test1-2 Flashcards
Alcholism effects
peripheral neuropathy, alcohol myopathy, wernickes encephalopthy, korsakoffs psychosis, alcohol cardiomyopathy, GI-itis, Cirrhosis, blood dyscrasia, fetal alcohol syndrome
alcohol detox
librium or ativan to prevent DTs, thiamine injections, multivitamins, and magnesium- hydrate -daily labs
phychaitric assessment
always send mail through the post office- appearance, speech, mood/memory, thoughts, perception, orientation
Benzodiazepines
AMs (alprazalam) sedative hypnotic for sleep, anxiety, panic- effect GABA in brain. SE: dizzy, drowsy, lethargy
Buspirone
first choice for anxiety. se: psychomotor slowing- takes a week to start working. dizziness, nausea, headache, nervousness, lightheadedness, excitement- level increased with grapefruit. no tolerance, withdrawal, or abuse and no effect with CNS depressants
pharm for OCD
First - SSRIs
second TCA- Clomipramine less tolerated. antidepressants relieve obsessive thoughts and subsequent compulsions
Pharm for GAD
benzos, ssris or snores especially if also has depression.
pharm for panic disorder
tcas or maois (need to avoid decongestants and certain foods- fish chocolate fermented foods)
nms
from dopamine antagonist (antipsych) muscular rigidity, hyperthermia, sweat, pallor, dysphagia, dyspnea, tremors, incontinence,hypertension, altered mental status
serotonin syndrome vs nms
all same except from serotonergic agents (MAOIs, SSRIs, SNRIs, Buspirone) dilated pupils, hyperreflexia (instead of hypo) and hyperactive bowel inste of normal or hypo
anticholinergics
like benztopine not used much in parkinson anymore but used to treat parkinsonsian like side effects from antipsychotics
v-q mismatch
v- ventilation q- perfusion. v is low then perfusion is normal- pneumonia or atelectasis, q (perfusion) low and ventilation normal- pulmonary embolism
peak flow meter
how much can be inhaled and exhaled- stay in green for maintained disease process- compared to personal best. green >80%
yellow 50-80% use meds and reassess
Pulmonary function test
most accurate test for dx of asthma and severity. measures CO2, forced vital capacity, forced expiratory volume, residual volume and total lung capacity. decreased FEV1 by 15-20 % expected in asthma and increase of 12% after med admin dx of asthma
short acting beta 2agonsit
fast acting for attack or before exercise. albuterol. watch pt for tremors and tachycardia
long acting beta 2 agonist
salmeterol. for prevention of attack- don’t take if having an attack
anticholinergic
ipratropium. bock parasympathetic system (broncho dilation and decrease secretions) used to prevent bronchospasm
corticosteroids
anti inflammatory-prevents attack from inflammation or allergen. take daily- only for when all other drugs fail. fluticasone, prednisone (corticosteroids) or nedocromil (croon) watch for decreased immunity fxn- avoid infection, report black stool, hyperglycemia,
asthma health promotion
prompt tx for respiratory infections, lots of hydration (thin mucous) and lose weight, take albuterol 10-30 min before exercise. regular flu and pneumonia vaccination
sx of asthma attack
labored breathing, altered LOC, coughing, accessory muscles, Low O2 sats, tachycardia
response to inadequate O2 from attack
take vitals, assess cognition, LOA, secretions, elevate HOB, ensure venous access, suction if needed, notify provider
respiratory status declining
wheezing, retraction of sternal muscles and premature ventricular complexes (PVCs)
care of copd pt
high fowlers -90deg, encourage coughing or suction, deep breathing and incentive spirometer, hydration, exercise,chest percussions,call light and O2 near pt
copd oxygen therapy
determined by ABGs. usually nasal cannula (1-4 L/min) or venturi mask (up to 40%)to control amount of o2
signs and sx of pneumonia
tachypnea, dyspnea, hypoxemia, cough, pleuritic chest pain. confusion from hypoxia very common in elderly, yellow sputum, crackles and wheezes, fever, chills, sweating
nursing care for pneumonia
for hypoxemia- nasal cannula and incentive spirometry. prevent obstruction- monitor secretions, promote hydration (monitor I&O, mucus membranes, skin turger and fever), encourage cough and deep breath, bronchodilators
albuterol
watch for tremors and tachycardia
clotting process
vasoconstriction, then platelet plug formation, then intrinsic or extrinsic pathway- coagulation cascade, next thrombin the tells fibrinogen to make fibrin and stabilize clot
fibrinolysis
plasminogen to plasmin that breaks clot
spleen function
fetal- makes rbcs, adults: helps clean out dead and defective RBCs, immunity support (removes bacteria from bloodstream, storage site for lymphocytes and immunoglobin) storage over 1ml of blood and 3/4 platelets.
Liver funtion
filters blood, stores glucagon, produces procoagulants- which tell blood to clot, stores iron and RBCs
normal INR
0.8-1.1, warfarin pts
PTT
intrinsic coagulation bleeding time. normal 25-35. when on heparin should increase 1.5-2.5 Xs- get baseline before starting hep
aPTT
newer version of PTT. 25-38 normal hep pts
DVT Caused by
Most common- stasis in blood flow starts coag process. injury to vessel wall triggers clotting to fix (high blood sugar), hypecoaguability (polycythemia- high RBC count increases viscosity)
increases risk of blood clot
ulcerative colitis, cancer (breast, brain, pancreatic sim RBC prodxn), Central vein/arterial cath (picc), diabetes, chronic hypoxia (stim RBC prodxn), sepsis (endotoxins increase hypercoaguability)
assessment dvt
pain in calf or groin, swelling of extremity, compare extremities, warmth and/or redness on the area. don’t do homien sign.
heparin
inhibits clotting factors to stop fibrin prodxn to prevent clot from getting any larger and any future clots. must go home on an oral like warfarin- clot will dissolve on own in 3-6 mos or with a thrombolytic. risk of bleeding
administering heparin
obtain baseline aPTT, CBC and platelet. verify no bleeding disorders, allergy, or recent surgery/ wound. verify dose with another nurse. usually bolus given before drip started recheck aPTT in 6 hrs. antidote protamine sulfate For Hep Induced Thrombocytopenia (HIT)
