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NSG 320 - MED SURG > Topic 3: Respiratory & ABGs > Flashcards

Topic 3: Respiratory & ABGs Flashcards

1
Q

respiratory acidosis risk factors

A

*Neuromuscular disorders
*CNS depression
*Hypoventilation
*Decreased respiratory rate

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2
Q

respiratory acidosis s/s

A

*Kussmaul breathing
*Chest pain
*Nausea /vomiting
*Abdominal pain
*General muscle weakness

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3
Q

respiratory acidosis interventions

A

*Bronchodilators
*Assisted ventilation
*Respiratory stimulants

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4
Q

metabolic acidosis risk factors

A

*Diabetic ketoacidosis
*Lactic acidosis
*Resp., renal, or heart failure
*Diarrhea, laxatives

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5
Q

metabolic acidosis s/s

A

*Vertigo
*Neuro changes
*Dyspnea
*Tachypnea
*Hyperpnea

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6
Q

metabolic acidosis interventions

A

*Monitor vitals
*Monitor respiratory status
*Monitor blood gases
*Correct cause
*Give bicarbonate

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7
Q

respiratory alkalosis risk factors

A

*Extended periods of hyperventilation
*Extreme anxiety
*Fever

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8
Q

respiratory alkalosis s/s

A

*Lightheadedness
*Agitation

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9
Q

respiratory alkalosis interventions

A

*Encourage patient to take slow deep breaths
*Decrease patient anxiety
*Monitor ABG

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10
Q

metabolic alkalosis risk factors

A

*Vomiting
*NG suctioning
*Hypokalemia
*Excess antacids/bicarb
*Steroids

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11
Q

metabolic alkalosis s/s

A

*Lightheaded; N/V
*Confusion; stupor
*Muscle twitching; tremors
*Numbness/tingling face or extremities
*Electrolyte imbalance, dysrhythmias

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12
Q

metabolic alkalosis interventions

A

*Monitor: Vitals, neuro status, I & O, ABGs,
*Warn/teach about taking too many antacids

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13
Q

what is the onset fro influenza

A

abrupt, usually 3-6 hours

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14
Q

what are the signs and symptoms of influenza

A

Þ Chills
Þ Fever (usually high 102-104 that lasts 3-4 days)
Þ Generalized myalgia
Þ Headache
Þ Cough
Þ Sore throat
Þ Fatigue

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15
Q

what are the diagnositc studies for influenza

A

Þ Viral cultures can be taken (throat swab, nasopharyngeal swab, sputum, ect.)
Rapid influenza diagnostic test (RIDTs)

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16
Q

when should antiviral drugs be given

A

can be given if its within 24-48 hours of onset

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17
Q

what can nurses instruct patients to do if they have influenza

A

Þ Rest
Þ Hydrate
Þ Take acetaminophen or ibuprofen for HA, aches, pain
Þ Antipyretics for fever

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18
Q

when should a pateint not get the flu vaccine

A

if they have already had it that year
or
egg allergy

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19
Q

prevention of influenza

A

Þ Hand washing
Þ Annual vaccination (best time to get the vaccine is in September or October, before flu exposure)
Þ Antiviral drugs
Avoid close contact with anyone who has the flu

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20
Q

what are the s/s of acute sinusitis

A

Þ Significant pain over affected sinus
Þ Purulent nasal drainage
Þ Nasal obstruction
Þ Congestion
Þ Fever
Þ Malaise
Þ Halitosis (bad breath)

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21
Q

how can sinusitis get diagnosed

A

X-rays or CT scan of sinuses
(sinuses are filled with fluid or thickened mucous membrane)

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22
Q

what are treatments for the SYMPTOMS of sinusitis

A

Þ Oral or topical decongestants (to promote drainage)
Þ Intranasal corticosteroids (decrease inflammation)
Þ Analgesics (reduce pain)
Þ Saline spray (relieve congestion)

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23
Q

what is important to teach patients when using topical decongestions

A

to use the medication for no longer than 4 to 5 days to prevent rebound congestion

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24
Q

Management of sinusitis

A

Þ Get plenty of rest to help body fight infection and promote recovery
Þ Hydrate to loosen secretions
Þ Take hot showers or steam inhaler
Þ Apply warm damp towels around sinuses
Þ Sleep with head elevated

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25
Q

what are the s/s of pneumonia

A

Þ Cough (can be productive or not productive)
Þ Sputum (may be green, yellow or rust colored-bloody)
Þ Fever, Chills
Þ Dyspnea, Tachypnea
Þ Pleuritic chest pain
Fine or coarse crackles may be auscultated over the affected region

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26
Q

what are the diagnostic tests for pneumonia

A

Þ Chest X-ray
Þ Sputum: Gram stain, culture and sensitivity test
Þ Pulse oximetry or ABGs
Þ CBC: WBC differential and routine blood chemistries (if indicated)
Blood cultures (if indicated)

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27
Q

what are some interventions for pneumonia

A

Þ Increased fluid intake (at least 3L/day), IV fluids
Þ Balance between activity and rest
Þ O2 therapy
Þ Physiotherapy
Þ VTE prophylaxis
Þ Critical care management, with mechanical ventilation as needed

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28
Q

nutritional therapy for pneumonia

A

Þ Hydration to prevent dehydration and to thin and loosen secretions
Þ Small, frequent meals are easier for dyspneic patients to tolerate
Þ Offer foods high in calories and nutrients

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29
Q

health promotion for pneumonia

A

Þ Frequent handwashing
Þ Proper nutrition
Þ Adequate rest
Þ Regular exercise
Þ Cough or sneeze into the elbow rather than hands
Þ Avoid cigarette smoke

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30
Q

when does a follow up x ray need to be done for pneumonia

A

in 6 to 8 weeks to evaluate resolution of pneumonia

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31
Q

what are the symptoms for active TB

A

Þ Productive cough
Þ Night sweats
Þ Afternoon temperature elevation
Þ Weight loss
Þ Pleuritic chest pain
Þ Crackles over apices of lungs
Þ Fatigue
Þ Malaise
Þ Anorexia
Þ Dyspnea (late symptom)

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32
Q

renal TB symptoms

A

dysuria and hematuria

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33
Q

bone and joint TB symtoms

A

may cause severe pain

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34
Q

meningitis TB symtoms

A

HA, vomiting, lymphandenopathy

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35
Q

what indicates a positive PPD (tuberculin skin test)?

A

induration; a palpable raised, hardened area of swelling (NOT REDNESS at the injebtion site

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36
Q

what is considered positive PPD in low risk individuals

A

> 15mm induration

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37
Q

what is considered positive PPD in immunocompromised patients

A

> 5mm

38
Q

interferon release assays

A

blood test that detect INF release from T cells in response to M. tuberculosis

39
Q

a TB diagnosis cannot be solely made on…

A

a chest x-ray alone

40
Q

what are the four drugs included in TB drug therapy

A

isoniazid, rifampin, pyrazinamide, and ethambutol

41
Q

directly observed therapy (DOT)

A

Þ Providing antiTB drugs to patients and watching them as they swallow to ensure adherence

42
Q

Bacille Calmette-Guerin Vaccine

A

Þ Usually given to infants in parts of the world with high prevalence of TB

43
Q

if a patient is suspected of having TB what should be done

A
  1. Be placed on airborne isolation (single occupancy room with 6-12 airflow exchanges/hour and health care worker wearing HEPA mask)
  2. Receive medical workup, including chest xray, sputum, smear and culture
  3. Receive appropriate drug therapy
44
Q

what is the treatment for ADULTS who are PPD+, ghons complex on CXR, and sputum+ (latent?):

A
  • isoniazid (INH) for 6 months
45
Q

what is the treatment for CHILDREN who are PPD+, ghons complex on CXR, and sputum+ (latent?):

A

INH or other antibiotic for 9 months.

46
Q

what is the treatment for HIX + who are PPD+, ghons complex on CXR, and sputum+ (latent?):

A

INH for 12 months.

47
Q

What is the treatment for patients with active TB

A

Multidrug therapy for 12-18 months (isoniazid, rifampin, pyrazinamide, ethambutol or streptomycin), may return home/community when sputum is negative

48
Q

SE of ethambutol

A

red-green vision loss, optic neuritis
blurred vison
N/V/D
HA

49
Q

SE of isoniazid

A

hepatotoxicity
asymptomatic elevation of ALT and AST
hyperglycemia
visual disturbances
vomiting, confusion, HA

50
Q

SE of pyrazinamide

A

hepatoxicity
arthralgias
hyperuricemia
photosensitivity
anemia
dysuria

51
Q

SE of rifampin

A

Turns body fluids orange
hepatoxicity
thrombocytopenia

52
Q

what are the s/s of asthma

A

-Weezing (on auscultation)
-Cough
-Dyspnea
-Chest tightness
-Hyperventilation (lungs responding to trapped air and airflow limitation, can cause respiratory alkalosis)

53
Q

“silent chest” means

A

Þ Decreased breath sounds means severe airway obstruction and impending respiratory failure

54
Q

Mild asthma symptoms

A

Dyspnea occurs with activity; may feel like they “can’t get enough air”

55
Q

moderate astham symptoms

A

Dyspnea interferes with or limits usual activates

56
Q

severe asthma symptoms

A

-Dyspnea at rest
-Speaks in words, not sentences because of difficulty breathing
-Feeling suffocation

57
Q

life threatening asthma symptoms

A

-To dyspneic to speak
-May feel drowsy or confused
-Perspiring

58
Q

what management is done for asthma

A

Þ Identify and eliminate triggers
Þ Drug therapy
Þ SaO2 monitoring
Þ ABGs
Þ O2 by nasal cannula or mask

59
Q

what is mild asthma treated with

A

Þ Prompt relief with inhaled SABA such as albuterol (via a nebulizer or MDI with a spacer)

60
Q

how often are patients with asthma instructed to take albuterol

A

take 2 to 4 puffs of albuterol every 20 minutes 3x to gain rapid control of symptoms

61
Q

moderathe asthma treatment

A
  • Usually requires office or ED visit
  • Relief is provided with frequent inhaled SABA
  • Oral systemic corticosteroids (symptoms may persist for several days even after corticosteroids are started)
62
Q

severe asthma treatment

A
  • Usually required ED visit and likely hospitalization
  • Partial relief from frequent inhaled SABA
  • Oral systemic corticosteroids. Some symptoms last for >3 days after treatment is begun
  • Adjunctive therapy: ipratropium, IV magnesium
63
Q

life threatening asthma treatment

A

Þ Requires ED visit/hospitalization. Possible ICU
Þ Minimal or no relief from frequent inhaled SABA
Þ IV corticosteroid
Adjunctive therapy: ipratropium, IV magnesium

64
Q

how to use an inhaler

A
  • Take off cap and shake inhaler
  • Breathe out all the way
  • As you start breathing in slowly through your mouth, press down on the inhaler one time
  • Keep breathing in slowly, as deeply as you can
  • Hold breath for 10 seconds, if you can
65
Q

how do you clean an inhaler

A

Þ : rinse only the mouthpiece and cap in warm water and let them dry overnight

66
Q

pursed lip breathing instructions

A
  • Inhale slowly and deeply through nose
  • Exhale through pursed-lips as if whistling, without puffing your cheeks
  • Make breathing out 3 times as long as breathing in
    8-10 repetitions, 3-4x a day
67
Q

SABA

A

albuterol

68
Q

SABA: albuterol use

A

For quick-relief or “rescue” medications

69
Q

SABA: albuterol onset

A

within minutes and are effective for 4 to 8 hours

70
Q

SABA: albuterol SE

A

tremors, anxiety, tachycardia, palpitations, and nausea

71
Q

LABA: Salmeterol use

A

-Should not be the first or only drug used to treat asthma (SHOULD BE USED WITH INHALED CORTICOSTEROIDS ICSs)
-Should be added to the treatment plan only if other controller medicines do not control asthma

72
Q

LABA

A

Salmeterol

73
Q

SABA: albuterol should be limited to…

A

Should be limited to less than 2x weekly

74
Q

what is ALWAYS used to treat sudden wheezing

A

SABA

75
Q

Methylxanthine (Xanthine) Derivatives

A

theophylline

76
Q

what should patietns avoid when using theophylline

A

Avoid caffeine to prevent intensifying adverse effects

77
Q

s/s of COPD

A

Þ Chronic intermittent cough
Þ Sputum production
Þ May report chest heaviness
Þ Gasping, increased effort to breathe
Þ Relies on intercostal and accessory muscles
Þ Fatigue
Þ Weight loss, anorexia
Þ Decreased breath sounds in all lung fields
Þ Barrel chest
Þ Tripod position
COR PULMONALE

78
Q

cor pulmonale

A

right-sided heart failure arising from chronic lung disease

79
Q

cor pulmonale s/s

A

can be seen with edema in the ankles, dyspnea is the most common symptom

80
Q

management of COPD

A

Þ Cessation of cigarette smoking
Þ Drug therapy
Þ Airway clearance techniques
Þ Breathing exercises and retraining
Þ Oxygen therapy (GOAL FOR SAO2 IS GREATER THAN 95%)
Þ Progressive plan of exercise, especially walking and upper body strengthening
Þ Chest physiotherapy
Þ Administer bronchodilators, corticosteroids

81
Q

hydration recommendation for COPD pateitns

A

2-3 L a day

82
Q

wht immunizations are recommended for COPD Patients

A

influenza and pneumococcal

83
Q

nutritional interventions for COPD patients

A

Þ Rest for 30 mins and use bronchodilator before eating
Þ Avoid exercise and treatments 1 hour before and after meals
Þ Ensure O2 therapy is in use during eating
Þ Encourage activity during the day to stimulate appetite
Þ If underweight; supply with protein and calories, moderate carbs and fat
Þ 5-6 small meals a day

84
Q

initial findings in infants with cystic fibrosis

A

meconium ileus: Þ a bowel obstruction that occurs when the meconium in your child’s intestine is even thicker and stickier than normal meconium, creating a blockage in a part of the small intestine called the ileum

85
Q

if patients were not diagnosed as newborns, what are other s/s of cystic fibrosis

A
  • Acute respiratory symptoms (wheezing, coughing, frequent pneumonia)
  • Failure to thrive or malnutrition
  • Steatorrhea (large, oily, frequent bowel movements)
  • Bronchiectasis
  • Fam history
86
Q

what test is done to diagnose cystic fibrosis

A

sweat chloride test

87
Q

what is a positive sweat chloride test

A

swear contains 4x the normal amount of sodium and chloride
-60mmol/L is considered positive

88
Q

management for the pulmoary problems of cystic fibrosis

A
  • Aerosol and nebulization treatments to dilate airways, liquefy mucus and facilitate clearance
  • CPT (postural drainage with percussion and vibration)
  • Expiratory techniques: PEP devices (Flutter device)
  • O2 therapy in severe disease
89
Q

management for controlling infection for cystic fibrosis

A

-antibiotic based on sputum culture

90
Q

management of pancreatic insufficiency for cystic fibrosis

A

-pancreatic enzyme replacement of lipase, protease and amylase, taken before each meal and snack (Pancreaze, Creon, Ultresa)

91
Q

what vitamins are supplemented for cystic fibrosis patients

A

Fat soluble vitamins must be supplemented because they are malabsorbed (A, D, E, K)

NSG 320 - MED SURG (63 decks)

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