Study Guide Flashcards
What to do when physician removes chest tube
Tell pt to perform valsalva maneuver and bear down
When to contact physician for chest tubes
Bubbling increases over time
Bubbling returns after having stopped
Output more than 100-150mL/hr
K normal range
3.5-5.5
Calcium normal range
8.5-10.5
Magnesium normal range
1.5-2.0
Atelectasis
Alveolar collapse due to obstruction
S/Sx of Atelectasis
Increased work of breathing - dyspnea
Decreased breath sounds
Crackles
Hypoxia
Tx for atelectasis
Remove secretions
Frequent turning, early ambulation, lung volume expansion (incentive spirometer), deep breathing, coughing
Surgical/procedural tx for atelectasis
Endotracheal intubation, mechanical ventilations = last resort
Thoracentesis
Pneumonia patho
Movement of WBC’s into alveoli leads to perfusion issues
Development of thick sputum leads to ventilation issues
Community-Acquired Pneumonia
Pt that have not been hospitalized/lived in long-term care within 14 days
Hospital-Acquired Pneumonia
Begins 48 hours+ after hospital admission
Ex. Ventilator-associated pneumonia (VAP)
Tx for bacterial pneumonia
Abx
Aspiration pneumonia
Entry of material from mouth into trachea/lungs
Necrotizing pneumonia
Rare complication
Lung tissue turns into thick/ liquid mass
Opportunistic pneumonia
Occurs in immunocompromised pts
- Malnutrition, HIV, chemotherapy
Risk factors for pneumonia
Smoking, COPD, immobility, depressed cough, NGT/other drains, old age, aspiration risks
How is pneumonia dx
S/sx, CXR, blood cx, sputum cx, bronchoscopy
S/sx of pneumonia
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
Infection goal of care
Remove bacteria and clear purulent drainage/sputum
Nursing interventions to promote airway clearance
Oxygen therapy - continuous SpO2 (humidified)
Hydration
Chest PT (physiotherapy)
- Inventive spirometer, cough and deep breath (IS/CDB)
NT (nasotracheal) suction
Nursing interventions for infection (lung infection/pneumonia)
Sputum culture
Abx administration
- Should be working by 48-72h
- Not for viral infections, but could be used for secondary bacterial infection
Medications for pneumonia
Antipyretics
Cough suppressants
Mucolytics
Long-term interventions for pneumonia
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
Post thoracentesis nursing interventions
Monitor HR and BP
Monitor for pneumothorax
Tension (spontaneous) pneumothorax
Accumulation of air in the pleural space under pressure, compressing the lungs and decreasing venous return to the heart
Iatrogenic pneumothorax
Traumatic pneumothorax secondary to an invasive procedure or surgery
S/SX of closed pneumothorax
Sudden pain
Tachypnea, air hunger, accessory muscle use
Absent breath sounds
Tracheal shift
Hypotension
Jugulovenous distention (JVD) - thoracic pressure
Hypoxemia - can lead to cyanosis
Tx for closed pneumothorax
Cover with vent dressing
Chest tube
Tx and interventions for ineffective airway clearance
IS/CDB
Suctioning
Bronchoscopy
Positioning - “good” lung down so “bad” lung can drain
Monitory for s/sx of pneumonia
How is TB contracted
Through air, person to person
Mostly effects immunocompromised
S/x of tuberculosis
High fever, chills, flu-like symptoms
Extrapulmonary TB (outside of lungs)
BCG vaccine
Bacillus Calmette–Guérin
Recommended for infants born in countries with high prevalence of TB - Africa, Asia, Eastern Europe
BCG vaccine side effects
Swollen lymph nodes
Fever (mild)
Headache
Injection site reactions
TB precautions
Airborne isolation with HEPA filter
Pt must wear surgical mask outside of room
Rifampin nursing considerations
Tx for TB
Orange urine/secretions
Liver failure - AE
Decreases hormonal birth control effectiveness
Risk factors for pulmonary embolism (PE)
DVT
Immobility, Surgery
Obesity, Smoking
HF, A fib
Pregnancy
Clotting disorders
Fx of long bones
Risk factors for head and neck cancer
Tobacco, ETOH, environmental exposure, HPV, over 50 men
Dx for head and neck cancer
Laryngoscopy with biopsy of tumor
CT/MRI
Barium swallow
Pharyngoscopy and laryngoscopy
Head and neck cancer tx
Surgery - first line
- Stage 1&2: Partial laryngectomy
- Stage 3&4: Total laryngectomy
Radical neck dissection
Radiation therapy
Radical neck dissection
Removal of:
All cervical lymph nodes
Sternocleidomastoid muscle
Internal jugular vein
Spinal accessory muscle
- Tx for severe head/neck cancers
Normal amount of drainage from JP drain
80-120 mL in first 24 hours
Central venous pressure
Measures the amount of blood returning to the right atrium
- Decreased if blood volume is decreased
Normal range: 2-8, 8-12(?)
Guillan Barre
Autoimmune disorder that destroys myelin on nerve cells
Causes of Guillan Barre
Viral infection: Flu, mycoplasma, HIV/Epstein Barr, campylobacter (GI bug)
Guillan Barre s/sx
Paresthesia of hands/feet
Weakness of respiratory muscles
Can progress to blindness and dysphagia
No change in cognitive status
Guillan Barre dx
Lumbar puncture or electromyelogram
Tx of Guillan Barre
No tx - supportive measures until myelin regenerates
IVIG and plasmapheresis - reduces s/sx length
Monitor respiratory status
PT/OT for mobility
Primary concerns for Guillan Barre
Altered breathing pattern
- Decrease in ventilation
Impaired swallowing - nutrition
Physical mobility
Autonomic dysfunction - controls bradycardic responses, rapid changes in VS
First symptoms of Guillan Barre
Can’t feel middle finger
Feet feel funny
Can no longer lift 20lb box
Falling
Hypersensitivity Reaction Type 1
Allergic response. IgE mediated
Histamine release, itchy eyes, runny nose, rashes, edema, anaphylaxis
Hypersensitivity Reaction Type 1 examples
Nasal allergic rhinitis or hay fever
Hives, atopic eczema, or erythema
Angioedema
Asthma
Anaphylaxis
Passive immunity
Receiving antibodies rather than making them
- Ex. Globulin injection, mother’s breast milk
Anaphylaxis s/sx
Tingling hands, flushing, oral swelling
Warm sensation, nasal congestion, periorbital swelling, difficulty swallowing, wheals
Anaphylactic shock s/sx
Bronchospasm
Laryngeal edema
Dyspnea
Hypotension
Cyanosis
Anaphylaxis tx
Epinephrine
Supplemental O2 with cooled water
Advanced airway
IV antihistamines
Corticosteroids
Anaphylaxis tx
Epinephrine
Supplemental O2 with cooled water
Advanced airway
IV antihistamines
Corticosteroids
Atopic reactions
Most common type 1 hypersensitivity
AKA seasonal/environmental allergies
Ex. Hay fever
Atopic reaction s/sx
Allergic rhinitis
Atopic dermatitis
Urticaria - hives
Angioedema
Atopic dermatitis
Type 1 hypersensitivity
Atopic dermatitis tx
Avoid cause
Topical corticosteroid creams
NSAID’s
Skin moisturizer
Parkinson’s disease
Slow, progressive neurologic movement disorder due to decreased dopamine levels
- Unknown cause
Parkinson’s risk factors
Increased incidence with age
More common in men 3:2
Well water, pesticides, rural residence
Parkinson’s characteristics
Tremor
Rigidity
Bradykinesia, akinesia
Postural instability
Hypokinetic dysarthria (speech abnormalities)
Dx of Parkinson’s
4 symptoms + responds to pharm therapy
Presence of Lewy bodies: protein deposits in the brain
Parkinson’s tx
Levadopa/carbidopa
Deep brain stimulator
Ablation: destruction of affected part of brain
Multiple sclerosis
Demyelinating disease of the CNS
T cells enter brain and cause inflammation, destroying myelin
Caused by virus
Risk factors for multiple sclerosis
Smoking
Vit D deficiency
Epstein Barr exposure
Women 30-35 yrs
Multiple sclerosis cause
Unknown
May be triggered by virus or northern climate
What can multiple sclerosis lead to
Chronic inflammation
Demyelination of nerves
Scarring of CNS
Multiple sclerosis s/sx
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
Multiple sclerosis drugs
Muscle relaxants: Benzos, Baclofen, Dantrolene
CNS stimulants - for fatigue
Antiseizure drugs
Tricyclic antidepressants
Multiple sclerosis complications
Urine retention - bladder training, avoid fluids at night, catheterization
Constipation - stool softeners, activity, high fiber/fluid diet
Myasthenia Gravis patho
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
Myasthenia Gravis s/sx
Facial/eyelid droop
Flat affect
Dysphonia
Peek sign - after closing eyes the eyes open slightly to show sclera
May progress to respiratory failure
Pharmacological tx for Myasthenia Gravis
Pyridostigmine bromide
IVIG - immune therapy
Plasmapheresis
Prednisone
How does Pyridostigmine bromide work
Inhibits ACH breakdown
Reduces symptoms of MG
Purpose of plasmaphersesis in myasthenia gravis tx
To remove antibodies to ACH
Pyridostigmine bromide AE
Abdominal pain, diarrhea
Prednisone use for myasthenia gravis and AE
Decreases overall immune response
AE: Leukopenia and hepatotoxicity
Surgical tx for myasthenia gravis
Thymectomy: Reduces T cell production
Myasthenic crisis
Exacerbation of MG symptoms
D/t extremely low ACH at neuromuscular junction from stressful event (URI, change in meds)
S/sx of Myasthenic crisis
Extreme weakness
Double vision
Drooping eyelids
Huntington’s disease
Chronic progressive hereditary disease
Results in choreiform (jerking or writhing) movements and dementia
- Death after 10-20 yrs of dx
Huntington’s disease patho
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
Huntington’s disease s/sx
Motor dysfunction: jerky movements
Cognitive impairments: attention deficits
Behavioral changes: apathy, blunt affect
Facial ticks
Slurred speech
Impaired swallowing
Disorganized gait
Huntington’s disease dx
Family hx
S/sx
CAG repeats: polymorphic nucleotide repeats present in the androgen receptor gene
Huntington’s disease meds
Benzos - control jerky movement
SSRI’s - psych symptoms
Antipsychotics - for late disease
HIV Patho
It is a retrovirus: attacks T cells and reproduces
Decrease in immune function (opportunistic infections)
How is HIV transmitted
Body fluids: Blood, semen, vaginal secretions, amniotic fluid, breast milk
What populations are at risk for HIV
Injection drug users
Sex with HIV+
HIV infected blood or organ transplant
Needlesticks - healthcare workers
How to prevent HIV
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
Tx for healthcare worker exposed to HIV
Post-exposure prophylaxis (PEP)
2-3 antiretroviral regimen taken within 72 hours of exposure
Taken for 28 days
Pneumocystis pneumonia
PCP
Serious lung infection that affects people with weakened immune systems
Active TB tx
Four drug regimen:
Isoniazid, rifampin, pyrazinamide, and ethambutol
- Airborne precautions
Empyema Question
Answer: Pneumonia
