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Med-Surg II > Study Guide Flashcards > Flashcards

Study Guide Flashcards

1
Q

What to do when physician removes chest tube

A

Tell pt to perform valsalva maneuver and bear down

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2
Q

When to contact physician for chest tubes

A

Bubbling increases over time
Bubbling returns after having stopped
Output more than 100-150mL/hr

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3
Q

K normal range

A

3.5-5.5

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4
Q

Calcium normal range

A

8.5-10.5

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5
Q

Magnesium normal range

A

1.5-2.0

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6
Q

Atelectasis

A

Alveolar collapse due to obstruction

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7
Q

S/Sx of Atelectasis

A

Increased work of breathing - dyspnea
Decreased breath sounds
Crackles
Hypoxia

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8
Q

Tx for atelectasis

A

Remove secretions
Frequent turning, early ambulation, lung volume expansion (incentive spirometer), deep breathing, coughing

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9
Q

Surgical/procedural tx for atelectasis

A

Endotracheal intubation, mechanical ventilations = last resort
Thoracentesis

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10
Q

Pneumonia patho

A

Movement of WBC’s into alveoli leads to perfusion issues
Development of thick sputum leads to ventilation issues

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11
Q

Community-Acquired Pneumonia

A

Pt that have not been hospitalized/lived in long-term care within 14 days

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12
Q

Hospital-Acquired Pneumonia

A

Begins 48 hours+ after hospital admission
Ex. Ventilator-associated pneumonia (VAP)

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13
Q

Tx for bacterial pneumonia

A

Abx

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14
Q

Aspiration pneumonia

A

Entry of material from mouth into trachea/lungs

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15
Q

Necrotizing pneumonia

A

Rare complication
Lung tissue turns into thick/ liquid mass

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16
Q

Opportunistic pneumonia

A

Occurs in immunocompromised pts
- Malnutrition, HIV, chemotherapy

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17
Q

Risk factors for pneumonia

A

Smoking, COPD, immobility, depressed cough, NGT/other drains, old age, aspiration risks

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18
Q

How is pneumonia dx

A

S/sx, CXR, blood cx, sputum cx, bronchoscopy

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19
Q

S/sx of pneumonia

A

Cough, fever, chills
Dyspnea, tachypnea, chest pain
Confusion - elderly
Coarse crackles, purulent sputum - vocal fremitus
Elevated RR
Decreased SpO2
Elevated WBC, + sputum culture
Respiratory acidosis

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20
Q

Infection goal of care

A

Remove bacteria and clear purulent drainage/sputum

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21
Q

Nursing interventions to promote airway clearance

A

Oxygen therapy - continuous SpO2 (humidified)
Hydration
Chest PT (physiotherapy)
- Inventive spirometer, cough and deep breath (IS/CDB)
NT (nasotracheal) suction

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22
Q

Nursing interventions for infection (lung infection/pneumonia)

A

Sputum culture
Abx administration
- Should be working by 48-72h
- Not for viral infections, but could be used for secondary bacterial infection

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23
Q

Medications for pneumonia

A

Antipyretics
Cough suppressants
Mucolytics

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24
Q

Long-term interventions for pneumonia

A

Pneumococcal vaccine
Oral abx - once pt is stable
Assess for aspiration risk - NG/OG tube = increased risk
Prevent hospital acquired infection
Teach abx adherence
Follow up with PCP in 6-8 wks

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25
Q

Post thoracentesis nursing interventions

A

Monitor HR and BP
Monitor for pneumothorax

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26
Q

Tension (spontaneous) pneumothorax

A

Accumulation of air in the pleural space under pressure, compressing the lungs and decreasing venous return to the heart

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27
Q

Iatrogenic pneumothorax

A

Traumatic pneumothorax secondary to an invasive procedure or surgery

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28
Q

S/SX of closed pneumothorax

A

Sudden pain
Tachypnea, air hunger, accessory muscle use
Absent breath sounds
Tracheal shift
Hypotension
Jugulovenous distention (JVD) - thoracic pressure
Hypoxemia - can lead to cyanosis

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29
Q

Tx for closed pneumothorax

A

Cover with vent dressing
Chest tube

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30
Q

Tx and interventions for ineffective airway clearance

A

IS/CDB
Suctioning
Bronchoscopy
Positioning - “good” lung down so “bad” lung can drain
Monitory for s/sx of pneumonia

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31
Q

How is TB contracted

A

Through air, person to person
Mostly effects immunocompromised

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32
Q

S/x of tuberculosis

A

High fever, chills, flu-like symptoms
Extrapulmonary TB (outside of lungs)

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33
Q

BCG vaccine

A

Bacillus Calmette–Guérin
Recommended for infants born in countries with high prevalence of TB - Africa, Asia, Eastern Europe

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34
Q

BCG vaccine side effects

A

Swollen lymph nodes
Fever (mild)
Headache
Injection site reactions

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35
Q

TB precautions

A

Airborne isolation with HEPA filter
Pt must wear surgical mask outside of room

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36
Q

Rifampin nursing considerations

A

Tx for TB
Orange urine/secretions
Liver failure - AE
Decreases hormonal birth control effectiveness

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37
Q

Risk factors for pulmonary embolism (PE)

A

DVT
Immobility, Surgery
Obesity, Smoking
HF, A fib
Pregnancy
Clotting disorders
Fx of long bones

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38
Q

Risk factors for head and neck cancer

A

Tobacco, ETOH, environmental exposure, HPV, over 50 men

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39
Q

Dx for head and neck cancer

A

Laryngoscopy with biopsy of tumor
CT/MRI
Barium swallow
Pharyngoscopy and laryngoscopy

40
Q

Head and neck cancer tx

A

Surgery - first line
- Stage 1&2: Partial laryngectomy
- Stage 3&4: Total laryngectomy
Radical neck dissection
Radiation therapy

41
Q

Radical neck dissection

A

Removal of:
All cervical lymph nodes
Sternocleidomastoid muscle
Internal jugular vein
Spinal accessory muscle
- Tx for severe head/neck cancers

42
Q

Normal amount of drainage from JP drain

A

80-120 mL in first 24 hours

43
Q

Central venous pressure

A

Measures the amount of blood returning to the right atrium
- Decreased if blood volume is decreased
Normal range: 2-8, 8-12(?)

44
Q

Guillan Barre

A

Autoimmune disorder that destroys myelin on nerve cells

45
Q

Causes of Guillan Barre

A

Viral infection: Flu, mycoplasma, HIV/Epstein Barr, campylobacter (GI bug)

46
Q

Guillan Barre s/sx

A

Paresthesia of hands/feet
Weakness of respiratory muscles
Can progress to blindness and dysphagia
No change in cognitive status

47
Q

Guillan Barre dx

A

Lumbar puncture or electromyelogram

48
Q

Tx of Guillan Barre

A

No tx - supportive measures until myelin regenerates
IVIG and plasmapheresis - reduces s/sx length
Monitor respiratory status
PT/OT for mobility

49
Q

Primary concerns for Guillan Barre

A

Altered breathing pattern
- Decrease in ventilation
Impaired swallowing - nutrition
Physical mobility
Autonomic dysfunction - controls bradycardic responses, rapid changes in VS

50
Q

First symptoms of Guillan Barre

A

Can’t feel middle finger
Feet feel funny
Can no longer lift 20lb box
Falling

51
Q

Hypersensitivity Reaction Type 1

A

Allergic response. IgE mediated
Histamine release, itchy eyes, runny nose, rashes, edema, anaphylaxis

52
Q

Hypersensitivity Reaction Type 1 examples

A

Nasal allergic rhinitis or hay fever
Hives, atopic eczema, or erythema
Angioedema
Asthma
Anaphylaxis

53
Q

Passive immunity

A

Receiving antibodies rather than making them
- Ex. Globulin injection, mother’s breast milk

54
Q

Anaphylaxis s/sx

A

Tingling hands, flushing, oral swelling
Warm sensation, nasal congestion, periorbital swelling, difficulty swallowing, wheals

55
Q

Anaphylactic shock s/sx

A

Bronchospasm
Laryngeal edema
Dyspnea
Hypotension
Cyanosis

56
Q

Anaphylaxis tx

A

Epinephrine
Supplemental O2 with cooled water
Advanced airway
IV antihistamines
Corticosteroids

57
Q

Anaphylaxis tx

A

Epinephrine
Supplemental O2 with cooled water
Advanced airway
IV antihistamines
Corticosteroids

58
Q

Atopic reactions

A

Most common type 1 hypersensitivity
AKA seasonal/environmental allergies
Ex. Hay fever

59
Q

Atopic reaction s/sx

A

Allergic rhinitis
Atopic dermatitis
Urticaria - hives
Angioedema

60
Q

Atopic dermatitis

A

Type 1 hypersensitivity

61
Q

Atopic dermatitis tx

A

Avoid cause
Topical corticosteroid creams
NSAID’s
Skin moisturizer

62
Q

Parkinson’s disease

A

Slow, progressive neurologic movement disorder due to decreased dopamine levels
- Unknown cause

63
Q

Parkinson’s risk factors

A

Increased incidence with age
More common in men 3:2
Well water, pesticides, rural residence

64
Q

Parkinson’s characteristics

A

Tremor
Rigidity
Bradykinesia, akinesia
Postural instability
Hypokinetic dysarthria (speech abnormalities)

65
Q

Dx of Parkinson’s

A

4 symptoms + responds to pharm therapy
Presence of Lewy bodies: protein deposits in the brain

66
Q

Parkinson’s tx

A

Levadopa/carbidopa
Deep brain stimulator
Ablation: destruction of affected part of brain

67
Q

Multiple sclerosis

A

Demyelinating disease of the CNS
T cells enter brain and cause inflammation, destroying myelin
Caused by virus

68
Q

Risk factors for multiple sclerosis

A

Smoking
Vit D deficiency
Epstein Barr exposure
Women 30-35 yrs

69
Q

Multiple sclerosis cause

A

Unknown
May be triggered by virus or northern climate

70
Q

What can multiple sclerosis lead to

A

Chronic inflammation
Demyelination of nerves
Scarring of CNS

71
Q

Multiple sclerosis s/sx

A

Initial: Poor coordination, loss of balance, double vision
Motor changes, sensory changes, cerebellar changes (nystagmus), changes in bowel/bladder/sexual function, cognitive changes, emotional changes

72
Q

Multiple sclerosis drugs

A

Muscle relaxants: Benzos, Baclofen, Dantrolene
CNS stimulants - for fatigue
Antiseizure drugs
Tricyclic antidepressants

73
Q

Multiple sclerosis complications

A

Urine retention - bladder training, avoid fluids at night, catheterization
Constipation - stool softeners, activity, high fiber/fluid diet

74
Q

Myasthenia Gravis patho

A

Antibodies attack acetylcholine receptors in nerve junctions
When nerves receive a signal they release ACH to stimulate muscle response
If there are no receptors, no signals get sent
Leads to weakness of voluntary muscles

75
Q

Myasthenia Gravis s/sx

A

Facial/eyelid droop
Flat affect
Dysphonia
Peek sign - after closing eyes the eyes open slightly to show sclera
May progress to respiratory failure

76
Q

Pharmacological tx for Myasthenia Gravis

A

Pyridostigmine bromide
IVIG - immune therapy
Plasmapheresis
Prednisone

77
Q

How does Pyridostigmine bromide work

A

Inhibits ACH breakdown
Reduces symptoms of MG

78
Q

Purpose of plasmaphersesis in myasthenia gravis tx

A

To remove antibodies to ACH

79
Q

Pyridostigmine bromide AE

A

Abdominal pain, diarrhea

80
Q

Prednisone use for myasthenia gravis and AE

A

Decreases overall immune response
AE: Leukopenia and hepatotoxicity

81
Q

Surgical tx for myasthenia gravis

A

Thymectomy: Reduces T cell production

82
Q

Myasthenic crisis

A

Exacerbation of MG symptoms
D/t extremely low ACH at neuromuscular junction from stressful event (URI, change in meds)

83
Q

S/sx of Myasthenic crisis

A

Extreme weakness
Double vision
Drooping eyelids

84
Q

Huntington’s disease

A

Chronic progressive hereditary disease
Results in choreiform (jerking or writhing) movements and dementia
- Death after 10-20 yrs of dx

85
Q

Huntington’s disease patho

A

Premature death of cells in the striatum of the:
Basal ganglia – leads to poor movement control
Cerebral cortex – defects in thinking, memory and judgement
Cerebellum – defects in coordination

86
Q

Huntington’s disease s/sx

A

Motor dysfunction: jerky movements
Cognitive impairments: attention deficits
Behavioral changes: apathy, blunt affect
Facial ticks
Slurred speech
Impaired swallowing
Disorganized gait

87
Q

Huntington’s disease dx

A

Family hx
S/sx
CAG repeats: polymorphic nucleotide repeats present in the androgen receptor gene

88
Q

Huntington’s disease meds

A

Benzos - control jerky movement
SSRI’s - psych symptoms
Antipsychotics - for late disease

89
Q

HIV Patho

A

It is a retrovirus: attacks T cells and reproduces
Decrease in immune function (opportunistic infections)

90
Q

How is HIV transmitted

A

Body fluids: Blood, semen, vaginal secretions, amniotic fluid, breast milk

91
Q

What populations are at risk for HIV

A

Injection drug users
Sex with HIV+
HIV infected blood or organ transplant
Needlesticks - healthcare workers

92
Q

How to prevent HIV

A

Condoms, dental dams, female condoms
Treat addictive disorders/mental health diagnoses
1 sexual partner
Early testing
No sharing blood contaminated items - razors, toothbrush
Pre-exposure prophylaxis - antiretroviral therapies

93
Q

Tx for healthcare worker exposed to HIV

A

Post-exposure prophylaxis (PEP)
2-3 antiretroviral regimen taken within 72 hours of exposure
Taken for 28 days

94
Q

Pneumocystis pneumonia

A

PCP
Serious lung infection that affects people with weakened immune systems

95
Q

Active TB tx

A

Four drug regimen:
Isoniazid, rifampin, pyrazinamide, and ethambutol
- Airborne precautions

96
Q

Empyema Question

A

Answer: Pneumonia

Med-Surg II (4 decks)

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