Pn2 Stuff T2 Flashcards
How to asses for changes in cardiac output
S/s
Check Bp - low
Cool extremities =decreases perfusion
Confusion, memory loss (older adults)
Malnourished/thin - WTs
Edema r/t (congestion of liver)
Distended stomach
Jaundice
Thready pulse - high or low
JVD
Hypoxemia/sob
Metabolic acidosis
Oliguria or no urine
How is MAP determined
Multiply the cardiac output by the TPR (total peripheral resistance)
Anything that increases heart rate or stroke volume will do what
Example that increases HR and BP
Increase cardiac output and blood pressure.
Caffeine
TPR determines what
How easily the blood flows through the vessels
Cardiac output is in turn affected by two factors:
HR and stroke volume
The MAP is what?
What drives the flow of blood throughout your body
Stroke volume in turn depends on what three factors?
Preload, afterload and contractility
Number of heart beats per min
Cardiac output
Volume of blood pumped from the ventricle per beat
Stroke volume
HR x SV = CO
What do diuretics do for HF?
Increase urine output:
They work on your kidneys by increasing the amount of salt and water that comes out through your urine.
Decrease BP:
Too much salt can cause extra fluid to build up in your blood vessels, raising your blood pressure.
Helps heart pump easier:
The rid of unneeded water and salt makes it easier for your heart to pump.
Lt HF s/s
Weak Palpitations Pallor Cool extremities Angina Confusion Oliguria during day Nocturia at night Weak peripheral pulses
Pulmonary congestion: hacky cough - worse at night, dyspnea, wheezes in lungs , frothy pink- tinged sputum
Rt sides HF s/s
JVD Large liver and spleen Anorexia Nausea Large abd - acities High BP from increase fluid or low BP from HF Wt gain Polyuria at night Swollen hands and fingers
Refractory edema May occur in progressed HF
Does not respond to diuretics or salt restriction
Most common type of HF
Left sided
Education for HF
Call to check On patient after discharge
D/c planning- continuing plan of care
Teach when to call dr
Take diuretics in AM , daily WTs, sliding scale with diuretics may be ordered depending on WT, take even if leaving for day??
What is the influence of albumin on the development of edema in clients with heart failure
Albumin is a protein that helps hold salt and water inside blood vessels, so fluid does not leak out into tissues
If albumin (blood protein) gets too low, fluid is retained and edema occurs; mainly in feet, ankles and legs
Low albumin may be due to poor nutritional status
Describe the side effects and patient education for the following common meds used to tx cardiovascular diseases
ARBs and ACEIs
Work better for euro Americans than for African Americans
Start slow- first dose may cause rapid drop in BP - especially if elderly, low sodium, or dehydrated
Monitor bp every hour for several hours after first dose and when dose is increased
If low BP occurs - place pt flat and elevate legs to increase perfusion and venous return
Low BP- asses Orthos , confusion, perfusion peripherally, reduced urine, potassium, creatine levels (renal issues?)
Ace inhibitors- dry cough
Suppress RAS- renin angiotensin system - regulates blood flow to kidneys, BP , fluid and electrolyte Balances
Reduce afterload and improve cardiac output
Block aldosterone which prevents sodium and water retention= decreases fluid overload
Reverse some vasoconstriction
Teach pt to move positions slowly from lying to sitting
Monitor potassium and renal function every few months
First line drug of choice for HF
Ace inhibitors
Drugs That Enhance Contractility.
decreasing dyspnea and improving functional activity.
This older and long-used drug is not expensive.
sinus rhythm and atrial fibrillation
Beta blockers
The potential benefits of digoxin include:
• Increased contractility • Reduced heart rate (HR) • Slowing of conduction through the atrioventricular node • Inhibition of sympathetic activity while enhancing parasympathetic activity
What is absorbed from the GI tract
It is eliminated primarily by renal excretion.
Many drugs, especially antacids, interfere with its absorption.
Older patients should be maintained on lower doses
Monitor for bradycardia or hypotension after the first dose is given.
Instruct the patient to weigh daily and report any signs of worsening HF immediately
The patient is evaluated at least weekly for changes in BP, pulse, activity tolerance, and orthopnea.
The benefits of this therapy are seen over a long period rather than immediately.
drugs that block norepinephrine and epinephrine (adrenaline)
Do not withdrawal suddenly - taper off
Digoxin/beta blockers
Side effects of beta blockers - LOLs
Beta blockers may cause
sexual dysfunction
low or high blood glucose
mask the symptoms of low blood glucose (hypoglycemia) in patients with diabetes patients.
\:■ Diarrhea ■ Stomach cramps ■ Nausea ■ Vomiting Rash, blurred vision, muscle cramps, and fatigue also may occur. Headache ■ Depression ■ Confusion ■ Dizziness ■ Nightmares ■Hallucinations
- Lowers BP: Lowers constriction–> Lower resistance –> Lowers afterload
- Renal protective vascular effects
ARBs
Side effects?
ARB’s: Sartans
- SE- 1. Angioedema, cough, fatigue, dizziness, hyperkalemia.
- Headache, upper respiratory infection, sinsitis, muscle weakness / cramps.
Patient education for ARBs
. Patient education: drug / side effects, home BP monitoring, other drugs which may interact / affect, hypotension symptoms, renal function. Daily weight.
Cronic nonprodutive cough,
anginoedema which is a serious though infrequent side effect and always a reason to discountine these agents.
Dizziness, lightheadedness, or loss of taste may occur as your body adjusts to the medication.
Dry cough may also occur.
Treats high bp and CHF
Ace inhibitors se
Explain the difference between primary and secondary hypertension and give examples of each.
What are the risk factors for developing HTN?
Describe the symptoms associated with HTN.
Essential hypertension is the most common type and is not caused by an existing health problem.
ESSENTIAL (PRIMARY)
• Family history of hypertension • African-American ethnicity • Hyperlipidemia • Smoking • Older than 60 years or postmenopausal • Excessive sodium and caffeine intake • Overweight/obesity • Physical inactivity • Excessive alcohol intake
• Low potassium, calcium, or magnesium intake • Excessive and continuous stress
Secondary HTN
Drugs
Pregnancy
Estrogen
Diseases
6) What are the signs and symptoms of fluid overload?
Bounding pulses, tachycardia, high blood pressure, JVD, increased weight, increased respirations, shortness of breath, crackles in the lungs, cool skin, pale, confused, headache, visual disturbances, increased liver size, edema
The patient with fluid overload and edema is at risk for skin breakdown.
Use a pressure-reducing or pressure-relieving overlay on the mattress.
Assess skin pressure areas daily for signs of redness or open area, especially the coccyx, elbows, hips, and heels.
Because many patients with fluid overload may be receiving oxygen by mask or nasal cannula, check the skin integrity around the mask, nares, and ears and under the elastic band.
Help the patient change positions every 2 hours or ensure that unlicensed assistive personnel (UAP) perform this action.
Fluid retention may not be visible. Rapid weight gain is the best indicator of fluid retention and overload
Sodium and fluid restriction
Name and describe the four types of cardiomyopathy discussed in lecture.
How are they treated?
is a disease of the heart muscle that makes it harder for your heart to pump blood to the rest of your body.
Cardiomyopathy can lead to heart failure.
s/s SOB, swollen feet/BLE, and bloated belly
- Dilated cardiomyopathy (DCM)
- Hypertrophic cardiomyopathy (HCM)- common knowledge athletes
- Restrictive cardiomyopathy (RCM)
- Left Ventricular Non-compaction (LVNC)
- Arrhythmogenic Right Ventricular Dysplasia (ARVD)
Treatments for cardiomyopathy include:
lifestyle changes, medicines, surgery, implanted devices to correct arrhythmias, and a nonsurgical procedure.
These treatments can control symptoms, reduce complications, and stop the disease from getting worse.
Treatment consists of ace inhibitors and diuretics
Drugs, implanted devices, surgery, and in severe cases, transplant, are treatments.
Medications
Blood thinners, Beta blocker, ACE inhibitor, Diuretic, Antihypertensive drug, Statin, and Antiarrhythmic
Medical procedure
Cardiac catheterization and Revascularization
Surgery
Coronary artery bypass surgery and Heart transplant
Devices
Pacemaker and Implantable cardioverter-defibrillator
backup” of fluid into pulmonary circulation
Left HF
backup” of fluid in venous circulation
Right HF
Which sided HF s/s?
unexplained fatigue or altered mental status, decreased exercise tolerance
Both sides
Stuff to know for HF:
Raise head of bed to decrease pulmonary congestion and improve gas exchange
Encourage physical rest
Daily rest
sodium restriction to decrease fluid overload; increase intake of potassium-rich foods if taking potassium-losing diuretics; restriction of high-potassium foods and salt substitutes if taking potassium-sparing diuretics; do not restrict water intake unless directed
radial pulse for 1 full minute before taking digoxin; withhold dose and call prescriber if pulse is lower than 50 or 60 as instructed (
Yes
Best Practice for Patient Safety & Quality Care Prevention of Pulmonary Embolism
range-of-motion exercises
- Ambulate patients soon after surgery.
- Use anti-embolism and pneumatic compression stockings and devices after surgery.
- Ambulate patients soon after surgery.
- Use anti-embolism and pneumatic compression stockings and devices after surgery.
anticoagulant therapy.
• Avoid the use of tight garters, girdles, and constricting clothing.
• Prevent pressure under the popliteal space (e.g., do not place a pillow under the knee; instead, use alternating pressure mattress).
•
Perform a comprehensive assessment of peripheral circulation.
• Elevate the affected limb 20 degrees or more above the level of the heart to improve venous return, as appropriate.
• Change patient position every 2 hours or ambulate as tolerated.
•
Prevent injury to the vessel lumen by preventing local pressure, trauma, infection, or sepsis.
• Refrain from massaging leg muscles.
• Instruct patient not to cross legs.
•
Administer prescribed prophylactic low-dose anticoagulant and antiplatelet drugs.
• Teach the patient to avoid activities that result in the Valsalva maneuver (e.g., breath-holding, bearing down for bowel movements, coughing).
• Administer prescribed drugs, such as stool softeners, that will prevent episodes of the Valsalva maneuver.
•
Teach the patient and family about precautions.
• Encourage smoking cessation.
Best Practice for Patient Safety & Quality Care Oxygen Therapy cracks
- Check the health care provider’s prescription with the type of delivery system and liter flow or percentage of oxygen actually in use.
- Obtain a prescription for humidification if oxygen is being delivered at 4 L/min or more.
- Be sure that the oxygen and humidification equipment are functioning properly.
- Check the skin around the patient’s ears, back of the neck, and face every 4 to 8 hours for pressure points, signs of irritation, and loss of TISSUE INTEGRITY.
• Ensure that mouth care is provided every 8 hours and as needed; assess nasal and oral mucous membranes for cracks or other signs of dryness or impaired tissue integrity.
•
Pad the elastic band and change its position frequently to prevent skin breakdown.
Pad tubing in areas that put pressure on the skin.
- Cleanse the cannula or mask by rinsing with clear, warm water every 4 to 8 hours or as needed.
- Cleanse skin under the tubing, straps, and mask every 4 to 8 hours or as needed.
- Lubricate the patient’s nostrils, face, and lips with nonpetroleum cream to relieve the drying effects of oxygen.
- Position the tubing so it does not pull on the patient’s face, nose, or artificial airway.
- Ensure that there is no smoking and that no candles or matches are lit in the immediate area
- Assess and document the patient’s response to oxygen therapy.
- Ensure that the patient has an adequate oxygen source during any periods of transport.
- Provide the patient with ongoing teaching and reassurance to enhance his or her adherence to oxygen therapy.
Trach
Nursing Safety Priority Action Alert
Always deflate the cuff before capping the tube with the decannulation cap; otherwise the patient has no airway.
Keep the temperature of the air entering a tracheostomy between 98.6° and 100.4° F (37° and 38° C) and never exceed 104° F (40° C).
Use half-strength hydrogen peroxide to clean the cannula and sterile saline to rinse it. If the inner cannula is disposable, remove the cannula and replace it with a new one.
. Apply continuous suction only during catheter withdrawal because intermittent suction does not protect the mucosa and can lead to “dropping” of secretions in the airway.
- Encourage the patient to “dry swallow” after each bite to clear residue from the throat.
- Avoid consecutive swallows of liquids.
- Provide controlled small volumes of liquids, using a spoon.
- Encourage the patient to “tuck” his or her chin down and move the forehead forward while swallowing.
How to use inhaler
Press down firmly on the canister of the inhaler to release one dose of medication into the spacer.
- Breathe in slowly and deeply. If the spacer makes a whistling sound, you are breathing in too rapidly.
- Remove the mouthpiece from your mouth; and, keeping your lips closed, hold your breath for at least 10 seconds and then breathe out slowly.
- Wait at least 1 minute between puffs.
Short-Acting Beta2 Agonist (SABA)—Primary use is a fast-acting reliever (rescue) drug to be used either during an asthma attack or just before engaging in activity that usually triggers an attack. Albuterol (ProAir, Proventil, Ventolin) (inhaled drug)
Teach patients to carry drug with them at all times because it can stop or reduce life-threatening bronchoconstriction. Levalbuterol (Xopenex)
Teach patient to monitor heart rate because excessive use causes tachycardia and other systemic symptoms.
When taking any of these drugs with other inhaled drugs, teach patient to use it at least 5 minutes before the other inhaled drugs to allow the bronchodilation effect to increase the penetration of the other inhaled drugs.
Teach patient the correct technique for using the MDI or DPI to ensure that the drug reaches the site of action.
Yes
Long-Acting Beta2 Agonist (LABA)—Causes bronchodilation through relaxing bronchiolar smooth muscle by binding to and activating pulmonary beta2 receptors. Onset of action is slow with a long duration. Primary use is prevention of an asthma attack. Salmeterol (Serevent) (inhaled drug) Indacaterol (Arcapta Neohaler) (COPD only) (inhaled drug) Teach patient to not use these drugs as reliever drugs because they have a slow onset of action and do not relieve acute symptoms. Teach patient the correct technique for using the MDI or DPI to ensure that the drug reaches the site of action. Formoterol (Perforomist) Arformoterol (Brovana) (COPD only)
Yes
Cholinergic Antagonist—Causes bronchodilation by inhibiting the parasympathetic nervous system, allowing the sympathetic system to dominate, releasing norepinephrine that activates beta2 receptors. Purpose is to both relieve and prevent asthma and improve GAS EXCHANGE. Ipratropium (Atrovent, Apo-Ipravent ) (inhaled drug) If patient is to use any of these as a reliever drug, teach him or her to carry it at all times because it can stop or reduce life-threatening bronchoconstriction. Tiotropium (Spiriva) Teach patient to shake MDI well before using because the drugs separate easily. Teach patient to increase daily fluid intake because the drugs cause mouth dryness. Teach patient to observe for and report blurred vision, eye pain, headache, nausea, palpitations, tremors, inability to sleep as these are systemic symptoms of overdose and require intervention. Teach patient the correct technique for using the MDI or DPI to ensure that the drug reaches the site of action.
Yes
Anti-Inflammatories—All of these drugs help improve bronchiolar airflow and increase GAS EXCHANGE by decreasing the inflammatory response of the mucous membranes in the airways. They do not cause bronchodilation.
Corticosteroids—Disrupt production pathways of inflammatory mediators. The main purpose is to prevent an asthma attack caused by inflammation or allergies (controller drug). Fluticasone (Ellipta) (MDI inhaled drug) Beclomethasone (Qvar) (MDI inhaled drug) Budesonide (Pulmicort) (MDI inhaled drug) Teach patient to use the drug daily, even when no symptoms are present, because maximum effectiveness requires continued use for 48-72 hr and depends on regular use. Teach patient to use good mouth care and to check mouth daily for lesions or drainage because these drugs reduce local immunity and increase the risk for local infections, especially Candida albicans (yeast). Teach patient to not use these drugs as reliever drugs because they have a slow onset of action and do not relieve acute symptoms. Teach patient the correct technique for using the MDI to ensure that the drug reaches the site of action. Prednisone (oral drug) Teach patient about expected side effects because knowing which side effects to expect may reduce anxiety when they appear.
Teach patient to avoid anyone who has an upper respiratory infection because the drug reduces all protective inflammatory responses, increasing the risk for infection. Teach patient to avoid activities that lead to injury because blood vessels become more fragile, leading to bruising and petechiae. Teach patient to take drug with food to help reduce the side effect of GI ulceration. Teach patient not to suddenly stop taking the drug for any reason because the drug suppresses adrenal production of corticosteroids, which are essential for life.
Yes
Cor pulmonale: Rt sided heart failure caused by pulmonary disease:
Hypoxia and hypoxemia • Increasing dyspnea • Fatigue • Enlarged and tender liver • Warm, cyanotic hands and feet, with bounding pulses • Cyanotic lips • Distended neck veins • Right ventricular enlargement (hypertrophy) • Visible pulsations below the sternum • GI disturbances such as nausea or anorexia • Dependent edema • Metabolic and respiratory acidosis • Pulmonary hypertension
Severity Classification for Primary Pulmonary Arterial Hypertension
CLASS SYMPTOMS I Pulmonary hypertension diagnosed by pulmonary function tests and right-sided cardiac catheterization No limitation of physical activity Moderate physical activity does not induce dyspnea, fatigue, chest pain, or light-headedness II No symptoms at rest Mild-to-moderate physical activity induces dyspnea, fatigue, chest pain, or light-headedness III No or slight symptoms at rest Mild (less than ordinary) activity induces dyspnea, fatigue, chest pain, or light-headedness IV Dyspnea and fatigue present at rest Unable to carry out any level of physical activity without symptoms Symptoms of right-sided heart failure apparent (dependent edema, engorged neck veins, enlarged liver)
TABLE 30-5
Warning Signals Associated With Lung Cancer
• Hoarseness • Change in respiratory pattern • Persistent cough or change in cough • Blood-streaked sputum • Rust-colored or purulent sputum • Frank hemoptysis • Chest pain or chest tightness • Shoulder, arm, or chest wall pain • Recurring episodes of pleural effusion, pneumonia, or bronchitis • Dyspnea • Fever associated with one or two other signs • Wheezing • Weight loss • Clubbing of the fingers
Warning Signs of Head and Neck Cancer
Pain • Lump in the mouth, throat, or neck • Difficulty swallowing • Color changes in the mouth or tongue to red, white, gray, dark brown, or black • Oral lesion or sore that does not heal in 2 weeks • Persistent or unexplained oral bleeding • Numbness of the mouth, lips, or face • Change in the fit of dentures • Burning sensation when drinking citrus juices or hot liquids • Persistent, unilateral ear pain • Hoarseness or change in voice quality • Persistent or recurrent sore throat • Shortness of breath • Anorexia and weight loss
TB
To prevent active tuberculosis after exposure, the client is initiated on a single agent regimen, usually isoniazid. For newly diagnosed active disease, a combination of antitubercular agents is used for at least the first several weeks: isoniazid, rifampin, and pyrazinamide. Combination therapy lessens the risk of drug resistance when treating a client with active disease, but this client has experienced exposure and does not have active disease. Except for streptomycin, which is for intramuscular use, antitubercular agents are administered orally.
Yes
.ADVENTITIOUS SOUND CHARACTER
Fine crackles Fine rales High-pitched rales
Character:
Popping, discontinuous sounds caused by air moving into previously deflated airways; sounds like hair being rolled between fingers near the ear “Velcro” sounds late in inspiration usually associated with restrictive disorders
Association:
Asbestosis Atelectasis Interstitial fibrosis Bronchitis Pneumonia Chronic pulmonary diseases
2.Sound:
Coarse crackles Low-pitched crackles
Character:
Lower-pitched, coarse, rattling sounds caused by fluid or secretions in large airways; likely to change with coughing or suctioning
Associated with?
Bronchitis Pneumonia Tumors Pulmonary edema
. Sound:
Wheeze
Character:
Squeaky, musical, continuous sounds associated with air rushing through narrowed airways; may be heard without a stethoscope Arise from the small airways Usually do not clear with coughing
Associated with:
Inflammation Bronchospasm (bronchial asthma) Edema Secretions Pulmonary vessel engorgement (as in cardiac “asthma”)
Rhonchus (rhonchi) Lower-pitched, coarse, continuous snoring sounds Arise from the large airways Thick, tenacious secretions Sputum production Obstruction by foreign body Tumors
- Sound:
Rhonchus (rhonchi)
Character:
Lower-pitched, coarse, continuous snoring sounds Arise from the large airways
Associated with:
Thick, tenacious secretions Sputum production Obstruction by foreign body Tumors
- Sound:
Pleural friction rub
Character:
Loud, rough, grating, scratching sounds caused by the inflamed surfaces of the pleura rubbing together; often associated with pain on deep inspirations Heard in lateral lung fields
Associated with:
Pleurisy Tuberculosis Pulmonary infarction Pneumonia Lung cancer
~~~Know complications of post thoracentesis. (Removing fluid/air from pleural space)
• Pneumothorax
o pain on side affected and worse at the end of inhalation and the end of exhalation, tachycardia, rapid shallow respiration, feeling of air hunger, the affect side does not move in and out with respiratory effort, new onset of nagging cough, and cyanosis
What are complications from tracheostomy tubes? Too much cuff pressure vs not enough cuff pressure?
•
Complications
o bleeding, infection, pneumothorax, subcutaneous emphysema. Cuff pressure can cause mucosal ischemia and hypoxia.
• Too much cuff pressure
o Occlude different neck tissues (tissue dies)
• Not enough cuff pressure
o Food and other stuff can go into lungs and can cause aspiration
~~~What are the risk factors for sleep apnea? Who is at risk?
•
Sleep apnea can cause heart disease, DM, and other long term health problems.
• Who are at risk
o obesity, neck circumference, smoking, narrow airway, male, older adult, family history, alcohol or sedative use or nasal congestion.
~~What are nursing interventions for patients with cystic fibrosis?
•
Nursing interventions focus on
o teaching about drug therapy, infection prevention, pulmonary hygiene, nutrition, and vitamin supplementation.
What are nursing interventions for post chest tube placement?
Make sure chest x-ray for placement.
• Ensure that the dressing on the chest around the tube is tight and intact. Assess for difficulty breathing and check by pulse ox.
• Listen to breath sounds in each lung.
• Check skin condition around the insertion site.
• Assess for pain.
• Assist pt to deep breath, cough, and use incentive spirometer.
• Reposition pt who report burning pain in chest.
• Keep drainage tube system lower than the level of the pt’s chest.
• Keep chest tube straight, no kinks.
• Assess for bubbling in the water -seal chamber, should be gentle bubbling.
• Assess the tidaling.
• Clamp the chest tube only when draining.
• Check and document amount, color and characteristics of fluids in the collection chamber.
Know what a cholinergic antagonist is and what it does?
•
It causes bronchodilation
o by inhibiting the parasympathetic nervous system, allowing the sympathetic system to dominate, releasing nor epinephrine that activates beta2 receptors.
• Purpose is to relieve and prevent asthma and improve gas exchange.
What is INH? How is it taken?
•
INH (isoniazid) kills actively growing mycobacterium outside the cell and inhibits the growth of dormant bacteria inside macrophages and caseating granulomas.
• Instruct the pt to avoid antacids and take medication on an empty stomach.
• Teach pt to take a daily multivitamin that contains Vitamin B complex.
• Remind pt not to drink alcohol while taking medication due to possible liver damage.
• Tell pt to report any yellowing of the skin, darkening of the urine and increased tendency to bruise or bleed easy.
Hard on liver enzymes
What do you do when a patient has a positive TB test?
•
Have a chest x-ray ordered to determine if the TB is new or old.
• Place the pt in a negative pressure room and place pt on contact and airborne precautions.
• Teach the pt to cover the mouth and nose when coughing and sneezing, to place used tissues in a plastic bags.
• Tell the pt that sputum specimens are needed usually every 2-4 weeks once during therapy begins.
• When 3 consecutive sputum cultures are negative, the pt is no longer infected.
~~~Know risk factors for oral cancer?
smoking and bad oral hygiene
~~~Know nursing interventions for subcutaneous emphysema?
•
Assess for effective gas exchange and monitor vitals. AIRWAY
• Assess the skin around a new tracheotomy to recognize subcutaneous emphysema.
• If it is puffy and you can feel a cracking sensation when pressing on this skin, notify physician immediately.
Know the nursing interventions for orthostatic hypotension?
•
Sit on the side of the bed until not dizzy
• Change positions slowly
• Side rails, bed rails
Know the normal ranges for albumin, hemoglobin, hematocrit, INR.
Albumin 3.5-5.0 • HGB o male: 14-18 o females: 12-16 o pregnant female >11 • HCT o male: 42-52 o female: 37-47 o pregnant female: >33 • INR 0.8-1.1
Know oxygen flow rate for a venturi mask
•
24%-50% FiO2
• usually 4-10 L/min; (usually 10)
• high flow
• provides high humidity
~~~What are nursing interventions for facial trauma?
•
PRIORITY- establish and maintain an airway for adequate GAS EXCHANGE. So intubation right away
• Stabilizing the fractured jaw allows the teeth to heal in proper alignment and involves fixed occlusion
• Teach pt about oral care with Water-Pik or Sonicare
• Dental Liquid Diet
• Collab with dietitian
• Instruct the patient to keep wire cutters with him or her at all times to prevent aspiration if vomiting occurs.
• controlling hemorrhage, and assessing for the extent of injury.
o If shock is present, fluid resuscitation and identification of bleeding sites are started immediately.
What are nursing interventions when the chest tube is dislodged?
•
FIRST cover the area with dry, sterile gauze.
• THEN immediately notify Physician or Rapid Response Team.
~~~Know which patients are at risk for the pandemic flu
•
People who have recently traveled to areas of the world affected by H5N1.
• Immunosuppressed
• Low-income rural areas
• Non vaccinated people
What are nursing interventions for patients with TB? What is done for these patients?
•
Promote airway clearance
• decrease drug resistance and infection spread
• strict adherence to combo drug therapy (isoniazid, rifampin, pyrazinamide, ethambutol)
• manage anxiety
• improve nutrition
• manage fatigue
What are nursing interventions for patients after having an EGD?
What do you teach the patient?
• checks vital signs frequently (usually every 15 to 30 minutes) until the sedation begins to wear off.
• Side rails
• NPO until the gag reflex returns (usually in 30 to 60 minutes).
• ASSESS GAG REFLEX
• IV fluids that were started before the procedure are discontinued when the patient is able to tolerate oral fluids without nausea or vomiting.
• The priority for care to promote patient safety after esophagogastroduodenoscopy is to prevent aspiration.
• Monitor for signs of perforation, such as pain, bleeding, or fever.
• be sure that the patient has someone to drive him or her home.
• Remind the patient to not drive for at least 12 to 18 hours after the procedure because of sedation.
• Teach him or her that a hoarse voice or sore throat may persist for several days after the test.
• Throat lozenges can be used to relieve throat discomfort.
What are some causes of oral candidiasis?
Viral infections like HIV
• Stomatitis
• Age (older people more at risk)
• Fungal infections of the skin
• Prednisone, inhaled corticosteroids, or antibiotics
• immunosuppression due to chemo or radiation,
Know signs and symptoms of fluid overload
•
Hypervolemia: Fluid excess o Signs and Symptoms: Tachycardia, bounding pulse, hypertension, tachypnea, increased central venous pressure, weakness, headache, ascites, crackles, and peripheral edema, kidney failure, heart failure, increased pulse rate, distended neck veins, skeletal muscle weakness o ASSESS Edema, Vitals, Neuro, Respiratory
Know what can cause epistaxis (nosebleeds)
•
Hypertension • leukemia • inflammation • tumor • decreased humidity • nose blowing, nose picking, • chronic cocaine use • nasogastric suctioning.
CF-average lifespan?
40 years old
Pain with walking
- test to see how blood is flowing due to this?
Claudication
ABI
Injections with vasoconstrictors?
Aspirate
Higher the INR number means what?
Thinner blood or slow clot time
Blocks calcium from entering cells of the heart and arteries
Dilates arteries
Decreases angina and BP
Calcium channel blockers / pines
Prevents angiotensin 2 = dilation and lower BP
Prils / ace inhibitors
Vasodilators
Diuretics - venous dilation Ace inhibitors Calcium channel blockers Nitroglycerin Hydrazaline Viagra Alpha blocker Isorbide Alcohol PNS
Vasoconstrictiors
Caffeine Diuretics- arterial constriction Epinephrine Salt Norepinephrine Dopamine Cold meds Methamphetamine Tyramine SANs sympathetic autonomic nervous system
Influenza- contagious how long b4? And after?
24 hours before
5 days after start
Influenza that is more rapid and sever e
Who is most at risk
Influenza A
B is GI
Elderly over 50, young kids and immunosuppressed ppl
Cough into what
Elbow or arm
How they make vaccines
Looking at last years strand
IM and intranasal
1 preventative to flu
Hand washing
When does the flu vaccine go into full effect
After two weeks after given
One of the main causes of sepsis
Pneumonia
Squires outside of a building
Community acquired
Ventilator can cause infection why
Antacids May also cause bacteria/inflammation
Can’t cough to get rid of secretions and bacteria and can aspirate
One of the most common bacterial infections worldwide
TB
Take drugs for 28 weeks
Need 3 negatives to be free of it - one every 2-4 weeks
Rhinosinutis
Complications of it
Sinus drainage
Cellulitis, abscess, meningitis
Pertusis
Precautions
Who it affects
Who to vaccinate
S/s
Whooping cough
Droplet precautions
Elderly and children
Adults who have newborns
Face turn red and throw up from coughing
Reasons for oxygen
Hypoxemia, fever, pulmonary Adema, sepsis, CHF
Room air is 21%
Chf normal O2
88 to 92%
Do you need an order for humidification?
No order for over 4 L a minute
How to diagnose sleep apnea
Sleep study
How. To prevent obstruction with trachs
What will suction do
Cough, deep breath, humidity, cleanWith half hydrogen peroxide and half sterile solution
Ensure ties are in place at all times to prevent dislodgment- notify doc if our
Suction 10-15 secs
- coughing, red face and tachycardia is common with suction
- release will decrease bp and pulse
80-120 mercury
Gold standard in diagnosing COPD
Tx
PFT
Plan activities , hydrate , pursed lip breathing , rest periods, neb s
Status asthmaticus LS?
Stridor
Airway obstruction
Chronic bronchitis affects what
Copd affects what- common in who
Airway
Lungs - retained co2 - more common in older men
Copd - best position for them
Tripod - opens airways - lean forward
Genetic Infertility in males Mucus every where Abcess in lungs Resp failure if main cause of death Need lung transplant Smelly stools Resp acidosis May develop type 1 diabetes due to decrease pancreases function Loose fat soluble vitamin - ADEK In stool
CF
Diagnose CF-
Tx
Sweat chloride test on skin
Decreased sodium due to excretion
Treat- manage wt , Manage respiratory with bronchodilators, increase water intake, immunizations, mucus meds, Lung transplant, no cure
Pah is what sided HF
May result in what
RT side
Heart and lung failure
Chest tubes - dressings
What it means in the bubbling stops?
What it means if excessive bubbling?
Bubbles when air leaves?
Always have airtight dressings
Kink or obstruction
Air leak
Normal
Oxygen safety
No vaseline
No wool
No smoke
If chest tube disconnects do what?
Put in sterile water and wrap in sterile and dressing tell doctor
X-ray to confirm placement
Vasoconstriction increases what
Afterload
May have what if no diuretics with Hf
Cpap
When does pulmonary edema occur in hf
Give what?
When Lt ventricle fails
Vasodilators - morphine
No eliquis
Antibiotics b4 surgery
Pericarditis
Tx
Can when laying down Worse when sitting up Pleural friction rub Pain with coughing Increase wbc
Antibiotics
Tx for cardiac tamponade or MI May occur
Pericardectomy - drain fluid
Rheumatic carditis
Strep
Can lead to heart failure
Arythomycin
atherosclerosis vs arteriosclerosis
Arteriosclerosis is the stiffening or hardening of the artery walls.
Atherosclerosis is the narrowing of the artery because of plaque build-up. Due to aging
Meds - causes Muscle pain , hard on liver
Med causes flushing
Statins
Niacin
Pad can lead to what
Dx
Osteomyelitis- infection of bone and amputation
Abi diagnosis
Blood no longer flows in area- emergent
Aortic dissection
If on Blood thinner but have clot - what to do?
Bed rest
Ivc filter to catch clot if travels to lungs
Artery weekends and larges to two times its normal size
Can be due to atherosclerosis
AAA s/s?
Sudden excruciating pain means what?
Aneurysm
Flank back pain, and pain, gnawing pain
Rupture
Cut open for compartment syndrome
Fasiotomy
Unable to speak - airway is separated from throat and mouth
Radial neck, Drop neck is normal and weakness
Can’t aspirate
- sudden stop of drainage could mean what??
Laryngectomy
Occlusion or clot in drain
When to d/c gastric tube
Teachings after d/c
Once swallowing
Eat slow, tuck chin, speech therapy
What to do during Epistaxis
Nose bleed Lean forward (prevent aspiration)
Ice pack
Hold for 10 min
Loose packing gauze
Cauterize if severe
Don’t blow nose
No nsaids , no strenuous activity
Educate blood thinner pts
These patient may have larger heart due to working harder
Sleep apnea
Teach sleep apnea pt to sleep how
Sleep on side
Exercise
Loose wt
No alcohol 3 hrs before bed
No large meals
No OTC meds
No smoke
No sleeping pills
Use cpap
Lungs has how many lobes
Pleural effusion helps decrease what
3
Friction
O2 comes from where of heart
Rt ventricle of heart to pull art artery to capillaries and alveoli = gas exchange
If hypoxic then hgb will do what
Increase
Crepitus - grating LS present in what
Emphysema
Wheezing
Asthma , copd
Pleural rub - Painful on inspiration
Inflammatory a long disorders or lung cancer
Fine crackles
Pneumonia
Course crackles
Fluid
Which LS side is most important
Posterior
Thiracentesis - do what
Needle aspiration of pleural fluid (drain)
RBC are decreased in who d/t period and hormones
Women
If INR is increasing and not on blood thinner
Lover disease may be present
Number one reason why sickle cell develops
Hypoxia
Pain is priority
Spleen destroys RBCs
Know what they have done in the past 48 hours
Narcotics and hydroxuria
KCD- most common cause of anemia
Elevate Hob 30 degrees
Common anemia in alcoholics
Elderly and women
Iron deficiency anemia
Cancer of blood cells
Number one cause of death
Leukemia
Stem cell transplant
Infection - # one priority - neutropenia
Neutropenic precautions
Bottled water, no plans, no fresh raw foods, private room, limit visitors, we are mask, hand wash, gloves, Avoid crowds, vaccines, Bleeding precautions, fall prevention, decrease needle sticks, ADL devices, soft toothbrush, electric razors
Lymphomas most common in who
Most treatable type?
Teens and young adults
Hodgkins
Swiss cheese appearance, Hallmark signs and symptoms are destroying and breaking down bones, pain control, decreased calcium, Give calcitonin
Multiple myeloma - plasma cell cancer
Filter on blood to filter out any clots or particles
Always tested for abnormalties
Verify order with who
Transfusions
Another nurse
Never run meds with what
Blood transfusions
If reaction to transfusion
Stop and take vitals
Notify doc
Do not take out new tubing
Transfusion should take no longer than how long
4 hours
Gauge with blood transfusions
18-20
Foot care with PVD
Wash feet with mild soap in room temp water
Keep feet dry - especially between toes and ankles
Never go with out shoes
Avoid injuries
Wear comfortable well fit shoes
Keep nails clean and filed - cut straight across
Apply lotion to feet
No extreme hot or cold
No heating pads on feet
Avoid constructing garments
Avoid pressure on feet or ankles
See podiatrist if unable to self care
Lung collapse
Pneumothorax
Vcf (vena cava filter) used for what
PE
chest tube if removed accidentally
Apply sterile gauze and tape only on 3 sides
Blood transfusion steps
Verify order
Obtain consent
Educate and explain procedure
Establish IV site
Obtain blood from lab
Verify with another RN
Inspect blood for discoloration, bubbles, cloudiness
Educate client on signs and symptoms of adverse reactions
Take pre-transfusion vitals
Prime with .9% saline
Prime to being with blood product
Initiate transfusion at 50 mL an hour
Document the start of transfusion
Stay with patient for the first 15 minutes in case of reaction
If no reaction occurs increase IV rate
Continue to monitor patient and vitals
Obtain post transfusion vitals
Disposable blood product per facility
Document the end of a transfusion
Verify what with another rn with blood transfusions
Patient ID, blood type, expiration time
If RH negative person receives rh positive blood it will cause hemolysis
Yes
Pacemaker teaching
Asses for hiccups
Carry ID card and take pulse daily, avoid contact sports and heavy lifting for 2 months
Sling, minimize shoulder movement
No MRIs
Will set off airport security detectors
Ok to use microwave and garage openers
Muffled Heart sounds
Low Bp
Paradoxical pulse (variance of 10 or more)
DJV
Tx?
Cardiac tamponade
Pericardiocentesis
Copd diet?
Position how when laying down
Meds
Increase calories and protein
Back with knees bent
Bronchodilators , mucus meds , anti-inflammation
Chest tubes - report drainage less than how much?
70ml/hr
Widening or ballooning of wall of a vessel
Flank back pain and abd mass
Ripping or stabbing in abd and back - ss of shock
Severe back pain, sob, hard to swallow, cough
What to report
Aneurysm
AAA
Aortic dissection
TAA
Urine output less than 30mL/hr
Chest tube removal
Pt take deep breath , exhale and hold it during removal
High Fowler’s
Hemostats, sterile water and dressing at bedside
Only clamp when ordered ; no stripping tubing
Chest X-ray to confirm
Apply sterile petroleum jelly gauze dressing over chest tube site
Bronchoscopy post procedure
A sure gag reflex before eating or drinking
Sore throat , small blood tinged sputum ad dry throat is normal
Nursing care for thoracentesis (surgical perforation of chest) to remove fluid and air
Pt sit upright With arms on pillows or over bed table and feet supported
Lying on the unaffected side with head of the. We elevated 30-45 degrees (if unable to sit upright )
Be still
Don’t remove more than 1L to prevent cardiovascular collapse
Monitor resp status
aPTT:
On heparin
30-40 Seconds
2x the amt (60-80) ish
Copd - hct?
Increased due to low o2
Loss of lung elasticity
Emphysema
Inflammation of bronchi
Bronchitis
If reaction of blood transfusion
Stop it and infuse .9% na cl through separate Line
Send second blood bag to lab
Low back pain, fever, chills, tachycardia, hypertension, tachypnea is what kind of blood transfusion reaction
Acute
Mild allergic blood transfusion s/s
Give what
Itching
Flushing
Hives (uticaria)
Give diphenhydramine
Anaphylactic blood transfusion reaction
Wheezing
Cyanosis
dyspnea
Hypotension
What to do if circulatory overload with transfusion
Slow the infusion rate
Administer diuretics
Early s/s of hypoxemia vs late
Early:Restless, irritable, tachypnea, tachycardia, pale skin, hypertension, nasal flaring, accessory muscles, adventitious LS
Late: confusion, cyanosis , low pulse low respirations, low bp,dysrhythmias
Oxygen toxicity s/s
Cough Substernal pain Nasal congestion N/v , fatigue Headache Sore throat
Pad teachings
Rest when pain with walking occurs
No crossing legs
No restrictive garments
Warm environment
Wear insulated socks
Avoid cold, stress, caffeine, nicotine (constricts)
Statins, plavix and aspirin
May lead to compartment syndrome (numb, pain with movement,edema)
Venous thromboembolism nursing care
Risks?
Elevate extremity
Warm moist compresses
Watch for PE s/s
No massaging
Nothing under knees
Compression stockings
Risks: Heart failure Surgery Immobility Pregnancy Oral contraceptives
Varicose veins risk factors
S/s
Female
Standing
Pregnancy obesity
Family hx
S/s: pruritus
Aching
Distended veins
Removal or insertion of central line can cause what
Air embolus
Emphysema - barrel chest is due to what
Hyper inflation on the lungs
Position to decrease dyspnea in copd
Standing or sitting upright
Client should place an inhaler how far from mouth
Two fingers from mouth
Creatinine normal level
Indicates?
Albumin
.6 to 1.35
Renal issue with antibiotics
3.4-5
Cells are replaced with fat
A plastic anemia
Need bone marrow transplant
Immunosuppression
Remove causing factor
HHOP for sickle cell Tx
Heat
Hydration
Oxygen
Pain relief
Iron is given how ?
IM - z track
Orally through straw
Test for b12 deficiency
Schillings
Blood thicker than normal
Can result in MI, CVA and bleeding
Polycythemia
Leukemia risk factors
Immunosuppressants
Radiation
anticoagulant
Downs
TPN is administered though what
Central line
If air in central line ?
Clamp catheter
Place pt in trendelenburg
Call doc
Give oxygen
Lyphodema May be notices when
While shaving
NifediPine , verapamil, diltiaZem hydrochloride
Calcium Chanel blocker
How does postassiun affect digoxin
Low potassium may cause toxicity
Do it apply pressure Over pacemaker
Yes
What to check before giving lovenox
Platelets
Jews and Hindi May refuse mechanical valves
Yes
Vascular spams Brought on by cold and smoking
Raynaud s syndrome
Pericarditis or endocarditis before dental surgery?
Give antibiotics
One with AAA (and aortic aneurysm) don’t do what?
Palpate abdomen
Unstaturated fat
Good (turkey)
Report what with crestor (rovastatin) for cholesterol
Muscle weakness
Ace inhibitors are often given with what
Diuretics (because ace causes high K+)
