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NURSING 220 > TEST 2 > Flashcards

TEST 2 Flashcards

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1
Q

what is important to know about simple masks

A

5-10 LPM
30-55% FiO2 (not exact)
can be humidified
must have 5+ LPM to prevent rebreathing

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2
Q

uses and contraindications of simple mask

A

uses- non acute situation
mild hypoxia

contraindications- needs below 5LPM
acute respiratory distress
Severe hypoxia

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3
Q

what is important to know about non-rebreather mask

A

10-15 LPM (high flow)
80-100% FiO2
unable to be humidified
reservoir bag MUST be inflated

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4
Q

Uses and contraindications of non-rebreather mask

A

uses- acute respiratory distress
short term high oxygen needs

contraindications- long term use

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5
Q

what is important to know about venturi mask

A

2-15 LPM
24-50% FiO2
prevents over oxygenation
different colors designed for exact FiO2
can be humidified

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6
Q

uses and contraindications of venturi mask

A

uses- underlying lung disease
contraindications- O2 needs over 50% FiO2

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7
Q

what is important to know about nasal cannula

A

1-6 LPM
24-45% FiO2
can be humidified

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8
Q

uses and contraindications of nasal cannula

A

uses- non acute situation
mild hypoxia
mouth breathing

contraindications- acute resp distress
severe hypoxia
mouth breathing

** i dont understand how mouth breathing is a use and a contraindication but thats what her poster says)

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9
Q

what is important to know about trach masks

A

5-15 LPM
35-90% FiO2
minimum of 5L required to prevent rebreathing
must be humidified
if O2 is not needed, compressed air with humidification is used

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10
Q

uses and contraindications of trach masks

A

uses- delivery of humidification and O2
for trach patients (duh??)

contraindications
patients without a trach (is this a joke)

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11
Q

what is important to know about 1/2 mask/face tent/shovel mask and what are the uses

A

5-15 LPM
35-50% FiO2
uses- delivery of higher amounts of humidification
postop oral/nasal surgery

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12
Q

Risk factors for TB

A

close contact with someone w/ active tb
immigration from other countries w/ a high prevalence(southeast asia, africa)
institutionalism (close proximity)
living in overcrowded, substandard housing
caring for immunosuppressed patients
exposure during high risk procedures

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13
Q

what groups of people are at risk for tb

A

immunocompromised (most at risk)
substance abusers
inadequate healthcare( homeless, minorities)
pre-existing medical conditions

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14
Q

clinical manifestations of tb

A

Cough lasting 3 weeks or longer
Hemoptysis
Sputum production
Weakness
Fatigue
Anorexia, weight loss
Low-gradefever, chills
Night sweats
Pleuritic chest pain

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15
Q

how is tb diagnosed

A

mantoux test (PPD)- skin test
ntiFERON-TB Gold (QFT-G)- blood test
sputum smear- Presence of AFB(acid fact bacteria) on a sputum smear may indicate disease but does not confirm the diagnosis
sputum culture- gold standard for diagnosis
chest x ray- lesions will be visible
ct thorax- show extent of damage to lung tissue
CBC- elevated WBC

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16
Q

non pharmacological treatment for tb

A

rest initially
well balanced high calorie diet
smoking cessation

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17
Q

pharmacological treatment for tb

A

pulmonary tb- Anti-TB agents (antibiotic) 6 to 12 months
administer humidified oxygen as prescribed

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18
Q

what are the most common tb antibiotics

A

rifampin(RIF)
isoniazid (INH)
pyrazinamide(PZA)
ethambutol(EMB)
all are bactericidal but work on different parts of bacilli
remember RIPE for the meds names

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19
Q

what is tb

A

Primarily infection of lung parenchyma
-Leads to impaired gas exchange
-May be transmitted and infect other areas of the body: meninges, kidneys, bones, lymph nodes and GI tract.
- infectious agent is M. tuberculosis

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20
Q

what do we teach patient to report with each tb antibiotic
rifampin(RIF)
isoniazid (INH)
pyrazinamide(PZA)
ethambutol(EMB)

A

rifampin(RIF)- orange urine/secretions, report jaundice, pain, swelling joints, anorexia, malaise
isoniazid (INH)- report s/s of hepatotoxicity, jaundice, malaise, anorexia, nausea, fatigue
pyrazinamide(PZA)-report jaundice, pain, swelling joints, anorexia, malaise
ethambutol(EMB)- report changes in vision

rifampin & pyrazinamide have the same s/s to report

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21
Q

what is the medication regimen for newly diagnosed active tb

A

all 4 oral antibiotics for the first 2 months
followed by an additional 4 months of rifampin and isoniazid

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22
Q

what is primary drug resistance in regards to tb

A

Resistance to one of the first line anti-TB agents in people who have not had previous treatment

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23
Q

what is secondary or acquired drug resistance in regards to tb

A

Resistance to one or more anti-TB agents in patients undergoing therapy

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24
Q

what is multidrug resistance in regards to tb

A

Resistance to two agents, isoniazid (INH) and rifampin. The populations at greatest risk for multidrug resistance are those who are HIV positive, institutionalized, or homeless.

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25
Q

what is DOT

A

direct observation therapy-Evidence is finding that meds can be given 3X /wk with DOT and not have any difference in outcomes

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26
Q

what are some tb medication considerations

A

Crosses placental barrier
Hepatotoxicity
Audiometric testing
Compliance- difficult
Evaluate at follow up visits
Non compliance

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27
Q

nursing interventions for tb ( acute and continuing)

A

acute- Promote Airway Clearance/Secretions
Prevent Transmission
-Airborne precautions
-Negative pressure room
-Patient education

Continuing
Promote Treatment Adherence
-Multiple-medication regimen complex,
-Many side effects
Promote Activity and Adequate Nutrition
Prevent Transmission
-Patient & family education

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28
Q

classifications of pneumothorax

A

1.Spontaneous
-Primary - no identifiable pathology
-Secondary - underlying pulmonary disorder
2.Traumatic
-Blunt or penetrating thoracic trauma
3.Iatrogenic
-Postoperative
-Mechanical ventilation
-Thoracentesis
-Central venous cannulation
4.Tension pneumothorax
-Build up of pressure in thorax
-Compresses heart and great vessels
-Medical Emergency!!!!

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29
Q

symptoms of pneumothorax

A

Most common acute pleuritic chest pain
Dyspnea from pulmonary compression
Symptoms proportional to size of the pneumothorax
Depend on the degree of pulmonary reserve
Physical signs include: tachypnea, increase resonance, absent breath sounds

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30
Q

treatments for pneumothorax

A
  1. conservative watch & evaluate
    -15-25% pneumothorax
    -Resolves about 1.25% per day
    -Supplemental O2 can increase resolution
  2. chest tube
    ->25% pneumothorax
    -Result of mechanical ventilation
  3. thoracic vent
    -option for smaller pneumothorax
    -able to go home
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31
Q

what are the stages of HIV

A

Stage 1
-Lack of AIDS defining condition
-CD4 count higher than 500cells/ml or
-Total lymphocytes over 29%
Stage 2
-Lack of AIDS defining condition
-CD4 count between 200 and 499 cells/ml or
-Total lymphocytes between 14-28%
Stage 3: AIDS:
-Presence of AIDS defining condition or
-CD4 lower than 200 cells/ml or
-Total lymphocytes less than 14%

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32
Q

HIV patient education

A

Reduce the number of sexual partners to one
Always use latex condoms; do not reuse
Use dental dams for oral-genital or anal stimulation
Avoid anal intercourse
Do not ingest urine or semen
Non-penetrative sexual activities
Don’t share: needles, razors, toothbrushes, sex toys
Abstinence
Mutually monogamous relationships

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33
Q

diagnostic tests for HIV

A

-Point of Care HIV testing (formally Rapid)- usually results in 30-60 minutes; not always accurate
-Further testing to confirm reactive test-used when POC HIV is positive- Enzyme-linked immunosorbent assay (ELISA)
-Western blot antibody testing-More reliable than ELISA,More expensive,Takes longer
-HIV viral load tests-Measures amount of actively replicating HIV
-CBC
-CD4 cell count- monitors progress of disease

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34
Q

HIV pharmacology treatment

A

highly active antiretroviral therapy (HAART)- combines 3-4 drugs
protease inhibitors
most of these drugs end in -vir
* there is a slide with a handful of meds but i wrote we are not tested on them*

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35
Q

what drugs are given to patients at high risk for being infected with HIV

A

truvada
descovy
dapivire

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35
Q

what drugs are given to patients at high risk for being infected with HIV

A

truvada
descovy
dapivire

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36
Q

what kind of precautions is a patient with HIV on

A

standard

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37
Q

what is acute stress disorder

A

A reaction to an event causing fear, hopelessness, and horror, starts soon after event lasting about 1 month

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38
Q

what is ptsd

A

A disturbing patter of behaviors by someone who experienced, witnessed or has been confronted with a traumatic event

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39
Q

what is adjustment disorder

A

A reaction to a stressful event that causes problems for the individual

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40
Q

what is dissociation

A

A subconscious defense mechanism that helps protect a person from experiencing the full effects of some horrific or traumatic events

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41
Q

symptoms of acute stress disorder

A

Loss of event recollection
Absent emotional response
Reliving event via flashbacks
Dissociation and Depersonalization
Increased irritability
Issues with sleep

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42
Q

what is a maturational/developmental crisis

A

Expected naturally occurring in life
ex. leaving for college

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43
Q

what is a situational crisis

A

sudden in nature, unanticipated
ex loss of job/spouse

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44
Q

what is a adventitious/ social crisis

A

natural disasters

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45
Q

risk factors for PTSD

A

Directly involved in traumatic event
Experience physical injury
Loss of loved one(s)
Lack of social supports
Previous psychiatric hx , family psych hx(esp. anxiety) or personality factors
Early separation from parents
Parental poverty
Childhood behavioral problems
Abuse in child hood
Adverse life events prior to trauma
Limited education
Female

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46
Q

ptsd diagnostic criteria

A

symptoms grouped in clusters:
A.Exposure to threat
B.Intrusion symptoms
C.Avoidance of stimuli
D.Negative mood and cognitive association with the event
E.Changes in arousal and reactivity
F.Duration of symptoms of B,C,D,E > 1 month
G.Clinical distress is noted
H.Distress not attributed to physiological disorder or substance

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47
Q

what is involved in ptsd assessment

A

-History of trauma/stress/abuse
-Observation of patient(appearance, behaviors etc)
-mood and affect range
-thought process/content (nightmares, hallucinations)
- sensorium/intellectual processes (memory gaps, poor decisions)
-roles/relationships (issues with)
-physiologic concerns(change in sleep, appetite, drug use)

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48
Q

therapeutic interventions for ptsd

A

-Focus on improving self-esteem & promote empowerment
-Refer to patient as a “Survivor” not victim
-Keep conversations/interactions structured
-Monitor use of humor and abstract conversations
-Assess for comorbidities
-Help Identify flashback triggers
-Reassure them they are safe during traumatic flashbacks
-Help with problem solving
-Watch for self harm behaviors
-Remind about past achievements
-Help to identify helpful defense mechanisms

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49
Q

ptsd treatments

A

psychotherapy
meds
self help groups
behavioral therapies
mental health promotion

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50
Q

ptsd medications

A

antidepressants:
SSRIs- Sertraline (Zoloft)
Paroxetine (Paxil)
Fluoxetine (Prozac)

SNRIs- Venlafaxine (Effexor)
Duloxetine (Cymbalta)

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51
Q

Normal respirations for newborns

A

30-60

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52
Q

normal respirations for infants

A

20-40

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53
Q

normal respirations for toddlers

A

20-30

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54
Q

normal respirations for elderly

A

12-24

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55
Q

normal respiratory physiology

A

Hypercarbia drives breathing
-Receptor sites in aortic arch

Requirements for normal O2 delivery
-Inflated, well-oxygenated alveolus
-Alveoli capillary association
-Free-flowing blood and adequate BP

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56
Q

Normal Ventilation/ Normal Perfusion

A

Intact breathing, oxygenation, perfusion;
If dyspnea present,
non-cardiopulmonary, ex neuromuscular

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57
Q

Inadequate Ventilation/Normal Perfusion

A

Reduced ventilation (into alveoli) to lungs
*Unoxygenated blood moves through heart into systemic circulation
*Obstruction in distal airways
*Pneumonia
*Atelectasis
*Tumor
*Mucus plug
*COPD
*Asthma
*Alveoli have collapsed or fluid filled

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58
Q

Normal Ventilation/ Inadequate Perfusion

A

Blood flow not able to reach capillaries to exchange
*Low cardiac output poor blood flow through capillaries
*Pulmonary hypertension
*Pulmonary Emboli

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59
Q

Inadequate Ventilation/ Inadequate Perfusion

A

Little or no ventilation and perfusion are present
*ARDS

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60
Q

alterations in oxygenation in infants due to their altered physiology

A

their airway diameter

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61
Q

alterations in oxygenation in elderly due to their altered physiology

A

DECREASED
-cough reflex
-Cilia
-Elasticity
-Chest wall movement
-Exercise
INCREASED
-Infection rate
-Chronic disease
-Kyphosis

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62
Q

Short Acting Beta Agonists
(for airway constriction)

A

-Albuterol
-Levalbuterol

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63
Q

Long Acting Beta Agonists
(for airway constriction)

A

-Serevent (Salmeterol)
-Foradil (Formoterol)

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64
Q

Long Acting Beta Agonists/ Corticosteroid combination
(for airway constriction)

A

-Symbicort (Formeterol-Budesonide)
-Advair (Salmeterol-Fluticasone)

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65
Q

Corticosteroids

A

-Short acting Oral/IV- Prednisone/ Solu-Medrol (Methylprednisolone)
-Long acting inhaled- Pulmicort (Budesonide)/ Asmanex (Mometasone)

66
Q

Anticholinergics

A

-Atrovent (Ipatroprium)
-Spiriva (Tiotropium)

67
Q

Xanthines

A

-Aminophylline (Theophylline)

68
Q

ABG’s

A

PH, PaCO2, HCO3, PaO2, SaO2

69
Q

normal PaCO2

A

35-45

70
Q

normal HCO3

A

22-26

71
Q

normal PaO2

A

80-100
(less than 80 is hypoxemia)

72
Q

normal SaO2

A

95-100
(less than 95% is hypoxia)

73
Q

Positive Communication

A

-“Before I go, do you have any questions?”
-“I brought this blanket, so you’ll stay warm during your radiology test.”
-“For your privacy, I’m closing this door.”
-“Is this a good time to…?”
-“Can you reach everything?”
-“Can I help you with that?”

74
Q

Negative Communication

A

-“It’s not my job…it’s not my problem.”
-“We’re short staffed.”
-“I can’t believe they kept you waiting so long.”
-“No one told me you were here.”
-“We have REAL emergencies ahead of you.”
-“You know how administration is around here.”

75
Q

Assertive Communication

A

-“I” statements
-Repetition
-Confidence
-Managing nonverbal communication
-Thinking before speaking
-Avoiding apologizing whenever possible
-Performing a post conversation evaluation

76
Q

Aggressive Communication

A

-Is negative
-It violates the rights of
people
-Not based on caring
-Often involves anger,
yelling
-Achieves short term
results

77
Q

Passive Communication

A

-Usually done to placate
-Causes negative feelings
-Continues until the passive person is overwhelmed
-Sometimes is seen in abusive relationships

78
Q

types of conflict

A

-Intrapersonal: Internal conflict
-Interpersonal: Between individuals
- Intergroup: Between different groups or departments
-Organizational: Within an organization

79
Q

Informal Leaders

A

-Respected for wisdom &
willingness to share it
-Role model for excellent
leadership
-Quietly lead care team
-High standards of performance
-No official title or office
-The go to person
-Power is earned

80
Q

Formal Leaders

A

-Responsible to anticipate the changes in health care systems and to lead the organization to success
-Little room for error
-Identifies, seeks out informal leaders
-Establishes a positive relationship with informal leaders

81
Q

Effective Leaders

A

They are expert at making people feel good about their jobs and their work environment
-Constancy
-Congruity
-Reliability
-Integrity

82
Q

Autocratic Leadership

A

-Task oriented
-Makes decisions for the group
-Motivates through
-Praise
-Blame
-Reward
-Best leader in an emergency
-Issues commands, not requests
-Maslow
-One way: top down

83
Q

Democratic Leadership

A

-Focuses on individual
-Uses group process
-Likely to give suggestions, share info
-Emergencies pose problem
-Usually no power struggles
-Maslow
-Two way: giving-seeking

84
Q

Laissez-Faire

A

-Refuses to assume the leadership role
-Workers have no supervision, direction
-No praise, criticism, feedback, info
-Frustrating situation for all employees
-Chaos in the system
-Maslow
-Little communication with employees

85
Q

Paradigm

A

A paradigm is a box or rules that restrict or
constrict our thoughts and beliefs.
-A Paradigm shift
-Changing the way we look at things
-A challenge to one’s views, perceptions or beliefs
-Like rewriting a fairy tale or nursery rhyme

86
Q

Lewin’s Theory: Unfreezing

A

-Educating about the planned change
-What, Why
-Decreases resistance against “threat”
-2 rules with unfreezing
-Don’t implement until unfreezing occurs
-Provide psychological safety everyone involved

87
Q

Lewin’s Theory: Change

A

-Change happens
-Mistakes can be made
-Provide support
-View as a learning experience
-Managers need to express appreciation
-Combat resistance!

88
Q

Lewin’s Theory: Refreezing

A

-Environment stabilizes
-Change integrated
-Policies & procedures related to change
are imbedded
-Refreezing in the new reality
-Change becomes new comfort zone

89
Q

Delegation Per the American Nurses Association (ANA)

A

“….reassigning a responsibility for the performance
of a job from one person to another.
-“It is crucial to understand that states have different
laws and rules/regulations about delegation, and it is
the responsibility of all licensed nurses to know what
is permitted in their state (NCSBN, 2017)

90
Q

Delegation vs. Supervision

A

-They are not the same!!!!
-Supervision is directly overseeing the work or
performance of another
-May supervise and delegate tasks and activities

91
Q

Qualities of a leader

A

Empathy Caring Respectful Initiative
Positive
Attitude
Problem
Solver
Critical
Thinker
Self
Directed
Confident Energetic

92
Q

Transformational
Leadership

A

-Guides staff by inspiring followers
-High level of engagement enhances satisfaction
- Promotes positive work environment
-Decreases staff turn over
-Reward good performance
-Correct bad performance
-Self-confident, self-directed, honest, loyal,
committed
-Empowers staff

93
Q

Management behaviors and qualities

A

Behaviors: Interpersonal, Decisional, Informational activities

Qualities: Leadership skills, Clinical expertise, Business sense

94
Q

Vicarious PTSD

A

Also called: Trauma exposure response, Compassion fatigue, Secondary traumatic stress disorder, Empathic strain

who is being diagnosed?* Could be anyone who is exposed to human suffering
-Veterinarians
-Animal rescue workers
-Biologists
-Ecologists

95
Q

PTSD Education

A

Goals:
-Patients are able to identify symptoms of anxiety
-Patients know when to notify provider of increased
symptoms
-Patients understand medication
-Patients have access to different coping strategies

96
Q

Trauma/Abuse Treatment Outcomes

A

The client will:
-Be physically safe
-Distinguish between ideas of self-harm and taking
action on those ideas
-Demonstrate healthy, effective ways of dealing with
stress
-Express emotions nondestructively
-Establish a social support system in the community

97
Q

Pediatric Considerations for respiratory

A

At birth
-Only about 25 million alveoli
-Child’s airway shorter, narrower
-Narrower airway causes increased resistance
-Trachea length increases in first 5 years
-Diminished cough reflex
-Immature immune system
-Environmental exposure
-High risk of adverse outcomes
-Pneumonia often resolves much sooner

98
Q

Acute Respiratory Distress Syndrome (ARDS)

A

NOT A DISEASE
A STATE OF RESPIRATORY FAILURE
-Rapid onset severe inflammatory process causing a malfunction in the
lungs ability to take in oxygen
-Alveoli capillary membrane damage leads to intravascular fluid leakage
-Diffuse alveolar dysfunction
-Alveolar cellular lining begins sloughing
-Mortality 30-40%
-Not primary diagnosis

99
Q

Acute Respiratory Distress Syndrome (ARDS): Causes

A

Direct Lung injury
-Aspiration
-Pneumonia
-PE
-Pulmonary Contusion
-Near Drowning
-Smoke inhalation
Indirect Lung injury- release of inflammatory cytokines
-Sepsis
-Trauma
-Massive Transfusion
-Overdose
-Burns
-DIC
-Pancreatitis
-Uremia
-Amniotic and air emboli
-Open heart surgery with bypass

100
Q

Acute Respiratory Distress Syndrome (ARDS): Signs & Symptoms

A

*NON-CARDIAC PULMONARY EDEMA
REFRACTORY HYPOXEMIA
-Cyanosis refractory to O2
-Rapid onset severe dyspnea < 72 hours from event
-Labored breathing
-Tachypnea
-Retractions
-Moist skin
-Decreasing LOC
-Scattered crackles and Rhonchi in all lung fields (alveolar condition)
-Bilateral infiltrates on CXR

101
Q

Acute Respiratory Distress Syndrome (ARDS): Testing

A

Labs:
-CBC
-Chemistry panels
-Lactic acid
-ABGs
-Sputum specimen
Imaging:
-CXR or CT

102
Q

Acute Respiratory Distress Syndrome (ARDS): Treatment

A

Treat underlying cause
-Control process causing fluid leakage
Ventilator support:
-Intubation
-IV fluids to maintain
hemodynamic status
-Nutritional support
-HOB 30◦ or greater
-Positioning

103
Q

Acute Respiratory Distress Syndrome (ARDS): Pharmacologic Treatment

A

-Bronchodilators
-Surfactant
-Corticosteroids
-Meds to support
ventilated patients

104
Q

Acute Respiratory Distress Syndrome (ARDS): Complications

A

-Unregulated inflammatory response prevents O2/CO2 exchange
-Leads to multisystem failure
–GI
–Kidneys
–Extremities
–Bones
The body’s protective mechanism to save brain and heart at expense of other organs

105
Q

what are the most common infectious cause of death in the US?

A

pneumonia and influenza

106
Q

what is pneumonia?

A

inflammation of lung parenchyma, disorder of lower respiratory system that affects respiration, ability to ventilate, and airway patency

107
Q

bacterial pneumonia is ______.

A

unilateral lobar pneumonia

108
Q

viral pneumonia is _______.

A

scattered patchy pattern of bronchopneumonia

109
Q

aspiration pneumonia is ______.

A

chemical injury causing inflammatory response- open to bacterial invasion

110
Q

etiology and pathophysiology of pneumonia

A

Once organism is in the upper airways, it multiplies in the epithelium and spreads to the lungs
A gel-like substance forms as microorganisms and phagocytic cells break down
Forms consolidation within the lower airway structures
Inflammation occurs and involves the alveoli, ducts and interstitial spaces around alveoli

PNA can also result from bloodborne organisms that enter the pulmonary circulation and are trapped in the pulmonary-capillary bed

111
Q

clinical manifestations of pneumonia?

A

cough
fever
chills
tachy
tachypnea
dyspnea
hemoptysis
excessive mucus production
chest pain
diminished appetite
cyanosis
manifestations of impaired gas exchange

112
Q

classifications of pneumonia?

A

community acquired, health care associated, hospital acquired, ventilator associated

113
Q

symptoms of community-acquired pneumonia?

A

develops quickly, SOB, cough, heavy sputum, fever, chill, chest pain, n/v

114
Q

what is an important distinction in health-care associated pneumonia?

A

causative pathogens often multi-drug resistive- difficult to treat due to MDR pathogen

115
Q

usual presentation of hospital acquired pneumonia?

A

new pulmonary infiltrate on CXR, evidence of infection (fever, resp. sx, purulent sputum, leukocytosis), develops > 48hrs after admission

116
Q

what is consolidation?

A

tissue that solidifies as a result of collapsed alveoli or infectious process, such as pneumonia, and bacteremia
(white patchy area on CXR)

117
Q

risk factors for hospital acquired pneumonia?

A

Impaired host defenses
Acute or chronic illness
Supine positioning – not getting out of bed
Aspiration
Coma
Malnutrition
Prolonged hospitalization
Emergency surgery
Depressed cough
Weak gag reflex
Impaired swallowing

118
Q

nursing interventions for hospital acquired pneumonia?

A

Keep HOB up 30 degrees
Avoid stimulation of gag reflex with suctioning
Check tube placement
Thickened liquids
TCDB
Early ambulation
Mouth Care

119
Q

ventilator-associated pneumonia requirement

A

endotracheal intubation with ventilator support for > 48 hours; form of HAP; most common infection in ICU

120
Q

how many alveoli do adults and children have?

A

adults- 600 million; at birth only 25 million

121
Q

pediatric considerations for pneumonia?

A

Child’s airway shorter, narrower
Narrower airway causes increased resistance
Trachea length increases in first 5 years
Diminished cough reflex
Immature immune system
Environmental exposure
High risk of adverse outcomes
Pneumonia often resolves much sooner

122
Q

pediatric pneumonia clinical manifestations

A

Children under 6 use diaphragm to breath
Leads to retractions
Oxygen consumption higher in children;
kids don’t have a decline like adults- they’re compensatory mechanisms just shut off

123
Q

pneumonia complications

A

Continuing symptoms after initiation of therapy
Sepsis and septic shock
Respiratory failure
Atelectasis
Pleural effusion
Changes in mental status

124
Q

diagnostic tests for pneumonia

A

CXR
CT
Sputum Gram stain, culture and sensitivity
CBC with WBC differential
Serology testing
Pulse oximetry, ABG’s
Fiberoptic Bronchoscopy

125
Q

tx for pneumonia?

A

Antibiotic therapy as indicated
IV then PO
Humidified O2 support
Antitussives (help with cough)
Expectorants: Mucinex (Guaifenesin)
Bronchodilators, inhalers and/or neb treatments
Antipyretics
IV fluids
Corticosteroids for inflammation (solumedrol)

126
Q

robitussin vs mucinex

A

both guaifenesin, robitussin is short acting and mucinex is long acting

127
Q

pneumonia vaccine information

A

antigens from 23 types of pneumococcus, recommended for all patients 65+ and those with chronic diseases, pneumococcal vaccine provides lifetime immunity

128
Q

indications for endotracheal intubation?

A

trauma to trachea or to face to ensure patient can breathe, resp arrest, ARDS, anytime patient is unable to oxygenate or protect their airway this will be a discussion

129
Q

cuffed vs uncuffed ET intubation

A

cuffed has balloon that inflates (used to be used primarily for kids); uncuffed- no balloon

130
Q

how long can patient be intubated for?

A

Pt can be intubated for 14 days before they need to be extubated or trached and pegged due to the damage to the trachea it will cause (fragile tissue), causes scar tissue and pressure injuries

131
Q

what is tracheostomy for?

A

long term vent use to bypass upper airway; can be cuffed, uncuffed, or fenestrated

132
Q

what can pt have if suctioning with trach and you hit carina?

A

bradycardia

133
Q

tracheostomy complications?

A

mucus plug

134
Q

what is PEEP?

A

positive end expiratory pressure; pressure within lungs during exhalation - measured in cm of H2O, helps leave alveoli open to avoid atelectasis

135
Q

normal tidal volume?

A

400-800mL, based on ml/kg

136
Q

what is FiO2 for with ventilator?

A

% of oxygen to maintain normal PaO2 at lowest O2 setting

137
Q

RR to be kept for vented pts?

A

12-18

138
Q

how long can weaning from a vent take?

A

hours to weeks; pressure support for weaning similar to BiPap

139
Q

ventilator complications?

A

Improper ET placement
Hospital-acquired pneumonia or VAP
Barotrauma
Pneumothorax
GI effects
Alarms

140
Q

causes of high pressure vent alarms?

A

increased secretions in airway; decreased airway size due to wheezing or bronchospasm; displacement of ET tube; obstructed ET tube (water/kink); pt coughs, gags, or bites ET tube; anxious pts- bucking on vent

141
Q

causes of low pressure vent alarms?

A

disconnection/leak in the ventilator or airway cuff; pt stops spontaneously breathing

142
Q

trouble shooting vent problems: DOPES

A

displacement
obstruction
pneumothorax
equipment
stacked pants

143
Q

post weaning for vent interventions

A

O2 therapy, ABG’s pulse Ox, bronchodilator therapy, Chest pt, nutrition, hydration, humidification, IS

144
Q

what makes up the immune system?

A

neutrophils, eosinophils, basophils, monocytes, b-lymphocytes, t-lymphocytes, natural killer cells

145
Q

neutrophil function?

A

immune defenses

146
Q

eosinophil function?

A

defense against pathogens

147
Q

basophil function?

A

inflammatory response

148
Q

monocyte function?

A

immune surveillance

149
Q

b-lymphocyte function?

A

antibody production

150
Q

t-lymphocyte function?

A

cellular immune response

151
Q

normal WBC count?

A

5,000 - 10,000

152
Q

WBC count for leukopenia?

A

WBC under 4,500

153
Q

WBC count for neutropenia?

A

under 2,000

154
Q

what is left shift?

A

increase in banded or immature neutrophils, infectious process

155
Q

what are T-cells?

A

Created in thymus
Approx. 75% of all lymphocytes
Mature into
Active helper T cells
Cytotoxic T cells
Memory T cells

156
Q

what are B-cells?

A

Created in bone marrow
Approx. 10% of lymphocytes
Mature when activated into:
Plasma cells
Secrete antibodies or memory cells

157
Q

what are natural killer cells?

A

Found in
Spleen,
Lymph nodes,
Bone marrow
Blood
Immune surveillance and resistance to infection
Destruction of early malignant cells
They are cytotoxic

158
Q

what is reactive oxygen species? (ROS)

A

an molecule that is formed with oxygen and is imbalanced due to an odd number of electrons- it takes electrons from other molecules to stabilize and excessive amounts of them causes cell damage and death

159
Q

ROS works with NK cells to _________.

A

attack cancer cells

160
Q

what are examples of molecules formed with oxygen?

A

peroxide, superoxide, hydroxyl radical, singlet oxygen, alpha-oxygen

161
Q

what can ROS cause?

A

cellular apoptosis *why we only use hydrogen peroxide for wound care with external fixators

162
Q

What is the problem with too much oxygen and ROS?

A

excess oxygen causes production of peroxynitrite which is an ROS-
ROS causes deterioration/aging/death of cells
ROS causes changes to DNA that can cause cancer
ROS effects on LDL believed to be cause of heart disease
ROS can cause damage to any cell in the body

163
Q

How can ROS be treated?

A

neutralization of ROS or free radicals
antioxidants provide electron for balance (vit E, vit C, beta carotene)

NURSING 220 (4 decks)

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