test 1 Flashcards
IV fluids – types and why they would be utilized
-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)
sodium
135-145
hyponatremia
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
hypernatremia
*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
potassium
3.5-5.0
hypokalemia
*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
hyperkalemia
*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
calcium
8.4-10
hypocalcemia
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
Hypercalcemia
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)
magnesium
1.5-2.5
hypomagnesemia
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
hypermagnesemia
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
phosphate
2.5- 4.4
hypophosphatemia
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
hyperphosphatemia
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
metabolic acidosis
*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
metabolic alkalosis
*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.
respiratory acidosis
*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
respiratory alkalosis
*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
oxygenation methods
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
oxygenation therapeutic methods
oIncentive Spirometry- expand lungs
oChest physiotherapy- break up mucous in lungs
oNebulizer treatment
oMechanical ventilation
fluid volume deficit
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
fluid volume excess
Weight gain, swelling, cramping, shortness of breath, high blood pressure, heart failure
Management: daily weight, sodium/water intake, diuretics or dialysis,
functions of the respiratory system
Performs ventilation and respiration
Acid-base balance
Speech
Sense of smell
Fluid balance
anatomy of resp system
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
physiology of resp system
inspiration, expiration, respieration
dead space/ shunting
oNo gas exchange at that site
oAnatomical- no oxygenated blood going back to heart
oAlveolar- large clot in pulmonary artery, low perfusion
ventilation/perfusion
ensures continuous delivery of oxygen and removal of carbon dioxide from the body
assessment of resp system
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
normal lung sounds
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
abnormal lung sounds
Crackles- short discrete, bubbling sound; pneumonia, bronchitis, CHF
Wheezes- continuous, musical sounds; bronchitis, emphysema, asthma
Friction rub- loud , dry creaking sounds; pleural inflammation
arterial blood gases
determine oxygenation status
pulse oximetry
utilizes wavelengths of light to measure saturation of hemoglobin with oxygen
capnography
continuous, monitors pco2 in airway with written tracing
capnometry
one time, measures co2 exhaled without continuous tracing
sputum analysis
don’t need consent, check for microorganisms and/ or abnormal cell growth
chest x-rays
don’t need consent, may identify lungs, heart, and pleural space problems
pulmonary function test
do not need consent, evaluate lung volumes to determine function
bronchoscopy
need consent, NPO, allows for direct visualization of the respiratory tract down to the level of the secondary bronchi
thoracentesis
need consent, NPO, needle is inserted into the pleural space to remove a specimen or excess fluid/ air
lung biopsy
- need consent, NPO, small piece of lung tissue removed and analyzed under a microscope
influenza
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
pneumonia
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
rhinitis
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
rhinosinusitis
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
obstructive sleep apnea
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
Laryngitis
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
laryngeal cancer
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
laryngeal trauma
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)
Asthma
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
COPD
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
cystic fibrosis
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
lung cancer
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
Tuberculosis
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
