties Risk factors: Obesity, smoking, cranial abnormalities, acromegaly, men>women (until menopause than women = men) Manifestations: - insomnia - daytime sleeping - partner may notice snoring - restless behaviors ``` Treatments: Mild (5-10 apnea episodes per hour) – positioning, Avoid sedatives and ETOH Weight loss CPAP (>15 apnea episodes per hour) ```

Answer 43

Influenza TB Pneumonia Acute Bronchitis **Seriousness of above conditions and/or complications that may occur can result in altered ventilation and perfusion concerns

Answer 44

Highly contagious that may cause serious morbidity and mortality (estimated 20,000 death each year) Flu season starts in September and extends to April Need annual flu vaccinations due to different Influenza virus strains mutating over time ``` s/s: headache fever (usually high) extreme muscle tiredness join aches runny or congested nose sore throat aches coughing Vomiting ``` Diagnosis: History & Physical Viral Cultures (usually take 3-10 days) Rapid Flu Tests (nasal secretions) – best done within 48 hours of onset of symptoms Collaborative Care:Prevent: -Good hand-washing and Vaccine (nasal vaccine not available) -Check for egg allergies prior to flu shot Antiviral – inhaler, oral or IV- best if given within 48 hours of s/s onset -Supportive therapy (rest, analgesics/antipyretics, hydration)

Answer 45

- Inflammation of the bronchi - Viral or Bacterial (Most are viral) ``` Manifestations: Cough Sputum production Headache Shortness of breath on exertion Rhonchi, wheezing ``` ``` Collaborative Care: Supportive (rest, fluids etc.) Antitussives Anti-inflammatory agents Bronchodilators ```

Answer 46

- Infectious disease caused by Mycobacterium tuberculosis - Lungs most commonly infected - 1/3 of world’s population is infected with TB - Leading cause of death in patients with HIV/AIDs - Prevalence is decreasing in the United States Multidrug-Resistant Tuberculosis (MDR-TB) Resistance to 2 of the most potent first-line anti-TB drugs Extensively Drug Resistant TB (XDR-TB) Resistant to any fluoroquinolone plus any injectable antibiotic ``` Risk Factors: Homeless Residents of inner-city neighborhoods Foreign-born persons Living or working in institutions (includes health care workers) IV drug users Poverty, poor access to health care Immunosuppression ``` Etiology and Pathophysiology - Spread via airborne particles - Can be suspended in air for minutes to hours - Transmission requires close, frequent, or prolonged exposure - NOT spread by touching, sharing food utensils, kissing, or other physical contact - Once particles lodge in bronchioles and alveoli -> local inflammatory reaction occurs -> calcified lesions and further spread stopped - Has affinity for lungs but can spread and grow in other organs Classifications -Primary infection When bacteria initiate inflammatory response – encapsulate organisms preventing disease -Latent TB infection (LTBI) Infected but no active disease -Active TB disease Primary TB Reactivation TB (post-primary) Clinical Manifestations: LTBI – asymptomatic Pulmonary TB: Takes 2-3 weeks to develop symptoms Initial dry cough that becomes productive Symptoms (fatigue, malaise, anorexia, weight loss, low-grade fever, night sweats) Dyspnea and hemoptysis late symptoms Hospitalization not necessary for most patients Infectious for first 2 weeks after starting treatment Drug therapy used to prevent or treat active disease Need to monitor compliance Vaccine Bacille-Calmette-Guérin (BCG) vaccine to prevent TB is currently in use in many parts of world In United States, not recommended Can result in positive PPD reaction Active Disease: Four-drug regimen (Isoniazid, Rifampin (Rifadin) Pyrazinamide Ethambutol) Teach side effects and when to seek medical care Monitor liver function Avoid Alcohol May need Direct Observed Therapy (DOT) ``` Latent TB infection: Positive TB test Drug therapy to prevent TB infection from becoming active disease Usually treated with Isoniazid for 6 to 9 months HIV patients should take Isoniazid for 9 months ```

Answer 47

Airborne isolation Single-occupancy room with 6-12 airflow exchanges/hour Health care workers wear high-efficiency particulate air (HEPA) masks Immediate medical workup Appropriate drug therapy Patient wears mask if outside of negative-pressure room Identify and screen close contacts

Answer 48

Can go home even if cultures positive Monthly sputum cultures Teach patient how to minimize exposure to others Ensure that patient can adhere to treatment Negative cultures are needed to declare the patient not infectious Notify Health Department Smoking Cessation

Answer 49

Acute infection of lung parenchyma Associated with significant morbidity and mortality rates Pneumonia and influenza are 8th leading cause of death in the U.S. Etiology : - When defense mechanisms become incompetent or overwhelmed - ↓ Cough and epiglottal reflexes may allow aspiration - Chronic diseases suppress immune system Three ways organisms reach lungs: 1. Aspiration from nasopharynx or oropharynx 2. Inhalation of microbes present in air 3. Hematogenous spread from primary infection elsewhere in body ``` Mucociliary mechanism impaired : Pollution Cigarette smoking Upper respiratory infections Tracheal intubation Aging ```

Answer 50

- Can be classified according to causative organism - Community Acquired Pneumonia (CAP) - Hospital-Acquired Pneumonia (HAP) - Ventilator Associated Pneumonia (VAP) - Multidrug-resistant (MDR) organisms (risks factors, advanced age, immunosuppression, history of antibiotic use, prolonged mechanical ventilation) - Aspiration Pneumonia - Necrotizing Pneumonia - Opportunistic Pneumonia - Pneumocystis jiroveci pneumonia (PJP)

Answer 51

1. Inflammatory response- attraction of neutrophils, release of inflammatory mediators, Accumulation of fibrinous exudates, red blood cells and bacteria 2. alveoli fill with fluid and debris (consolidation) and increased production of mucus (airway obstruction) 3. Decreased gas exchange 4. Resolution of infection - macrophages in alveoli ingest and remove debris - normal lung tissue restored - gas exchange returns to normal

Answer 52

S/S: - cough ( productive cough: blood streaked, yellow, rusty sputum=infection) - fever - chills - tachycardia - tachypnea - dyspnea - pleural pain - malaise - respiratory distress - decreased breath sounds Diagnostic orders: - sputum culture - chest X-ray - ABGs Collaborative Care: - oxygen - hydration - rest and activty - patient teaching ``` Medications: antibiotics analgesics/antipyretics cough sepressants corticosteroids bronchodilators ```

Answer 53

-pulmonary embolism -asthma -COPD (chronic bronchitis vs. emphysema)

Answer 54

PE occurs when a blood clot becomes lodged in a lung artery, blocking blood flow to lung tissue. Blood clots often originate in the legs ``` Risk Factors: > 90% arise from thrombi in the deep veins of the legs -Immobilization -Surgery within last 3 months (especially orthopedic surgery i.e. hip/knee replacements) -Stroke -Malignancy -Obesity -Smoking -Hypertension/Chronic -Heart Disease ``` PE Classifications: Massive Sub-massive Low risk s/s: - Dyspnea (most common - 85% of patients) - Anxiety - Tachycardia - Cough/Hemoptysis - Chest pain - Syncope - Sudden change in MS - Massive emboli produce abrupt hypotension and shock; sudden collapse of the patient Collaborative Care: - O2 therapy - Bed rest – Semi-Fowler’s - Call for assistance -Drug Therapy Anticoagulant Therapy Thrombolytic agent -Surgery Embolectomy Vena Cava Filter

Answer 55

-Reversible expiratory airflow limitation -Disease of Inflammation along with bronchial hyper-responsiveness -Parasympathetic Dominance : Mucosal Inflammation Bronchial smooth muscle construction Excess mucus production Risk Factors: - inflammatory factors allergens, respiratory infections, environmental factors -irritants change in temp, exercise, cold air, stress and emotions, strong odors -other medications, tobacco, gastric reflux, pollutants, food additives ``` S/S: Wheezing Coughing Dyspnea Chest tightness Use of accessory muscles to breath Anxiety Tachycardia, Diminished breath sounds ``` ``` Classification-severity: Intermittent Mild persistent Moderate persistent Severe persistent Treatment is based upon stages ``` Collaborative Care: -Medications β-agonists, anti-inflammatory, mucolytics, methylxanthines, anticholigenerics, Leukotriene modifiers) - Oxygen - Nebulizer Treatments - Elimination of causative factors - Daily monitoring of PEFR - Self-management plan (Green, Yellow, Red Zone) Asthma Action Plan -

Answer 56

1. Hold inhaler 2-3 cm from mouth, shake canister, spray one puff and inhale; hold for 10 seconds 2. 1-2 minutes in-between each puff of the same type of inhaler 3. Rinse mouth after use of steroid inhalers

Answer 57

COPD (Chronic Obstructive Pulmonary Disease) Disease state characterized by the presence of airflow obstruction -Chronic bronchitis Presence of chronic productive cough for 3 months X 2 years -Emphysema Abnormal enlargement of airspaces accompanied by destruction of walls

Answer 58

Hypertrophy & hyperplasia of bronchial glands Increased # goblet cells increased mucus Decreased cilia Chronic Inflammation- airway narrowing Altered function of alveoli macrophages ``` S/S: Cough-frequent, productive Frequent respiratory infections Dyspnea on exertion (DOE) Hypoxemia & Hypercapnia Edematous Coarse rhonchi & wheezing ```

Answer 59

Destruction of alveolar walls 2o proteolytic enzymes-->destroys elastin & collagen Alveolar air trapping--> hyperinflation-->alveoli meld together--> bleb/bullae Lose normal elastic recoil ``` S/S: Dyspnea Cough-minimal Thin and underweight Finger Clubbing Pursed-lip breathing Diminished breath sounds Hypercapnia ```

Answer 60

-Oxygen Therapy ( "O2 drive" -CO2 narcosis) - My carbon dioxide can be raised- do not give me high flow O2- low flow only 24% Hypoxic Drive theory: is a form of respiratory drive in which the body uses oxygen chemo-receptors instead of carbon dioxide receptors to regulate the respiratory cycle *it is believe when a patients has chronically elevated CO2, that CO2 levels stop being the drive to breath, and that low oxygen level becomes the main drive to breath.* ``` Treatment: -STOP SMOKING -Poisitioning- high fowlers -breathing exercises- pursed lip breathing -coughing Nebulizer treatments Chest physiotherapy Postural drainage Airway suctioning Tracheostomy tubes Mechanical intubation Chest tube management ```

Answer 61

``` Nutrition therapy Modifications depending on condition: -Encourage 3L/Day -Small, frequent meals -Fluids between meals -Rest 30 minutes before eating -Bronchodilator may be needed before eating -Frozen & microwave foods – conserve energy in food preparation (be careful of sodium content-read labels) -Sodium restriction may be necessary -Avoid foods that cause bloating and gas -5-6 small meals/day -Liquid commercials diets -Avoid food that requires significant chewing -Avoid exercises for 1 hour after eating -Low carbohydrate diets ```

Answer 62

Explore patient concerns Bronchodilator before sex Less stressful positions O2 if needed

Answer 63

Transfusion Therapy: Injection/administration of blood or blood products into the blood stream Universal donor: is 0- Universal Recipient is: AB+

Answer 64

Rh factor is an antigen that is a component of the Rh blood groups and is made up of numerous complex antigens Rh(+) indicates a person has Rh factor on surface of RBCs Rh(-) indicates person does not have Rh factor on surface of RBCs Rh factor is a powerful antigen Rh(-) person may only be transfused with Rh(-) blood to prevent formation of antibodies to Rh(+) blood Rh(+) person may be transfused with either Rh(-) or Rh(+) blood

Answer 65

``` With FFP… Liquid portion of blood (no cells) Contains clotting factors AB is considered the universal donor O is the universal recipient ```

Answer 66

Blood Typing: Blood test that determines blood type Cross-matching: Blood test that indicates compatibility between blood of donor and recipient Clumping in test tube=BAD not compatible

Answer 67

``` Whole Blood Packed RBCs Platelets Granulocytes Fresh Frozen Plasma (FFP) Anti-hemophilic Factor VIII Cryoprecipitate Albumin Immune Serum Globulins ```

Answer 68

- 19 gauge IV line or greater - Establish patency before requesting blood! - Sterile technique - NSS/”Y-type” IV tubing set-up at bedside (or as per institution protocol) - Baseline VS - Check orders - Double-check patient ID and blood product ID data with another licensed RN (or RN and MD) - Administer blood as soon it arrives to floor (within 2-4 hours) - Minimal handling of bag - Vital signs at start of infusion, 15 minutes into infusion (and as per institution protocol) - Stay with patient for first 15 minutes - Administer very slowly for the first 15 minutes DO NOT: -do not use dextrose solution or LR for blood administration - will cause RBC hemolysis -DO NOT give any additives (including meals) via same tubing unless cleared with NSS Post Transfusion: -Vital signs/necessary assessments at end of transfusion - Document findings after transfusion - Complete any adverse reaction forms if needed - Monitor lab values H/H (generally one unit of packed RBC raises the HCT by 3% and hemoglobin by 1g/dL)

Answer 69

``` Nursing Responsibilities: -STOP THE INFUSION -Maintain patency of cannula via NSS -Monitor vital signs and urine output -Notify the physician -Emergency equipment at bedside -Implement appropriate interventions -Written documentation -Follow appropriate protocol for reporting incident and collecting blood bag for lab ```

Answer 70

- Most dangerous - Infusion of ABO-incompatible whole blood, RBCs, or components containing 10 mL or more of RBCs - Antibodies in recipient’s plasma attach to antigens on transfused RBC = RBC destruction s/s: - chills - fever - hypotension - uncontrollable bleeding - heat sensation in the transfused vein - BACK PAIN - increased heart rate - constricting chest pain - heboglobinuria - hyperbilirubinemia - acute kidney injury - vascular collapse - cardiac arrest - Death Nursing Actions: STOP THE BLOOOD Discontinue blood Emergency fluids/drugs/dialysis to maintain renal perfusion/blood pressure Treat shock Red urine appears on next void – need to collect urine Collect blood specimen

Answer 71

-Can be mild or severe -Results from recipient's sensitivity to donor plasma proteins -Flushing, itching, Antihistamines/ corticosteroids -Monitor closely -Can lead to anaphylaxis s/s: - anxiety - chills - flushing - itching - shortness of breath - chest pain

Answer 72

- Emergency situation - Sensitivity to donor plasma proteins - Usually follows quickly - after only a few milliliters of blood S/S: Anxiety, urticaria, dyspnea, wheezing, bronchospasm, shock, possible cardiac arrest - swelling of the conjunctiva - runny nose - swelling of lips, tongue, throat - increase or decrease in HR - low BP - Hives, flushing itching - pelvic pain - dizziness, LOC, confusion, headache - OSB, wheezes or stridor - hoarseness - pain with swallowing - coughing - crampy abdominal pain - diarrhea/comiting - loss of bladder contorl

Answer 73

-Occurs when blood is administered more rapidly that the circulatory system can accommodate S/S: Cough, dyspnea, chest tightness, tachycardia, pulmonary edema, HTN, restlessness, JVD -dyspnea -cyanosis -orthopnea -headache -systolic hypertension . increase >50 mm hg Nursing actions: 1. Stop transfusion 2. Increase HOB 3. IV NSS to KVO 4. Notify MD

Answer 74

-Due to transfusion of bacterially infected blood components, or when blood sits around too long S/S: Rapid onset chills, high fever, vomiting, diarrhea, marked hypotension, shock ``` Nursing actions: Stop blood NSS to KVO Notify MD Blood bag and tubing sent back to lab ```

Answer 75

- Possible reaction between recipient’s leukocytes and donor’s antibodies = pulmonary inflammation and capillary leak = sudden development of non-cardiogenic pulmonary edema - Usually 2-6 hours after transfusion S/S: Fever, hypotension, tachypnea, dyspnea, ↓O2 sat, frothy sputum ``` Nursing actions: Stop blood O2 Steroids IV KVO ```

Answer 76

Occurs days to weeks after infusion Usually less severe S/S: Fever, malaise, gradual decrease in H/H No red urine Important to monitor because may be a precursor to a more severe reaction in further transfusions

Answer 77

``` Hepatitis B & C HIV Malaria EBV Lyme disease West Nile virus ``` Transfusion Hyperkalemia- prolonged storage of blood, cell destruction, improper handling of blood products Transfusion Hypocalcemia- preservative used to store blood binds to calcium to cause a deficiency

Med Surg Final Flashcards

Hormonal Regulation Glucose Regulation (Diabetes and Hypoglycemia) Gas Exchange (Upper airway obstruction, allergic rhinitis/sinusitis, Influenza, sleep apnea) Lower Respiratory/Impaired Transportation (Anemia PE, Pneumonia, Tuberculosis, Asthma & COPD,) Blood Administration