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Patho Fall 2023 Block 1 > Signature Assignment PREP > Flashcards

Signature Assignment PREP Flashcards

1
Q

PNA clinical diagnosis

A

-S/S on assessment: wheezing, productive cough (bacterial- purulent), Scant cough (viral) fever, dyspnea, chills, malaise, confusion in elderly.
-Diagnostic Tests: CXR (infiltrates), WBC w/diff (leukocytosis, shift to the left)
-(+) sputum for C&S
-usually follows some other respiratory infection/flu.

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2
Q

Nursing management: PNA

A

-VS/pulse ox regularly and trend
-lung auscultation
-supplemental O2 ordered (>95%)
-pulm toilet/IS
-Increase fluid intake (IVF or PO)
-Ambulation
-Energy conservation
-DRUG therapy (analgesics for pleuritic pain, ABX for bacterial, antipyretics for fever).
Teaching: PNA vaccine/FLU vaccine, stay healthy.
-strict adherence to hygiene.
-pneumococcal vaccine.

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3
Q

Emphysema

A

Alveolar damage- alveoli are over-inflated/stretched out –> impaired gas exchange.

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4
Q

Chronic bronchitis

A

excessive secretion production.

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5
Q

COPD characteristic features

A

Increased AP diameter (1:1) due to hyperinflation
Breath sounds decreased, wheezing, rales, rhonchi
Prolonged expiration (having to push it out).
Adv disease: PLB’ing, neck vein distention, peripheral edema (pulm HTN), cachexia (malnourished).

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6
Q

COPD nursing related problems

A

activity intolerance, SOB, ineffective breathing pattern (too fast, too slow, shallow, deep), ineffective airway clearance (congestion and can’t expectorate), impaired gas exchange, anxiety, poor nutritional status.
-Target O2 88-92%
-Tripod positioning
-huff cough technique
-energy conservation.

**O2 should never be withheld…

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7
Q

COPD nursing implications

A

-Smoking cessation
-teach flu/PNA vaccine
-Teach early detection of respiratory infections
-Inhaler therapy

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8
Q

Medications for Bacterial PNA:

A

-Macrolides: azithromycin & erythromycin
-Penicillin: Amoxicillin
-cephalosporin: Cefepime
-IVF to thin secretions
-Tylenol for antipyretic needs.
-neb treatment
-

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9
Q

Medications for emphysema:

A

-Bronchodilators- Salmeterol, albuterol for rescue only.
-Corticosteroids: Budesonide (inhaled)
-ABX (if you have bacterial inf or acute bronchitis)
-smoking cessation therapies
-Selective PD4 inhibitor: Roflumilast (anti-inflammatory to prevent exacerbations)

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10
Q

Diagnostic testing/Labs for emphysema

A

-Lung function tests, CXR, CT scan, spirometry

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11
Q

Treatment for Pleural Effusion:

A

-Thoracentesis-needle into the pleural space to remove pleural fluid. Before: RN gets signed consent, upright on elbows over bedside table to open intercostal spaces. Instruct pt not to talk. After: CXR, assess for hypoxia/pneumothorax
-Chest tube

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12
Q

Central Venous Catheter

(advantages)

A

TPN
Chemotherapy
Long -term antibiotic use
loss of peripheral access

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13
Q

Nursing implications for Anemia:

A

-monitor labs (CBC, serum iron, serum transferrin/serum ferritin)
-Monitor signs of hypoxia (decreased O2 in blood).
-Monitor VS & O2 (may administer O2)
-Assess neuro status (B12)
-provide rest periods.
-Keep warm
-Blood transfusion (PRBC) if severe.

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14
Q

Central Venous Catheters (CVC)

Types

A

Non-tunneled
Tunneled
Implanted Ports
Peripherally-inserted
central catheter

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15
Q

NON-TUNNELED CVC

“deep lines”

A

Subclavian (SC)
Internal Jugular (IJ)

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16
Q

Tunneled CVC

A

Hickman
Groshong
Broviac

“Hungry Groundhogs Burrow”

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17
Q

What does an acute asthma attack patient look like?

A

-Severe wheezing, SOB, coughing that wont stop, chest tightening, pale/sweaty face, tachypnea (30RR), use of accessory muscles & tachycardia (HR 120)

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18
Q

Medication for Acute Asthma Attack

A

Bronchodilator: Albuterol (short-acting B2)

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19
Q

Non-tunneled CVC

FACTS

A

inserted by HCP pr specially trained RN
1-5 ports; 710 in long
Tip located in superior vena cava
CXR post -procedure
used for short term - emergency, trauma, critical care, surgery

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20
Q

Non- tunneled CVC

Complications

A

bleeding
air embolus
pneumothorax
CLABSI

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21
Q

Signs of FVE

HF/Renal patient

A
  • Increased BP
  • Bounding pulse
  • Increased central venous pressure
  • dyspnea-crackles, SOB (pulm edema)
  • S3 heart sound
  • jugular vein distention
  • water weight gain
  • pitting edema
  • hyponatremia
  • Hyponatermia- think change in mental status
22
Q

Non- tunneled CVC

RN care

A

Removed by RN
-check INR if on anticoag
- gather supplies (sterile suture removal kit, sterile & clean gloves, occlusive dressing, measure tape)
- Explain procedure (supine or trendelenburg, Valsalva maneuver
- apply pressure x 3-5 minutes
- apply occlusive dressing
- measure length of catheter (may culture tip)

23
Q

Tunneled CVC

FACTS

A

placed in OR
used when infusion therapy is frequent and prolonged (even years)
Adv- stability and does not require needle sticks
Disadv- Prolonged break in skin integrity
Removed by HCP

24
Q

Signs of FVD

Dehydrated

A
  • Tachycardia, but weak/thready pulse
  • postural hypotension (BP initially shoots up, then drops)
  • restless, drowsy, confused
  • dry mucous membranes
  • cold, clammy skin
  • decreased urine output
  • increased RR
  • weight loss
  • Dry skin
  • Hypernatremia-think change in mental status.
25
Q

Tunneled CVC

complications

A

catheter damage
occlusion
thrombosis
sepsis

26
Q

Tunneled CVC

RN care

A

irrigation protocol varies - may or may not require heparin (know agency policy )

Site care- per agency policy

27
Q

Implanted Ports

FACTS

A

-for patients who require IV therapy >a year
-considered “semi-permanent”
-Placed in the OR - catheter attached to a port which is placed in SQ tissue pocket on chest wall
-Closed incision post- procedural
-Uses Huber needle for punctures
-Removed by HCP

28
Q

GLU

A

Normal: 70-100
Increase: DM, stress, steroid use, IVF w/dextrose, diet, chronic renal failure, infection.
Decrease: NPO, insulin overdose.

29
Q

How many punctures can an Implanted port receive?

A

Chest port = 2000 punctures
Upper arm port= 750 punctures

30
Q

Implanted Ports

Complications

A

catheter occlusion

31
Q

Implanted Ports

RN care

A

site care - none when not accessed

Change Huber needle weekly

Clean/dress -per hospital protocol

32
Q

PICC line

FACTS

A

placed at bedside by certified RN, HCP, radiologist
Duration 3-12 months
placed at antecubital fossa; basilic or cephalic vein
Tip is placed in the superior vena cava or right atrium

33
Q

PICC line

Complications

A

lower complication rate than CVC
-less microorganisms on arm
-less insertion complications

Phlebitis
Catheter occlusion

34
Q

PICC line

RN care

A

NO BP’s or blood draws
site care- per agency protocol (includes swabbing all capps with alcohol , dressing changed- day after, than every other wednesday- UK)

Removed by RN - sit/ lay down - hold arm below heart, bear down while withdrawaling - withdrawl slowly and relax catheter after each inch- DO NOT pull catheter if vein spasms
measure length of catheter

35
Q
A
36
Q

BUN

A

Normal: 10-20
Increase: Renal/kidney disease, dehydration (false high), CHF, MI, increase protein intake/tube feeding. IF BUN is high and Cr is not, check H&H for possible GI bleed (blood is rich in protein).
Decrease: Overhydration (false), liver failure, malnutrition.

37
Q

Cr

A

Normal: 0.5-1.2
Increase: RENAL FAILURE- most reliable indicator of kidney disease.
Decrease: somone who does not have much muscle to break down (malnourishment, muscle atrophy, debilitation).

38
Q

K+

A

Normal: 3.5-5.0
Increase: Renal failure/kidney disease (K+ is not getting excreted by kidneys), increased intake, dehydration.
Decrease: Decreased intake, diuretics, vomit/diarrhea, increase urine output, burns, insulin.

Think CARDIAC DYSRHYTHMIAS

39
Q

Na

A

Normal: 135-145
Increase: Increased intake, dehydration, hypertonic tube feeds w/o free water, DM, insensible loss: sweat, increased RR.
Decrease: Decreased intake, FVE/3rd spacing, diuretics, V/D, renal insufficiency, HF, AKI, cirrhosis

40
Q

Ca

A

Normal: 9.0-10.5
Increase: Hyperparathyroidism, increased intake, malignancy (paraneal plastic disorder), Vit D supplement.
Decrease: Renal failure–>renal osteodystrophy, parathyroid def/removed, increased phos, VitD def, malnutrition, muliple blood transfusions.

41
Q

H&H
RBC

A

Hgb: men 14-18; women 12-16
HCT: men 42-52% women 37-47%
Increase: polycythemia vera, dehydration, COPD
Decreased: hemorrhage, chemo, renal disease, dietary insufficiency.

42
Q

Platelets

A

Increased: polycythemia vera, RA, iron deficiency, infection, malignancy.
Decreased: hemorrhage, chemo, infection.

43
Q

PT/INR

A

Increased: liver disease, warfarin use.

44
Q

PTT
Anti Xa

A

Increased: clotting deficiency, cirrhosis, Heparin use.

45
Q

Treatment for high K+
hyperkalemia

A
  • Stop intake
  • loop/HCTZ diuretics
  • dialysis (really high)
  • temporary fixes: IV insulin/dextrose, polystyrene sulfonate, if acidic–>sodium bicarb

Monitor EKG

46
Q

Treatment for decreased K+
Hypokalemia

A
  • Increase med intake (oral or IV)
  • Increase PO intake: apricot, orange, prune, dried fruit, peanut butter, beans, broc, potato, chocolate. yogurt, bran, nuts, avacado.
  • IV KCL–> never IV PUSH!!!!!!!! always dilute.
  • hypokalemia precipitates digitoxicity (digoxin).
47
Q

Treatment for Increased Na
Hypernatremia

A
  • Dilute the Na with fluids (hypotonic) SLOWLY
  • Remove/decrease Na from diet
  • Monitor serum sodium/osmolality
48
Q

Treatment for decreased Na
Hyponatremia

A
  • If mild, restrict fluids & loop diuretics
  • Acute (Na around 120): small amounts of Hypertonic IVF (NS 3%) slowly over 24-48 hours (cerebral edema)
  • Seizure precautions as needed/safe environement.
49
Q

Nursing implications for CKD:

A
  • Excess fluid volume: r/t kidneys inability to excrete fluid.
    -Monitor for FVE, weigh daily, fluid restrictions.
  • Malnourishment: pt does not feel like eating & is in a hyper metabolic state.
    -Monitor for N/V, weight trends, serum protein levels, H&H and offer desirable foods.
  • Risk for injury: r/t alteration in bone structure Irenal osterodystrophy)
    -Monitor electrolyte levels, administer prescribed supplements- calcium, Vit D
  • Address grieving: involve family and offer community resources.
  • Risk for infection: suppressed immune system.
    -limit visitors, monitor for s/s of infection, aseptic tech for for line mgmt.
  • Activity intolerance: need rest time.
  • can admin erythropoietin monitor H&H.
50
Q

Drugs not to give to CKD patients secondary to nephrotoxicity:

A

NSAIDS
aminogycocydes: Gentamycin

Patho Fall 2023 Block 1 (3 decks)

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