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test 1 Flashcards

1
Q

IV fluids – types and why they would be utilized

A

-Isotonic- lactated ringers, 0.9%
-Hypotonic- 0.45% saline- more fluid- too much sodium - hypernatremia
-Hypertonic- 3% saline, more particles- hyponatremia (common symptom is confusion)

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2
Q

sodium

A

135-145

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3
Q

hyponatremia

A

Loss of sodium, water gains that dilute ECF
*Diuretics, impaired aldosterone production
*Vomiting, Diarrhea, GI suctioning
*GI tubes irrigated with water instead of saline
*Manifestations: Headache, lethargy, confusion, convulsions, nausea / vomiting, coma
*Loop diuretics to promote isotonic diuresis
*Give 3% saline
*Restrict fluid

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4
Q

hypernatremia

A

*Sodium is gained in excess of water, or when water is lost in excess of sodium
*Manifestations: thirst, lethargy, weakness, agitation, irritability; can progress to seizures, coma, and death
oReduce sodium in diet
o0.45% saline

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5
Q

potassium

A

3.5-5.0

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6
Q

hypokalemia

A

*Causes inadequate potassium intake; excessive renal, intestinal, or skin losses; redistribution between the ICF and ECF
*Manifestations: weakness, lethargy, hyporeflexia, ST depression on EKG, PVCs, nausea and vomiting, constipation
*Diuretic causes low potassium
*Foods high in potassium= spinach, strawberries, orange, cantaloupe, potatoes
*NEVER GIVE POTASSIUM IV PUSH

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7
Q

hyperkalemia

A

*Causes: impaired renal excretion of potassium from untreated renal failure, adrenal insufficiency, acidosis (causes K to leave the cell)
*Manifestations: cramps, weakness, widened QRS complex, elevated T wave
o Kaexaylate- medication to get rid of excess potassium
oDextrose 50 + Regular insulin

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8
Q

calcium

A

8.4-10

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9
Q

hypocalcemia

A

oCauses: hypoparathyroidism, diarrhea, malnutrition, renal failure, chronic alcohol abuse
oManifestations: anxiety/ confusion, Tetany, Fractures/ irritability, seizures, Chvostek and Troussea signs positive
oLengthening QT interval -> risk for ventricular dysrhythmias
oTreat:
Give Calcium Gluconate IV (never IM or SQ- sloughing of tissue)
*Slowly= cardiotoxic and can cause BP to decrease
*Antidote: Magnesium sulfate IV

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10
Q

Hypercalcemia

A

oCauses: hyperparathyroidism and malignancies
oManifestations: dehydration, renal stones, confusion, severe thirst, polyuria, elevated BP
oParathyroid gland has an issue
oLasix to promote elimination of excess calcium
oCalcitonin to promote uptake of calcium into bones
oSodium phosphate/ potassium phosphate (calcium binds to phosphate, decreasing serum levels
oIsotonic fluids (promote fluid excretion- sodium and calcium excretion accompany one another)

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11
Q

magnesium

A

1.5-2.5

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12
Q

hypomagnesemia

A

oCauses= chronic alcoholism, protein-calorie malnutrition, diabetic ketoacidosis, kidney disease
oManifestations: (CNS depression) tremors, muscle twitching, weakness, excitability, tetany, seizures, tachycardia, PVCs
oCardiac dysrhythmias/ sudden death= hypokalemia + hypomagnesemia= digitalis toxicity

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13
Q

hypermagnesemia

A

oCauses: less common, but can occur with renal failure, especially if magnesium is administered
oManifestations: (CNS depression) Nausea and vomiting, weakness, drowsy, decreased DTRs, bradycardia, hypotension, coma, resp. failure

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14
Q

phosphate

A

2.5- 4.4

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15
Q

hypophosphatemia

A

Can indicate total body deficit or a shift of phosphate into the intracellular space
*Decreased GI absorption of excess renal excretion
*Manifestations: anorexia, weakness, muscle pain, Rhabdomyolysis

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16
Q

hyperphosphatemia

A

Causes: acute or chronic renal failure, rapid administration of phosphate- containing solutions, extensive trauma, heat stroke, or disruption of mechanisms that regulate calcium levels
Manifestations: possibly tetany with low calcium, muscle cramps, pain, muscle spasms

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17
Q

metabolic acidosis

A

*Caused by excess acid or loss of bicarbonate
oTissue hypoxia, diabetic ketoacidosis, acute or chronic renal failure
omanifestations: headache, weakness, fatigue, anorexia, nausea, vomiting, flushed skin, stupor, possible coma, dysrhythmias, cardiac arrest, deep and rapid respirations

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18
Q

metabolic alkalosis

A

*Caused by loss of acid or excess bicarbonate
oSecondary to hospitalization, hypokalemia
*Manifestations: muscle spasms, numbness, tingling, tetany, confusion, dizziness, depressed respirations, and possible respiratory failure
*Treatment: naturally body hypoventilates, retaining CO2; naturally kidneys increase renal excretion of bicarb; sodium chloride plus potassium chloride causes renal excretion of bicarb.

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19
Q

respiratory acidosis

A

*CO2 retention caused by hypoventilation
*Manifestations acute: headache, irritability, decreased level of consciousness, warm skin, blurred vision, cardiac arrest
*Manifestations chronic: weakness, dull headache, impaired memory, personality changes, sleep disturbances, daytime sleepiness
*Treatment: correct underlying cause; naturally kidneys retain bicarb which increases the pH; oxygen, BIPAP, ventilation; bicarb infusion if acidosis is severe

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20
Q

respiratory alkalosis

A

*Causes: anxiety with hyperventilation; high fever or hypoxia; gram- negative bacteria; thyrotoxicosis
*Manifestations: lightheadedness, tremors, tinnitus, panic feeling, difficulty concentrating, sensation of chest tightness, seizures and circumoral and distal extremity paresthesia
*Treatment: resolve underlying cause, severe- breathe in own CO2, sedate the patient

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21
Q

oxygenation methods

A

o Nasal Cannula- 6 L
 Low flow
o Face Mask
 Simple
 Partial rebreather
 Nonrebreather- O2 flow meter all the way up
o High flow
 Venture mask, aerosol mask, trach collar, high flow nasal cannula
o Noninvasive Positive Pressure Ventilation
 CPAP- same level going in and out
 BIPAP- bilevel positive air pressure, respiratory acidosis

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22
Q

oxygenation therapeutic methods

A

oIncentive Spirometry- expand lungs
oChest physiotherapy- break up mucous in lungs
oNebulizer treatment
oMechanical ventilation

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23
Q

fluid volume deficit

A

Decrease in intravascular, interstitial, and/or interstitial fluid in the body
Causes= vomiting, diarrhea, GI suctioning, hot environment, hemorrhage
Manifestations: rapid weight loss, decreased skin turgor and urine output, tachycardia, hypotension
Lab values: sodium, potassium, H/H, serum osmolality/ urine osmolality/ urine specific gravity- rises is kidney conserving water, BUN/ Creatinine
Management
*Treat underlying cause, oral fluids, isotonic solution, Reassess- pulmonary, renal, VS, Neuro

24
Q

fluid volume excess

A

Weight gain, swelling, cramping, shortness of breath, high blood pressure, heart failure
Management: daily weight, sodium/water intake, diuretics or dialysis,

25
Q

functions of the respiratory system

A

 Performs ventilation and respiration
 Acid-base balance
 Speech
 Sense of smell
 Fluid balance

26
Q

anatomy of resp system

A

Air travels through the upper respiratory system to the lower respiratory system
Upper respiratory system- nose, mouth, sinuses, pharynx, and larynx
Lower respiratory system- trachea and lungs

27
Q

physiology of resp system

A

inspiration, expiration, respieration

28
Q

dead space/ shunting

A

oNo gas exchange at that site
oAnatomical- no oxygenated blood going back to heart
oAlveolar- large clot in pulmonary artery, low perfusion

29
Q

ventilation/perfusion

A

ensures continuous delivery of oxygen and removal of carbon dioxide from the body

30
Q

assessment of resp system

A

oHistory of present illness
oFactors that exacerbate or improve symptoms
oHealth history- current meds, allergies, past medical history, previous surgeries, family history, occupation/ residence, smoking/ social history, recent travel
oPhysical assessment- inspect, palpate, percuss, auscultate

31
Q

normal lung sounds

A

Bronchial – loud, high-pitched sounds, hollow, longer during expiration than inspiration
Bronchiovesicular- medium pitch and intensity of sounds (tubular), heard anteriorly over primary bronchus from 1st to 2nd intercostal space, 1:1 ratio
Vesicular- soft, low pitched gentle sounds, heard over all areas of lungs except major bronchi; 3:1 ratio

32
Q

abnormal lung sounds

A

Crackles- short discrete, bubbling sound; pneumonia, bronchitis, CHF
Wheezes- continuous, musical sounds; bronchitis, emphysema, asthma
Friction rub- loud , dry creaking sounds; pleural inflammation

33
Q

arterial blood gases

A

determine oxygenation status

34
Q

pulse oximetry

A

utilizes wavelengths of light to measure saturation of hemoglobin with oxygen

35
Q

capnography

A

continuous, monitors pco2 in airway with written tracing

36
Q

capnometry

A

one time, measures co2 exhaled without continuous tracing

37
Q

sputum analysis

A

don’t need consent, check for microorganisms and/ or abnormal cell growth

38
Q

chest x-rays

A

don’t need consent, may identify lungs, heart, and pleural space problems

39
Q

pulmonary function test

A

do not need consent, evaluate lung volumes to determine function

40
Q

bronchoscopy

A

need consent, NPO, allows for direct visualization of the respiratory tract down to the level of the secondary bronchi

41
Q

thoracentesis

A

need consent, NPO, needle is inserted into the pleural space to remove a specimen or excess fluid/ air

42
Q

lung biopsy

A
  • need consent, NPO, small piece of lung tissue removed and analyzed under a microscope
43
Q

influenza

A

Highly contagious infection rapidly spread; 3 types = A, B, C
Pathophys=aerosolization of small droplets from infected individual’s sneezing and coughing. Direct contact with fomites inhaled and deposited on upper respiratory tract epithelial cells
Manifestations= more severe than a cold and come on quickly
Management- sampling of respiratory secretions for viral culture (10 days to provide confirmation), rapid influenza diagnostic tests, treatment directed toward prevention by annual vaccination

44
Q

pneumonia

A

Epidemiology- occurs at any time and at any age, 1/3 occurs in persons over 65 years of age, hospital acquired pneumonia develops after 48 hours of hospital admission
Pathophys- inflammation of lung parenchyma from bacterial, viral, or fungal infection
Mid to severe clinical manifestations: fever, chills, fatigue, tachypnea/ dyspnea, tachycardia, cough (productive or nonproductive), pleuritic chest pain, myalgia/ arthralgia
lab tests- ABG, CBC, sputum culture, CMP, chest xray
interventions: incentive spirometer, postural drainage
education- hand hygiene, take antibiotic fully

45
Q

rhinitis

A

Classification: allergic, non-allergic, acute, chronic
Allergic rhinitis treatment- allergy testing, avoidance of allergen, antihistamines (Benadryl, Zyrtec), Decongestants (Mucinex, rubatussin)
Non-allergic rhinitis treatment- nasal spray (corticosteroid), decongestants, possibly antibiotics
Nursing interventions: vital signs, nasal drainage, administer prescribed medication, educate on use of medications, avoid allergies, preventing spread of infection

46
Q

rhinosinusitis

A

Sinus infection
Involves inflammation of nasal and paranasal cavities
Classified as acute, subacute, and chronic
Symptoms: nasal drainage (colored or cloudy), nasal obstruction, facial pain or pressure, weakness, coughing
Treatment is based on the cause of infection
*Bacterial- antibiotics, analgesics, antipyretics, decongestants
*Viral- analgesics, antipyretics, decongestants
Nursing interventions: vital signs (mainly oxygenation), medications, examining patient for drainage, percuss sinuses, teaching moments: proper med administration, hand hygiene, report worsening symptoms

47
Q

obstructive sleep apnea

A

Condition where the upper airway becomes obstructed during sleep
At risk patients include obesity, atrial fibrillation, heart failure, type II diabetics
-Symptoms include excessive daytime sleepiness, snoring, observed periods of apnea
Treatment/ management- combined treatment (CPAP, weight management, oral appliances), those intolerant of CPAP or oral appliances may require surgical procedures
Nursing interventions: vital signs, risk assessment (stop bang), CPAP management, teaching moments: importance of taking prescribed medications, weight management

48
Q

Laryngitis

A

Inflammation of the mucous membranes of the larynx
Causes: infection, GERD, environmental pollutants, asthma inhalers, intubation
Symptoms: hoarseness, cough, fatigue, postnasal drip
 Stridor- extreme airway obstruction (high pitched wheeze)
Management/ treatment- rest and humidification, avoidance to smoking or environmental pollutants, bacterial infection: may require antibiotics, hoarseness continues after 5 day- malignancy may be a source
Interventions: vital signs, airway assessment, teaching moments- humidification, taking prescribed medications, voice rest, increase fluid intake

49
Q

laryngeal cancer

A

Cancerous tissue that resides on the larynx
Symptoms: voice changes, persistent sore throat, pain with swallowing, difficulty swallowing and eating, feeling of lump or mass in the neck
Cuffed vs uncuffed trachea
Treatment/management
*Dependence of severity: radiation, chemotherapy, surgery (laryngectomy)
*Tracheostomy
oCordectomy
oPartial laryngectomy
oTotal laryngectomy
Not able to speak, need tracheostomy
At risk for aspiration
Interventions: vital signs, airway management, administer prescribed medications, communication strategies, teaching moments: involve family, practice oral hygiene

50
Q

laryngeal trauma

A

Trauma that directly involves the larynx
Symptoms: dyspnea, dysphagia, hemoptysis
Check airway,
Diagnosis- inspection with swelling, discoloration
Management/ treatment- intubation, maintain airway, surgery
*head of bed 45 degrees or greater
*NPO
Interventions: vital signs, head elevation, humidification, teaching moments: symptoms of obstructed airway, limit talking (voice rest)

51
Q

Asthma

A

Chronic lung disease that affects the bronchial airways
Symptoms: wheezing, dyspnea, coughing, increased RR, increased HR, anxiety
Inability to speak in full sentences
Status Asthmaticus-asthma attack that wont stop
Treat with anti-inflammatories and inhaled corticosteroids (bronchodilators)
Management/ treatment
*Pulmonary function tests
oSpirometry- measures airflow and lung volumes
oForced expiratory volume- measures the amount of air forced out the lungs after one full inspiration (measured over 1 second)
oPeak expiratory flow- measures the maximum flow expired during forced expiration
oPulse oximeter
*Medications
oAnti-inflammatories, corticosteroids, bronchodilators
oNebulizer
*Control of environmental factors and triggers
*Interventions
oVital signs, respiratory assessment, tripod position, administer oxygen if needed, purse-lip breathing, teaching moments: importance of medication management, proper inhaler administration

52
Q

COPD

A

Third leading cause of death
Primary cause is smoking
Copd combination of emphysema and chronic bronchitis
Symptoms: increased work of breathing, shortness of breath, barrel chested wheezing
Management/ treatment
*Pulmonary function tests
*Four goals for COPD
oAssess and monitor the disease
oReduce modifiable risk factors
oManage stable COPD
oManage exacerbations
*Medications
oBronchodilators and anticholinergics
Nursing interventions: vital signs, assessing respiratory effort and rate, position in semi fowlers, oxygen needed if below 88%
*Teaching moments: smoking cessation, medication management, inhaler administration
Chronic Bronchitis
Emphysema

53
Q

cystic fibrosis

A

A genetic chronic disease that affects the lungs and digestive, affects glands
Survival rate is mid 30s
Symptoms: coughing, wheezing, inflammation in nasal passages, repeated lung infections, severe constipation
Management/ treatment
*Clearing airway secretions (postural drainage/ chest physiotherapy)
*Anti-inflammatory
*Antibiotics
*CFTR modulators
*Pancreatic enzymes
*Lung transplant
Interventions: vital signs, oxygenation, administration of medications, teaching moments: airway clearance techniques, importance of taking medications, nutritional supplements

54
Q

lung cancer

A

Uncontrolled growth of abnormal cells in the lungs
*Non-small cell
*Small cell
Symptoms: vary based on advancement of disease : chronic cough, bloody sputum, SOB, wheezing, chest pain, weight loss
Management/treatment
*Surgical treatment – no metastasis
oLobectomy- removing entire lobe of lung
oPneumonectomy- removal of entire lung
oWedge resection- removal of small section of lobe
*Chemotherapy
*Radiation
*Palliative care
Interventions
*Vital signs, oxygenation, oxygen therapy, pain control (help them breathe), possible chest tube management, teaching moments- smoking cessation, use of medications

55
Q

Tuberculosis

A

oEpidemiology- potentially life-threatening respiratory infection, 1/3 of world’s population
oPathophys- transmitted by aerosolized droplets inhaled from the coughing or sneezing of an infected individual, can remain suspended in air for several hours
oMeds- 6 mos to 1 year
oClassifications
Latent tb infection
Primary tb infection
Primary progressive tb infection
Drug resistant tb
oManagement
Diagnosis by lab testing, skin test, and chest x-ray
Mantoux tuberculin skin test
Treatment goal to cure patient and minimize exposure

adult health (1 decks)

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