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Med Surg Lecture > Section 1 > Flashcards

Section 1 Flashcards

1
Q

Physiology

A

The study of the functional activities of the body

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2
Q

Pathophysiology

A

The study of disordered function of the body

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3
Q

Compensatory Mechanisms are

A

The body’s attempt to restore homeostasis

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4
Q

When compensatory mechanisms are not adequate, function becomes disordered leading to

A

pathological mechanisms or disease.

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5
Q

How do we define Stress?

A

A real or perceived threat

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6
Q

How do we define Goals when it comes to stress?

A

Adaptation

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7
Q

The Stress coping process is

A

a compensatory process with physiological and psychological components

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8
Q

How do we define Stressors?

A

An internal or external event or situation that creates the potential for physiologic, emotional, cognitive, or behavioral changes in the individual

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9
Q

What are the 3 classifications of stress?

A
  1. Day-to-day
  2. Major, complex occurrences
  3. Life events
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10
Q

What is “hardiness”?

A

Perspective on stress that it can be meaningful, is a learning opportunity, giving it a positive spin with determination/grit

quality that can be taught - essential for coping with stress

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11
Q

What are the two branches of the Autonomic Nervous System (ANS)?

A
  1. Sympathetic Nervous System (SNS)

2. Parasympathetic Nervous System (PSNS)

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12
Q

It is the ___, with its neurotransmitter of norepinephrine that is activated in response to stress.

A

SNS

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13
Q

The body’s physiologic response to stress is a ___ response that affects the entire body.

A

rapid and short-lived

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14
Q

What is an example of a compensatory mechanism?

A

Increased respiratory rate after sprinting

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15
Q

Stress causes

A

imbalance to equilibrium

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16
Q

Which type of stress impacts health in the greatest way?

A

Day-to-day

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17
Q

Examples of “major, complex occurrences” classification of stress

A

Hurricanes, terrorism, floods

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18
Q

Helping patients to ____ is important in the stress coping process

A

identify stressors

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19
Q

Remember that the PNS is the ___ system

A

“rest and repose”

the SNS is activated by stress

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20
Q

Because of the ___ produced by the SNS, the body experiences ___ effects during stress

A

norepinephrine

adrenergic

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21
Q

Common adrenergic effects of stress

A
  • Shunting of blood TOWARDS the heart and brain and AWAY from the GI system and peripheral –> because of this, patient can look pale and feel cool
  • Bronchodilation –> respirations become rapid, but shallow

– Increased blood sugar and lipid levels

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22
Q

Alpha receptors affect the ___ and cause ___

A

arms and legs

Peripheral vasoconstriction

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23
Q

Beta 1 receptors affect the

A

cardiac system

positive inotropic and chronotropic (increase heart rate and force of contraction)

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24
Q

Beta 2 receptors affect the ___ and cause ____

A

lungs

cause bronchodilation

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25
Q

4 maladaptive ways of coping with stress

A
  1. Drugs and alcohol
  2. “Type A” personalities (impatient, competitive, hostile)
  3. Denial
  4. Avoidance
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26
Q

People tend to have a ____ of behavior during stress

A

characteristic pattern

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27
Q

___ is most essential for nurses helping patients deal with stress, as is enlisting support

A

Patient teaching

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28
Q

4 main Nursing Implications for stress

A
  1. Early identification of stress
  2. Promote a healthy lifestyle
  3. Use education
  4. Enlist support
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29
Q

Infants are about ___ % water

A

70-80%

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30
Q

Adults are about ___% water

A

60%

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31
Q

Geriatric/elderly are about ___% water

A

45-50%

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32
Q

What 2 patient populations are most at risk for fluid imbalance?

A

infants and elderly

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33
Q

___ hospital patients require IV fluids. The only time a patient doesn’t need IV fluids is if they’re ____

A

Most

eating and drinking normally

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34
Q

Intracellular fluid (ICF) is ___ of overall body fluid

A

2/3

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35
Q

What is the prime cation of ICF?

A

K+ (potassium)

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36
Q

What are the 2 components of extracellular fluid (ECF)?

A
  1. Intravascular (Plasma)

2. Interstitial

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37
Q

extracellular fluid (ECF) is ___ of overall body fluid

A

1/3

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38
Q

What is the prime cation of ECF?

A

Na+ (sodium)

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39
Q

For intake and output, remember that 1 oz =

A

30mL

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40
Q

The walls between the ECF and ICF are ___, meaning that water and electrolytes can flow back and forth

A

porous

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41
Q

On average, people usually take in about ___ mL of fluids per day, as well as ___ mL from food

A

1300mL

1100mL from food

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42
Q

Oxidation accounts for __ mL fluid input

A

200mL

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43
Q

Total average daily input and output should be

A

2600mL

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44
Q

On average, urine accounts for ___ mL fluid output, feces accounts for ___ mL fluid output, and insensible (lungs and skin) account for ___ mL?

A

1500 mL urine

200mL feces

300mL from lungs, 600 from skin

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45
Q 
If the I and Os reads breakfast as:
-4 oz of apple juice
-6 oz of coffee
-2 oz milk
-2 slices of toast
-1 pat of butter   
What is the total intake in oz?
A

12 oz (don’t count the toast and butter)

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46
Q

hydrostatic pressure is

A

The pressure exerted by a fluid at equilibrium at a given point within the fluid, due to the force of gravity

weight and volume of water

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47
Q

If we give too much fluid too fast, the increased volume can lead to increased ____ which will lead to ____

A

hydrostatic pressure

leaking fluid out of the intravascular area – this causes edema

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48
Q

Osmotic Pressure

A

of particles in each compartment that keeps water where it is suppose to be

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49
Q

Osmolality

A

of particles in a kg of fluid

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50
Q

Osmolality normal levels

A

285-295 mOsm/L

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51
Q

Osmolarity

A

of particles in a L of fluid

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52
Q

1L water =

A

1 kg (2.2 lbs)

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53
Q

Remember that water diffuses from a ___ concentration to a ___ concentration

A

high to low

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54
Q

What are the 3 main things that draw water and increase osmotic pressure?

A
  1. Glucose
  2. Albumin
  3. Sodium
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55
Q

Osmolality and osmolarity are often used interchangeably, but ___ is used more often in clinical settings

A

osmolality

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56
Q

As osmolality increases, patient may develop

A

fluid deficit

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57
Q

As osmolality decreases, patient may develop

A

fluid volume excess

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58
Q

When blood volume or BP is low, ____ detect change in pressure

A

baroreceptors

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59
Q

What 2 hormone-related processes occur when blood pressure is low?

A
  1. Renin-Angiotensin-Aldosterone System

2. Posterior pituitary releases ADH

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60
Q

What 2 things happen in the Renin-Angiotensin-Aldosterone System?

A
  1. Renin secretes angiotensin I, which activates angiotensin II and leads to increased BP
  2. Renin leads to the secretion of Aldosterone, which means the kidney retains H2O and Na – this increases blood volume and pressure
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61
Q

What happens when the posterior pituitary releases ADH?

A

the kidney retains H2O and BP and blood volume are increased

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62
Q

Remember that increased BP means increased

A

preload

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63
Q

When blood volume and blood pressure are high, ___ is secreted by the atria and ___ is secreted from the ventricles

A

ANP

BNP

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64
Q

BNP is most often used in measurement because

A

it’s a lab test that can find out if patient issues are cardiac or pulmonary in origin

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65
Q

If patient issues related to high BP and blood volume are cardiac-related, BNP would be

A

very high

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66
Q

ANP and BNP are ___ enough to totally overcome the compensatory mechanism of the baroreceptors and reactive systems

A

NOT

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67
Q

How do both ANP and BNP decrease blood pressure?

A

they decrease systemic vascular resistance which increases the loss of water and Na

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68
Q

Atrial Natriuretic Peptide (ANP) is secreted by the ___ when the blood volume or BP is ___

A

atria

high

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69
Q

Atrial Natriuretic Peptide (ANP) and B-type Natriuretic Peptide (BNP) both inhibit

A

Renin-Angiotensin and the SNS

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70
Q

BNP is a diagnostic tool for what types of conditions?

A

CHF, PE, and pulmonary HTN

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71
Q

B-type Natriuretic Peptide (BNP) is secreted by the ___ when ____

A

by the ventricles when heart muscle is stretched

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72
Q

Shock is ___ process

A

dynamic

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73
Q

when a patient goes into shock, it affects

A

every single body system

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74
Q

shock is a state of inadequate circulation, which means

A

inadequate blood flow to vital organs (brain and heart) which means inadequate delivery of oxygen at the cellular level

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75
Q

When a patient is in shock or cardiac arrest, one of the issues is ____ due to lack of oxygen

A

buildup of lactic acid

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76
Q

The decrease of oxygen to cells in shock forces them to start producing ATP ___, as opposed to it being a ___ process normally

A

anaerobically

aerobic is normal

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77
Q

Shock occurs at the ____ level and leads to ___

A

cellular

cell death

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78
Q

3 types of shock

A
  1. hypovolemic
  2. cardiogenic
  3. distributive (circulatory)
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79
Q

In hypovolemic shock, there is a loss of ___ but theoretically the ___ is still functioning properly

A

circulating volume

heart

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80
Q

In hypovolemic shock, the patient becomes ___ and ____

A

hypoperfused and hypoxic

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81
Q

hypovolemic shock can occur in trauma and surgery patients because of

A

loss of blood

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82
Q

hypovolemic shock can occur in burn patients because of

A

loss of plasma

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83
Q

hypovolemic shock can occur in FVD patients with severe dehydration because of

A

loss of water

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84
Q

in Cardiogenic shock, ___ failure occurs in the ___

A

pump

left ventricle (the working force of the heart)

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85
Q

in Cardiogenic shock, when the left ventricle is not able to pump the blood out through the aorta to the rest of the body in a sufficient manner, it causes a

A

drop in cardiac output

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86
Q

in cardiogenic shock, though there may be enough blood in circulation, ____

A

the heart is not able to move it forward so you’re not getting the perfusion of blood

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87
Q

Causes of cardiogenic shock

A

massive MI/heart attacks

arrhythmias (severe brady or tachy cardia)

anything that can knock out the beating of the left ventricle

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88
Q

Distributive (Circulatory) shock is ____ which leads to ____, because the cells are not perfused adequately

A

massive vasodilatation

pooling of blood in the extremities

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89
Q

In distributive shock, the increase in capillary permeability causes decreased

A

BP and CO

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90
Q

3 types of distributive shock

A

Neurogenic
Anaphylactic
Septic

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91
Q

In neurogenic distributive shock, blood gets trapped in ___, which causes ____

A

blood gets trapped in the periphery

decrease in cardiac output and spinal pressure

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92
Q

Causes of neurogenic distributive shock

A

spinal cord injuries

it’s one of the adverse effects of spinal anesthesia

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93
Q

Anaphylactic shock is characterized by a release of ___ that causes ___

A

release of histamine etc. that cause vasodilatation - dropping BP and CO

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94
Q

Examples of anaphylactic shock

A

penicillin allergy
bee sting
blood transfusion reaction

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95
Q

Septic shock is often the result of ____, such as in patients with ____

A

toxins released from bacteria

bad systemic infections, uncontrolled pneumonia

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96
Q

3 stages of shock

A
  1. compensatory
  2. progressive
  3. irreversible
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97
Q

Characteristics of shock due to hypoxia

A

Restlessness (change in LOC)

and a subtle increase in respiratory rate (higher than 20)

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98
Q

the compensatory stage of shock often

A

passes so quickly that we miss it

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99
Q

True or false: during compensatory shock, all of the patient’s compensatory mechanisms are still working.

A

True

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100
Q

You’ve been taking care of patient all morning and they’ve been talking to you, everything seems fine, maybe you leave the room for 10-15 minutes and when you come back, you find that he’s leaning over, covers are disjointed, he’s not answering questions with astuteness, appears anxious. What do you do first?

A

Assess the patient (RR, vital signs, 02 sat)

and call rapid response, or provider (some superior) to come look at the patient

check them for postural hypotension, monitor closely

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101
Q

In shock, by the time blood pressure begins to drop, we know that

A

damage has already been done at the cellular level

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102
Q

In the progressive stage of shock, compensatory mechanisms have ___ and patient would be treated in the ___

A

failed

ICU

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103
Q

chances of survival from shock depend on

A

the pre-shock level of health

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104
Q

In progressive stage of shock, fluid starts moving from the ____ to the ____, which causes ____ and ____

A

moves from the intravascular TO them interstitial

causes EDEMA and drop in cardiac output

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105
Q

disseminated intravascular coagulation (DIC) occurs in the progressive phase, and is

A

massive tiny clotting throughout the body - you see simultaneous clotting AND bleeding (fingers and hands may look blue but they’re also bleeding)

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106
Q

Irreversible stage of shock is when the patient

A

is not responding to treatment

severe organ damage, organ failure, can lead to death

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107
Q

Overarching Goals for Managing Patient with Shock (2)

A
  1. limit any further damage
  2. improve cardiac functioning

improve oxygenation but DECREASING patient’s oxygen demand

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108
Q

In what position should you put a patient in shock?

A

Modified Trendelenburg - feet at 20 degrees

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109
Q

Why do we put shock patients in Modified Trendelenburg?

A

in order to increase venous return from the legs and bring that blood back into circulation

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110
Q

Key parts of shock prevention are

A

early recognition (restlessness, increase in RR)

careful, constant observation, frequent vital signs

give oxygen - until people arrive to help, put nasal cannula at 2-3L

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111
Q

For shock patients, intake and output should be recorded

A

every hour

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112
Q

We give isotonic solutions like ringer’s lactate and normal saline (most often used) because

A

it’s more apt to stay intravascularly and we increase the pressure/volume

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113
Q

In terms of comfort for shock patients, we need to recognize that the patient may feel cool because they’re vasoconstricted. How should you help them?

A

if you start layering blankets on them, BP will fall even lower - just put LIGHT COVERS on them and put patient on complete bedrest

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114
Q

whether your patient is awake or unconscious, we don’t know when hearing stops, so

A

you should talk to them, explain what’s going on

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115
Q

For shock patients, all medications are given

A

IV

not PO because blood is shunted away from GI tract, not IM because there’s poor perfusion to periphery

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116
Q

Goals for medication with shock patients are to ____ AND ____

A

maintain cardiac output AND decrease cardiac workload

(even though these are two totally opposing pharmacological plans) - must be continually titrated

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117
Q

2 prime classifications of medications that are used with shock patients

A
  1. Adrenergics (Dopamine, dobutamine)

2. Vasodilators (Nitroglycerin - Tridal)

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118
Q

Adrenergics such as dopamine or dobutamine help to ____ in shock patients

A

increase the cardiac output, help with peripheral vasoconstriction which increases afterload

also a positive inotropic so you’ll have better cardiac contractility

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119
Q

Vasodilators such as Nitroglycerin (Tridal) help to ____ in shock patients

A

decrease preload, which helps the heart not work as hard

if you decrease the afterload because you have arterial vasodilatation, that also decreases the cardiac workload

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120
Q

If the IV infiltrates with a shock patient, what do you do?

A

get it out and have it restarted!

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121
Q

When giving medications to shock patients, make sure that these meds are piggybacked onto our IV, because

A

that way the lines are preserved and you can stop and start the meds if you need without cutting off or changing the line

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122
Q

Vasodilators and adrenergic medications work best when patient has ___, so normally after they are given IV push, the nurse will follow them with ____

A

pH within normal limits

20 mL of fluid - just open the IV a little bit and let some run in - helps push the medication into central circulation

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123
Q

Other PRN medications for shock patients

A

norepinephrine, epinephrine, anti-arrhythmic

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124
Q

“Central lines” usually go into the ___ so that we can ___

A

right atrium

measure pressures - they can be floated into the pulmonary artery

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125
Q

2 ways of inserting right heart catheters - which is less risky?

A
  1. subclavian

2. interjugular (less risky)

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126
Q

What is the concern with inserting the right heart catheter through the subclavian?

A

you run the risk of puncturing lung and creating pneumothorax

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127
Q

right atrial pressure runs about 6-12, so if patient is less than 6 they have ___, if higher than 12 they have ___

A

FVD and need more fluids

FVE - be careful

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128
Q

When establishing a central line, make sure that the X-ray team is there so that

A

you can make sure that the catheter is in the correct area (right atrium)

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129
Q

6 types of shock complications

A 
shock lung or ARDS
GI bleeding
renal failure
liver failure
DIC
MODS (multiple organ dysfunction syndrome )
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130
Q

hallmark signs of shock lung or ARDS in shock patients are:

A

Pa02 keeps dropping even though we keep turning up the percentage of oxygen

chest x-ray looks like total whiteout

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131
Q

7-10 days after initial shock symptoms, ____ can develop. What is the prophylactic measure?

A

ulcers (stomach bleeding)

we start them on PPIs before this as a prophylactic measure to prevent that bleeding

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132
Q

Shock patients can appear restless because

A

they are hypoxic, decrease in circulation to the brain

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133
Q

How often should you monitor a patient in hypovolemic shock, and what complications are you looking out for?

A

ever 5-10 minutes because his condition can change quickly and we are concerned that things could deteriorate from here.

Monitoring for: drop in BP that might indicate moving from compensatory to progressive state of shock.
Also for mental status, respiratory, acid-base abnormalities

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134
Q

Nursing interventions to decrease restlessness in shock patients include:

A

Give oxygen that was ordered

Reassure, explain what doing

Ask about pain level, try to get an order for pain medication

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135
Q

From case study - order of carrying out orders in event of trauma shock

A
  1. Oxygen at 2 liters/minute via nasal cannula
  2. Place two large bore IV’s and infuse 0.9% normal saline at 125 cc/hr in each line
  3. Obtain complete blood count, serum electrolytes
  4. Type and cross for 4 units of blood
  5. Flat plate of the abdomen stat
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136
Q

Normal saline is always hung with ___. Because ____

A

blood

it’s isotonic, and if we’re anticipating that the patient may need a blood transfusion, this is the correct solution to pair with the blood (D5W can cause clotting)

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137
Q

COPD is an umbrella term which includes ___ and ___

A

chronic bronchitis and emphysema

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138
Q

COPD affects ___ million adults in the US

A

11.4

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139
Q

COPD is the __ leading cause of death in the US

A

4th

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140
Q

COPD is projected to rank ___ in 2020 for burden of disease world-wide.

A

5th

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141
Q

24 million american adults have evidence of impaired lung function, which suggests

A

an under-diagnosis of COPD

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142
Q

Cigarette smoking is the ___ controllable risk factor for the development of COPD.

A

primary

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143
Q

Alpha 1-antitrypsin (AAT) deficiency is a COPD genetic risk factor that is more often seen in ____ patients

A

caucasian

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144
Q

COPD: Emphysema is

A

A slowly progressive disease characterized by destruction of the alveoli

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145
Q

by the time COPD symptoms are evident, there is already

A

irreversible damage to their lungs

146
Q

Emphysema causes ____, leading to ____

A

destruction of the alveoli

decreased surface area for gas exchange

147
Q

In COPD, expiration becomes an ___ process and patients work hard to get the air in and especially to get the air out

A

active

148
Q

COPD: Emphysema signs during the nursing assessment (10)

A
  1. SOB, shallow
  2. Chest wall rigidity
  3. Chronic productive cough
  4. Prolonged expiration
  5. Expiratory wheezes
  6. Appearance changes: clubbing
  7. mental changes due to hypercapnia and hypoxia
  8. right-sided heart failure
  9. chronic lung infections
  10. coma -stupor -death
149
Q

patients with right-sided heart failure are going to look like

A

the patient with FVE (lot of edema)

150
Q

Nursing Diagnoses: COPD
Emphysema or Chronic Bronchitis

A
  • Ineffective Breathing pattern
  • Potential for alterations in cardiac output
  • Fear related to dyspnea
  • Impaired gas exchange
  • Potential for infection
  • Potential for injury: safety
  • Knowledge deficit
151
Q

Nursing Diagnoses: COPD
Emphysema or Chronic Bronchitis

A
  • Ineffective Breathing pattern
  • Potential for alterations in cardiac output
  • Fear related to dyspnea
  • Impaired gas exchange
  • Potential for infection
  • Potential for injury: safety
  • Knowledge deficit
152
Q

Overarching medication goal for patients with COPD Emphysema is to

A

improve gas exchange

153
Q

For patients with COPD Emphysema, you should give __ L/day fluid as long as their heart, kidneys and lungs can take it

A

2-3

154
Q

Remember that all bronchodilators have ADE, so give them cautiously through IV, if PO with water - watch vital signs and breath sounds - must listen to breath sounds and get RR ____ giving medication

A

before

155
Q

Give bronchodilators ___ corticosteroids

A

before

156
Q

For patients with mild COPD Emphysema, administer what medications?

A

short acting bronchodilators

157
Q

For patients with moderate COPD Emphysema, administer what medications?

A

Long acting bronchodilators AND short acting bronchodilators for break through

158
Q

For patients with severe COPD Emphysema, administer what medications?

A

Long acting bronchodilators AND short acting bronchodilators for break through AND add a steroid

159
Q

Pulmonary Function Tests are

A

Comparisons of forced expiratory volume (FEV) to forced vital capacity (FVC) are used to classify COPD as mild to very severe

160
Q

Forced Expiratory Volume:

A

How fast the air in the lungs can be moved in and out in 1, 2 and 3 seconds (FEV1)

161
Q

Forced Vital Capacity:

A

How much air volume can be moved in and out of the lungs (FVC)

162
Q

Medications to treat COPD Emphysema

A
  1. bronchodilators (adrenergic, anticholinergics, Methylxanthines)
  2. anti-inflammatory meds (corticosteroids
163
Q

How do Bronchodilators work?

A
  • Relieve bronchospasm
  • Reduce airway obstruction
  • Increase O2 distribution
164
Q

2 types of adrenergic bronchodilators used for patients with COPD Emphysema - prototypes and when they are used

A
  1. B2 Selective Short acting
    Prototype: albuterol (Proventil)
    Use: For occasional tx during an acute exacerbation
  2. B2 Selective Long acting
    Formoteral (Foradil), Salmeterol (serevent)
    Use: Daily for maintenance
165
Q

B2 Selective Long acting adrenergic bronchodilator is ___, and is used ___

A

Formoteral (Foradil), Salmeterol (serevent)

used Daily for maintenance

166
Q

B2 Selective Short acting adrenergic bronchodilator is ___, and is used ___

A

albuterol (Proventil)

used For occasional tx during an acute exacerbation

167
Q

Anticholinergic bronchodilators work by

A

Blocking the PSNS, acetylcholine which leads to bronchodilation and drying of secretions

168
Q

Anticholinergic bronchodilators for acute events

A

ipratropium bromide (Atrovent)

169
Q

Anticholinergic bronchodilators for daily maintenance

A

Tiotropium (Spiriva)

170
Q

Examples of Methylxanthines (bronchodilators) - what are they used for?

A

Aminophylline
Theophylline

Daily maintenance

171
Q

What corticosteroid is used for acute exacerbation in COPD patients?

A

Prednisone (methylprednisolone)

172
Q

What corticosteroid is used for daily maintenance only for severe or advanced COPD cases

A

flunisolide (Aerobid)

173
Q

3 qualities for chronic bronchitis (type of COPD), defintion

A
  1. excessive mucus secretions
  2. chronic cough
  3. dyspnea

these three things have to last 3 months or more in 2 consecutive years

174
Q

2 main causes of chronic bronchitis

A
  1. Recurrent lower RT infections

2. Smoking

175
Q

primary prevention in the context of COPD patients

A

taking normal, healthy people and getting them to stop smoking, improve diet, start working out (working with healthy patients that have unhealthy habits)

176
Q

secondary prevention in the context of COPD patients

A

trying to help patient who has COPD (just been diagnosed) to stop smoking

177
Q

3 main nursing interventions for patients with chronic bronchitis

A
  1. Prevention
  2. Treat Respiratory Tract infections
  3. Increase fluid intake
178
Q

_____ is the most common chronic disease of childhood

A

Asthma

179
Q

Asthma is

A

a chronic but reversible inflammatory disease of the airways

180
Q

What number of Americans are diagnosed with asthma? What’s the financial burden?

A

22.2 million Americans diagnosed

Financial impact is $16.1 billion dollars in direct care and lost productivity

181
Q

asthma triggers the release of what 4 things?

A
  1. Histamine
  2. Bradykinin
  3. Prostaglandins
  4. Leukotrienes
182
Q

Key signs and symptoms of asthma during nursing assessment

A
  • Cough
  • Wheezing (sometimes so loud you can hear w/out steth)
  • Dyspnea
  • Anxious & fearful
  • Color (may be pale or can become cyanotic, depending on the degree of hypoxia)
  • Diaphoresis
  • Pulse may be weak, very rapid
  • ABGs and O2 Sat would show a little hypoxia (PaCO2 tends to be pretty normal, or maybe slightly decreased (a little hypocapnic))
183
Q

when PaCO2 starts rising in an asthma patient, this signals

A

“this patient is exhausted - they can’t keep this up” and something acute needs to be done or else they will go into respiratory distress

184
Q

3 main goals of nursing interventions for patients with asthma

A
  1. Improve air flow
  2. Relieve symptoms
  3. Decrease future attaches
185
Q

During an asthma attack, what are the 4 things you should do for the patient?

A
  1. Give oxygen
  2. Stay with the patient
  3. Breathing exercises
  4. Comfort
186
Q

When patients have an acute asthma attack and end up in the ER, we often treat them with

A

sub-Q epinephrine

187
Q

Mast cell stabilizers are best for what type of asthma?

A

exercise-induced

188
Q

Albuterol can be used ___ or ____ often first category choice for patients with asthma

A

for rescue

less than 2x/week

189
Q

Atrovent is usually given via

A

inhaler

190
Q

Atrovent is usually given via

A

inhaler

191
Q

Short-acting meds for asthma

A
  • B1 and B2 Adrenergic bronchodilators (Epinephrine, ephedrine)
  • B2 Selective Adrenergic bronchodilators (albuterol - Proventil)
  • Anticholinergic (ipratropium bromide - Atrovent)
192
Q

Long-acting meds for asthma

A
  • Corticosteroids

Long-acting bronchodilators:

  • Mast Cell Stabilizers
  • Adrenergic: Beta 2 agonist
  • Methylxanthines
  • Leukotriene Inhibitors
193
Q

What type of B1 and B2 Adrenergic bronchodilators are given to patients with asthma, and why?

A

Epinephrine (Adrenaline) – for Tx in the ER

Ephedrine – this is In many OTC tx

both are short-acting

194
Q

What type of B2 Selective Adrenergic bronchodilators are given to patients with asthma, and why?

A

Albuterol (Proventil)

Short acting
For occasional tx, exercise induced asthma or a rescue inhaler
Often first category of drug choice

195
Q

What type of Anticholinergic meds are given to patients with asthma, and why?

A

ipratropium bromide (Atrovent)

short acting

MAY be used pre-exercise for exercise induced asthma

196
Q

What two types of corticosteroids are given to patients with asthma, and why?

A
  1. Daily maintenance: inhaler
    Prototype: flunisolide (Aerobid)
  2. Acute exacerbation: systemic
    Prednisone (methylprednisolone)
197
Q

What type of Mast Cell Stabilizers are given to patients with asthma, and why?

A

cromolyn sodium (Intal)

Daily maintenance
May prevent exercise induced asthma
NOT for acute treatment

198
Q

True or false: all the long-acting bronchodilators are used for daily maintenance, NOT acute attacks?

A

true

199
Q

What type of Methylxanthines are given to patients with asthma, and why?

A

Aminophylline, Theophylline

as a long-acting bronchodilator (daily maintenance only)

200
Q

What type of Leukotriene Inhibitors

are given to patients with asthma, and why?

A

zarfirlukast (Accolate)

as a long-acting bronchodilator (daily maintenance only)

201
Q

Status Asthmaticus can be caused by the same things that bring on a regular asthma attack, but the issue is

A

that treatments do not end up working

these patients often end up in the ICU on IV bronchodilators or IV corticosteroids

202
Q

Step 1 and 2 (aka mild asthma patients) may be started on ___ or ____

A

short-acting beta agonist OR low dose inhaled corticosteroid

203
Q

Step 1 and 2 (aka mild asthma patients) may be started on ___ or ____

A

short-acting beta agonist OR low dose inhaled corticosteroid

204
Q

Bronchiole is the ___ and consists of ____

A

Unit of respiration

alveoli & capillary

205
Q

How many lobes are in each of the lungs?

A

3 lobes on R

2 lobes on L

206
Q

Parietal Pleura lines the ___, while Visceral Pleura lines the ____

A

PP: lines the thoracic walls

VP: lines the lungs

207
Q

diffusion of gases occurs in the

A

alveoli and capillary

208
Q

mediastinum consists of the

A

great vessels and heart btwn sternum and spinal column

209
Q

as the trachea comes down, the right mainstem bronchus tends to be ____ as opposed to the left, which diverts more sharply

A

straight

210
Q

What is the first thing you want to do after they’ve intubated the patient, before there is any tape on the tube?

A

the FIRST thing you want out of your pocket is your stethoscope and IMMEDIATELY listen so that you can hear breath sounds on both sides

211
Q

Alveoli produce a surfactant which

A

is a phospholipid which helps to decrease surface tension each time we exhale, decrease the work of breathing

without this we’d have to work really hard to open up the alveoli

212
Q

decrease in alveoli-produced surfactant occurs in

A

ARDS

213
Q

There is ___mL dead space in the average adult (1 mL for every pound)

A

150mL

214
Q

The use of accessory muscles during inspiration indicates what?

A

Quantifies the “work of breathing”

215
Q

2 late signs of difficulty breathing in adults

A

flaring nostrils

mouth breathing

216
Q

Ventilation is

A

movement of air in and out

217
Q

inspiration is an ____ process where ____

A

active

negative pressure is created within thorax - air is sucked in

218
Q

during trach/ventilator weaning, the question is:

A

can patient generate enough negative inspiratory force to get a breath in? they need to be alert enough, have thoracic cavity strength

219
Q

patient must have NIF higher than ___ to consider weaning

A

20-25

220
Q

Normal NIF is

A

60

221
Q

Respiration is

A

Breathing – gas exchange occurs

At the cellular level

222
Q

ability of air to move in and out is based on

A

pressure change

223
Q

inhalation is ____, whereas exhalation is ____

A

negative

positive

224
Q

the rate of inhalation or respiratory is affected by the

A

resistance in the airways

225
Q

resistance is determined by

A

the diameter of the airway

226
Q

as the resistance ____ greater effort is needed by the patient to breathe

A

increases

227
Q

Cough, 2 types

A

Protective reflex

Types:
Dry/nonproductive
Wet/productive

228
Q

if a patient is cyanotic, that’s a ___ sign of hypoxia

A

late

229
Q

for patients with orthopnea, ask how many pillows do you sleep on at night? – normal vs. abnormal

A

1-2 is normal; 3-4 is abnormal (document as 3 pillow orthopnea)

230
Q

SOB =

A

breathlessness, usually indicates high C02

231
Q

DOA =

A

dyspnea on exertion, labored breathing

232
Q

Hemoptysis

A

patient coughing up blood

233
Q

Where are the 2 cough reflexes?

A

1 cough reflex at back of throat, one at the carina

234
Q

What is stridor, and what does it usually mean?

A

High pitched
Medical emergency
usually denotes acute airway obstruction (might be what you hear if a child swallows a grape or a toy

235
Q

keep in mind that chest pain is ___ in respiratory illnesses

A

not that common

we may see it with pulmonary or lung cancer, or pulmonary embolism but it’s more of a late sign, not an early sign

as a general rule, COPD asthma general bronchitis do not have chest pain associated with them

236
Q

CAT scan is

A

a series of narrow beam x-rays done in cross-section

237
Q

On a chest x-ray, if there’s fluid in the lungs, it will

A

be whited out because fluid is heavier than air - see it at the bottom

238
Q

Whenever you see “oscopy” it means

A

they are looking in somewhere

239
Q

When is informed consent necessary, who does it, and what does it need to involve?

A

necessary to have a procedure of any kind done

as an RN and as a student you cannot get a consent form

usually done by the person who is performing the procedure, who tells them the benefits, risks, and possible alternatives

240
Q

lung scan

A

injecting radioactive isotopes into vein and watch circulation through pulmonary vasculature - can also be inhaled

241
Q

After a bronchoscopy, what are the 3 main points for assessment?

A

Assess ABCs (airway, circulation, breathing)
Gag reflex
Dysphagia

242
Q

after a Bronchoscopy, don’t give the patient anything to eat or drink unless

A

you’re sure they can swallow

243
Q

pulmonary function tests usually involve ___ and are used to ____

A

some kind of incentive spirometer

give a baseline and used to make initial diagnoses
also used to monitor the success of treatment

244
Q

pulse oximeter reads ___ and measures ___

A

reads the SaO2 - measures oxygen saturation

Norm: > 95%

245
Q

if a patient has a nasal cannula, it’s often run at

A

2-3L/min

anything over 4 is quite high and usually uncomfortable for the patient

246
Q

mask gives about somewhere between ___ % oxygen

A

35-60%

247
Q

partial rebreather has ____ so that the patient takes back in some of the CO2 they exhale

A

a bit of respiratory alkalosis

248
Q

non-rebreather mask delivers

A

the highest percent of oxygen we can give a patient without intubating

249
Q

venturi mask is best for what kind of patient, and why?

A

best for patient with COPD because its exact - most precise method

250
Q

when a patient has a trach, they’ve lost the ability to ____, so they need to have ____

A

they’ve lost the ability to breathe through their nose which filters and humidifies the air, so they either need to have a trach collar that’s humidified or getting more fluid

251
Q

PPV

A

pushes the tidal volume into the patient, inspiration becomes positive

252
Q

at the end of expiration, the pressure is still

A

positive

253
Q

PEEP is

A

a predetermined positive pressure that’s going to be maintained at the end of expiration

patients on PEEP never have a negative

they can usually have a lower percentage of O2 - helps keep the alveoli open

254
Q

In normal respiration, inspiration is ___ and expiration is ____

A

negative

positive

255
Q

When a patient is on a positive pressure ventilator, inspiration is ____ and expiration is ____

A

positive

negative

256
Q

When a patient is respirating on PEEP, inspiration and expiration are both

A

positive

257
Q

9 times out of 10, if you see an incentive spirometer, ask the patent

A

how to use it - they’re often wrong

they should be INHALING when they use this, not exhaling

258
Q

Incentive Spirometers are used for what 3 things?

A
  1. used post-op to prevent atelectasis or pneumonia
  2. used as a way to stimulate maximum expiration
  3. give pain meds before using if ordered
259
Q

when should percussion never be done?

A

after surgery

260
Q

How does percussion work, and what is the correct placement?

A

percussion helps to loosen mucus by cupping hands

you want something between your hands and the skin, starting above the level of the kidneys

start at the bottom and go up - keep an eye on the monitor

261
Q

pursed lip breathing creates ___ in the airways, helping to ____

A

positive pressure

helps to prolong exhalation (COPD, emphysema) so that they can get out more CO2

262
Q

The higher the patient’s head, the better ____

A

the expansion of the thoracic cavity to be able to take deep breaths

263
Q

Humidity helps to ____

A

keep the secretions loose so they can cough it up

2000-3000mL fluid per day

264
Q

What are examples of hypotonic crystalloids, and how do they work?

A

0.33% NS
0.45% NS
D5W

Shifts fluid out of vessel into cells
Hydrates cells

265
Q

What are examples of isotonic crystalloids, and how do they work?

A

(> 250 mOsm/L)
0.9% NS
Lactated ringers

  • No fluid shift
  • Vascular expansion
  • Electrolyte replacement
266
Q

What are examples of hypertonic crystalloids, and how do they work?

A

(>375 mOsm/L)
D5 0.45% NS D5 0.9% NS
Hypertonic Saline

  • Shifts fluid intravascular
  • Vascular expansion
  • Electrolyte replacement
267
Q

3 main nursing considerations with hypertonic crystalloids

A
  1. May irritate veins
  2. May cause FVE
  3. May cause hypernatremia
268
Q

3 main nursing considerations with isotonic crystalloids

A
  1. May cause FVE
  2. Generalized edema
  3. Dilutes hemoglobin
269
Q

3 main nursing considerations with hypotonic crystalloids

A
  1. May worsen hypotension
  2. Can increase edema
  3. May cause Hyponatremia
270
Q

4 types of colloids

A
  1. Albumin 5% or 25%
  2. Dextran
  3. Hetastarch (HES)
  4. Mannitol 5% or 25%
271
Q

3 main Action/Uses of Albumin (colloid)

A

Keeps fluid intravascular
Maintains volume
Replace protein and tx shock

272
Q

2 Action/Uses of Dextran (colloid) and Hetastarch (colloid)

A

Shifts fluid into vessels

Vascular expansion

273
Q

2 Action/Uses of Mannitol 5% or 25% (colloid)

A

Oliguric diuresis

Eliminates cerebral edema

274
Q

Note that all colloids may cause

A

FVE

275
Q

Fluid volume excess (FVE) is also known as

A

Hypervolemia

276
Q

Signs of FVE in patients

A
  • Rapid weight gain
  • Peripheral and Perioribital edema
  • JVD, bounding HR, increased BP
  • increased CVP, R atrial P
  • SOB, pulmonary crackles
  • low HCT, Na
  • Personality changes
  • increase capillary hydrostatic pressure: CHF
  • decreased in Plasma Proteins: Cirrhosis, Malnutrition
  • Obstructed Lymphatics: Breast Cancer surgery w/ lymph node dissection
  • Kidney Malfunction: Renal disease
  • increased Capillary permeability: Allergies, Infection, Toxins
  • Medications: Steroids, NSAID, Estrogen, some BP meds
277
Q

2nd spacing edema is

A

Localized or generalized

278
Q

Examples of 3rd spacing edema (4)

A
  1. Ascites
  2. Pulmonary edema
  3. Pleural effusion
  4. Pericardial effusion
279
Q

FVE patients should be kept on a ___ diet

A

A low Na diet, with low H2O

280
Q

Patients with FVE are often given ___ or ___ medications

A

Lasix (diuretic)

Intravenous hypertonic therapy: Albumin

281
Q

Fluid volume deficit (FVD) is also known as

A

Hypovolemia

282
Q

Common Clinical Situations for FVD (3 categories)

A

Decreased Intake:
NPO, Nausea
Coma, Immobilized
3rd space shift

Increased Output:

  • Diarrhea/Fistulas
  • Vomiting/ GI suctioning
  • Hyperventilation/ Tracheostomy
  • Fever/ Excessive perspiration
  • Burns/ Hemorrhage

Decreased Absorption of Fluid:
Intestinal Obstruction

283
Q

What are the signs and symptoms of of FVD?

A
  • Thirst, Dry mouth, Sordes
  • decreased Skin Turgor
  • increased temperature
  • Oliguria/ Anuria
  • increased HCT, increased Serum Na, increased BUN
  • Restlessness, delirium, convulsions
  • decreased BP, postural hypotension
  • decreased CVP, decreased atrial pressure, flat neck veins
284
Q

increased HCT, increased Serum Na, increased BUN are all signs of

A

FVD

285
Q

One way to assess for hypovolemic shock in patient with FVD is to check for

A

Postural hypotension

286
Q

Critical values for sodium (Na)

A

160

287
Q

Critical values for Potassium (K)

A

6.0

288
Q

Critical values for Blood Urea Nitrogen (BUN)

A

80 or >

289
Q

Critical values for Creatine

A

4 or >

290
Q

Critical values for Glucose

A

500

291
Q

Sodium normally dwells in the ___, and is the ___ regulator of H20

A

ECF

prime
Gain Na, gain water
Lose Na, lose water

292
Q

When Na

A

Hyponatremia

293
Q

4 main causes of Hypocalcemia

A

Inadequate intake of calcium
Anorexia
Renal failure
Lasix

294
Q

3 main causes of Hypercalcemia

A

increased bone reabsorption
Cancers (bone and others)
immobility

295
Q

3 main signs of Hypercalcemia

A
  1. Serum Ca > 10.5
  2. Lethargy, weakness
  3. decreased reflexes, constipation
296
Q

4 key interventions for Hypercalcemia

A

Decrease calcium intake
Lasix
Calcitonin
Ambulation

297
Q

___ % of calcium is in the bones. Only ___ % of ingested calcium is absorbed

A

99% in bones

30- 50% of ingested calcium is absorbed

298
Q

Normal calcium levels

A

8.5 – 10.5 mg/dL

299
Q

Main sign of Hypocalcemia is

A

Tetany (intermittent muscle contractions) leading to convulsions

300
Q

Emergency intervention for Hypocalcemia is

A

CaCl or Ca Gluconate IV

301
Q

Intervention for chronic Hypocalcemia

A

Increase dietary Calcium or Ca supplements

302
Q

Potassium is a major ___ ion, and is ___ stored by the body

A

intracellular

not

303
Q

Note that lab values for potassium are ____ levels only

A

intravascular

304
Q

Normal levels of potassium

A

3.5 – 5.2 mEq/L

305
Q

Signs of hypokalemia

A

K

306
Q

Causes of hypokalemia

A

Loss from GI tract
Diet: Eating disorders
Diuretics

307
Q

Interventions for hypokalemia

A

Administer K+
PO: Klor, KDor
IV: KCL

308
Q

With hypokalemia, what are the 3 main ECG signs?

A

Depressed ST segment
Low T
Prominent U wave

309
Q

With hyperkalemia, what are the 3 main ECG signs?

A

Low P wave
Widening of QRS segment
Peaked T

310
Q

Causes of hyperkalemia

A 
Kidney failure
Intake of excess K
Crush injuries
Burns
Addison's disease
311
Q

Signs of hyperkalemia

A 
K > 5.2
Irregular heart beat
Nausea
Slow weak, or absent HR
Paresthesias, muscle cramps
ECG changes
Acidosis
312
Q

Interventions for hyperkalemia

A 
Calcium Gluconate
IV fluids
IV Na Bicarbonate
Hemodialysis
Kayexalate
Insulin and Glucose IV
313
Q

Hypernatremia is when Na is

A

> 145 mEq/L

314
Q

If hypernatremia is due to water loss, how should you intervene?

A

IV Fluids: D5W

Oral glucose-electrolyte solutions – low Na

315
Q

If hypernatremia is due to excess Na, how should you intervene?

A

Restrict Na intake

316
Q

CNS signs of hypernatremia

A

restlessness, irritable, delirium, twitching, seizures, coma

317
Q

Signs of Hypernatremia with FVD

A 
Thirst
poor skin turgor
rapid HR
decreased BP
increased temp
oliguria
318
Q

When Hypernatremia is due to water loss, some of the causes may include:

A
  • Excessive Fluid loss:
    (diarrhea, open burns, fever, excessive perspiration, heat stroke, diuretics)
  • decreased Fluid intake
  • Hyperglycemia
  • Renal failure
319
Q

When Hypernatremia is due to Na Excess, the main cause may be:

A

Hypertonic NG tube feedings

or

Diabetes Insipidus

320
Q

When Hyponatremia is due to loss of Na, the two main cause may be:

A

Diuretics: Lasix
Loss of GI fluids

Also:
Decreased ADH due to adrenal insufficiency (Addison’s)
Renal Disease

321
Q

When Hyponatremia is due to gain of water, the main cause may be:

A
  • Excess electrolyte-poor IV fluids

Also:
Excess H20 to hypotonic tube feedings
Irrigation of NGT w/ tap H2O
SIADH

322
Q

4 patient cases in which H20 intake is greater

A
  • CHF
  • Polydipsia
  • Liver failure
  • Renal failure
323
Q

Na of 115 or less may cause:

A

muscle twitches, focal weakness, seizures

all these can lead to coma

324
Q

If a patient is displaying neurological symptoms of hyponatremia, what should you administer?

A

3% or 5% NS IV

325
Q

When Na

A

hyponatremia

326
Q

Main signs of shock due to hypoxia:

A

Restlessness (change in LOC) and a subtle increase in respiratory rate (higher than 20)

327
Q

The type of IV fluid we give a patient can affect the

A

osmotic pressure in the body

328
Q

Hypertonic solutions can be very irritating to the veins, so you’d prefer them to be given

A

into a larger vessel (i.e. antecubital, central line)

329
Q

Giving a small amount of colloids (250mL) can be the same effect as

A

4L of crystalloids

so a small amount of colloids has a bigger impact

330
Q

Albumin is a ___ colloid

A

natural

331
Q

Dextran and Hetastarch are ____ colloids.

A

synthetic

332
Q

if you have a major trauma patient that is in shock and you need to give them blood, you need to _____ BEFORE you give the dextran and hetastarch

A

type and cross them (come up with the exact blood match)

333
Q

Mannitol is often used with neuro ICU patients with _____

A

cerebral edema

334
Q

dependent edema

A

someone that’s upright with hands at their sides, hands may get swollen – if they’re on their feet, their legs may get swollen – if patient is laying flat in bed, the sacral or scrotal area can become edemous

335
Q

ascites is

A

fluid in the abdominal/peritoneal cavity

336
Q

pulmonary edema is

A

fluid in the alveoli

337
Q

pleural effusion

A

fluid in the pleura between the lungs

338
Q

pericardial effusion

A

if there’s an infection, the excess fluid can fill this area so that the fluid begins pressing on the heart – the heart therefore has less and less room to contract/beat because of the increased pressure

this can cause decreased cardiac output, lightheadedness

339
Q

Sordes is

A

brown, crusty material can develop on patient’s lips or in their mouths – mouth care and oral hygiene is critically important

340
Q

postural hypotension

A

change of more than 15 mm in systolic from lying to sitting

341
Q

Most frequent causes of loss of sodium is ___ and ____

A

DIURETICS (Lasix) and loss of GI fluids

342
Q

Hypernatremia is often associated with

A

FVD

343
Q

Increase of extracellular sodium causes intracellular fluid to shift out of the cells and into

A

the intravascular space, and the cells can become dehydrated

344
Q

If sodium comes back 121 means the patient definitely has

A

hyponatremia

345
Q

If patient has hyponatremia, give fluids only up until

A

the neurological signs and symptoms decrease

346
Q

Aldosterone will excrete potassium when

A

the kidneys are retaining sodium and water

347
Q

For the patient on DIGOXIN – low potassium levels will ____ the effect

A

increase

348
Q

Hypokalemic patients will have a very low ___ wave on the EKG

A

T

349
Q

burns can cause hyperkalemia, especially during the first ____ hours when the cells break and release potassium

A

24-48

350
Q

Trusseau’s sign

A

a test for hypocalcemia where the hand will contract into a claw almost spontaneously

351
Q

Chvostek’s sign

A

a test for hypocalcemia where tapping on the facial nerve will cause a contraction

352
Q

As you assess your patient, you find he has +2-pitting edema up to his knees, a rapid, bounding pulse, and shortness of breath. Your nursing diagnosis is

A

Fluid volume excess

353
Q

When assessing a patient with fluid volume deficit (FVD), you would expect to find

A

Oliguria

354
Q

Your patient is hemorrhaging from his surgical incision. As the nurse, you expect that compensatory mechanisms associated with hypovolemia will cause

A

Him to be normotensive

355
Q

The patient is admitted with severe vomiting for 24 hours. She is exhausted and weak. Her ECG (electrocardiogram) shows a flattened T wave. The most likely potassium value for this patient is

A

2.5 mEq/L

356
Q

Your patient is transferred from the ICU to your unit with a CVP (central venous pressure) line in place. CVP readings are taken to determine

A

Hypovolemia

357
Q

The order is for KCL (potassium chloride) IV for a patient with severe hypokalemia. In administering the KCL, the nurse is aware that KCL

A

Should be administered at 10 mEq/hour or less

358
Q

For inspiration to occur the intrathoracic pressure must be

A

Negative

359
Q

The major cause of emphysema in this country is

A

Cigarette smoking

360
Q

A priority nursing diagnosis for a patient with emphysema

A

Ineffective breathing patterns

361
Q

In teaching the newly diagnosed asthma patient, it is most important to stress that she:

A

Take her medications as prescribed

Med Surg Lecture (5 decks)

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