Week 03 Flashcards
Respiratory Alterations/ Pharmacology/ Blood Administration
upper respiratory pathophysiology
provides a passage for air to be breathed in and out of the lungs, but it also heats, humidifies, and filters the air and is involved in cough, swallowing and speech
lower respiratory pathophysiology
pull in air from the upper respiratory system, absorbs oxygen, and releases carbon dioxide in exchange
which side of the lungs has more lobes
right side
what happens to blood pressure on vent patients
BP drops
what is ventilation
mechanical and involves the movement of air
what is respiration
involves the exchange of gases in the alveoli
are rails and crackle lungs sounds wet or dry
wet
should you use a breathing treatment on a patient with rails or crackle lung sounds
no
what is the only medication that will help stridor
racemic epinephrine
what is racemic epinephrine
inhalation epi
if acidic pH is
low
if alkaline pH is
high
what does ROME stand for
- R: respiratory
- O: opposite
- M: metabolic
- E: equal
what breath sound is due to fluid overload
rails
subjective assessment data
health history, medications, surgeries
objective assessment data
physical observation, inspect, palpate, auscultate, percuss
what position should you inspect the thorax in
sitting
what are some abnormal lung sounds
- fine crackles
- corse crackles
- wheezing
- pleural friction rub
- stridor
- cheye-stokes
compensation mechanisms: mechanical buffers
- on the scene in seconds
- already present in tissue and will handle minor changes in acid base balance
compensation mechanisms: respiratory
- retention or elimination of CO2
- happens within minutes
- respiratory compensation can handle mild to moderate acid base shifts
compensation mechanisms: renal
- regulate bicarb (HCO3) to combat hydrogen losses and gains
- starts within hours but more permanent
what happens when first two compensation mechanisms fail
the renal system slowly gets to work and requires up to 5 days to complete
what should be monitored for a arterial occlusion
changes in color, temp, swelling, loss of pulse, pain
what side should patient be placed on and position for a air embolism
left side in trendelenburg
acidosis, normal, or alkalosis
pH: less than 7.35
CO2: greater than 45
HCO3: less than 22
acidosis
acidosis, normal, or alkalosis
pH: 7.35 - 7.45
CO2: 35 - 45
HCO3: 22 - 26
normal
acidosis, normal, or alkalosis
pH: greater than 7.45
CO2: less than 35
HCO3: greater than 26
alkalosis
what is the purpose of endoscopy/ laryngoscopy
visualize the vocal cords, remove foreign objects, obtain tissue samples
what is the purpose of mediastinoscopy
insertion above the sternum to the area between the lungs, visualize tumors, obtain tissue samples
what is the purpose of a bronchoscopy
permits visualization of the larynx, trachea, and bronchi
what is a/the purpose of thoracentesis
a large bore needle is inserted into the pleural space to obtain specimens, instill medications, remove fluid/air
upper respiratory conditions
- allergic rhinitis
- bacterial/ viral infection
- sinusitis/ rhinitis
- influenza
- epistaxis
- obstructive sleep apnea
lower respiratory conditions
- bronchitis
- pneumonia
- pulmonary TB
- fungal histoplasmosis
what is rhinitis
a upper respiratory infection
rhinitis pathophysiology
inflammation of the mucosa and sinuses
sinusitis/ rhinosinusitis pathophysiology
- inflammation of the mucous membrane of one or more sinuses
- swelling and inflammation block drainage and lead to infection
when does sinusitis/ rhinosinusitis occur
after rhinitis
bronchitis pathophysiology
inflammation of the bronchi
pneumonia pathophysiology
- many causes that result in reduced gas exchange
- excess fluid in the lungs
- acute infection of lung parenchyma
what is community acquired pneumonia (CAP)
contracted outside the healthcare system
what is healthcare associated pneumonia (HAP)
onset occurs less than 48 hours of hospital admission
what is hospital acquired pneumonia (HACP)
onset/ diagnosis greater than 48 hours of hospital admission
what is ventilator associated pneumonia (VAP)
onset/diagnosis within 48-72 hours after EET intubation
what is aspiration pneumonia
chemical pneumonitis of gastric contents
what is necrotizing pneumonia
cavitation of lung and abscess
RARE
what is opportunistic pneumonia
immunocompromised leading to pneumocystis jiroveci (PJP) and cytomegalovirus (CMV)
best position for pneumonia/ respiratory patients
high-fowler’s
most used medication for pneumonia
penicillin and cephlosporins
latent TB pathophysiology
- TB lives but doesn’t grow in the body
- don’t make a person feel sick or have symptoms
- can’t spread
- can advance to TB disease
TB disease pathophysiology
- Tb is active and grows in the body
- makes a person feel sick and have symptoms
- can spread from person to person
- can cause death if not treated
pulmonary TB medications
- Isoniazid (INH)
- Rifampin (RIF)
- Pyrazinamide (PZA)
- Ethambutol
- Streptomycin Sulfate
what is histoplasmosis
fungal infection
histoplasmosis pathophysiology
inhalation of spores, not transmittable
biggest risk factor to contracting histoplasmosis
bird and bat droppings
histoplasmosis treatment
amphotericin B-IV
what is epistaxis
nosebleed
when is a nosebleed considered an emergency
- non stop bleeding for 20 minutes
- significant blood loss
- caused by severe trauma
- patient has high BP
- can taste blood
obstructive sleep apnea pathophysiology
obstruction or narrowing of air passages r/t relaxation
healthy alveoli look like what compared to unhealthy alveoli
healthy look like popcorn
unhealthy look like turtle chocolate candy
respiratory alkalosis s/s
- seizures
- rapid deep breathing
- hyperventilation
- tachycardia
- low or normal BP
- hypokalemia
- numbness and tingling of extremities
- lethargy and confusion
- light headedness
- N/V
respiratory alkalosis causes
- hyperventilation
- mechanical ventilation
respiratory acidosis s/s
- hypoventilation > hypoxia
- rapid shallow respirations
- skin/ mucosa pale to cyanotic
- headache
- dysrhythmias
- increase potassium
- drowsiness, dizziness, disorientation
- muscle weakness, hyperreflexia
respiratory acidosis causes
- respiratory distress
- airway obstruction
- pneumonia, COPD, ARDS, PE
metabolic alkalosis s/s
- confusion
- dysrhythmia (tachy from decrease K+)
- compensatory hypoventilation
- dizzy
- increased irritability
- N/V, diarrhea
- anxiety
- seizures
- tremors, muscle cramps, tingling of fingers and toes
metabolic alkalosis causes
- increased HCO3 (antacids)
- NG suctioning
- prolonged vomiting
- hypercortisolism
metabolic acidosis s/s
- headache
- low BP
- muscle twitching
- warm flush skin
- n/v
- decrease muscle tone/ reflexes
- kussmaul respirations
metabolic acidosis causes
- DKA
- hyper metabolism
- renal failure
- dehydration
- liver failure
- diarrhea
- fistulas
metabolic acidosis treatment
- bicarbonate
- fluids
- for DKA: IV insulin, normal saline, K+, D50
metabolic alkalosis treatment
- fluid and electrolyte repletion
- decrease n/v
respiratory acidosis treatment
- bronchodilator
- antibiotics
- fluids
- ventilation
respiratory alkalosis treatment
- reventilate (paper bag)
- oxygen
- anti-anxiety/ sedative meds
pH: 7.32
CO2: 36
HCO3: 19
uncompensated metabolic acidosis
pH: 7.1
CO2: 43
HCO3: 13
uncompensated metabolic acidosis
pH: 7.87
CO2: 39
HCO3: 33
uncompensated metabolic alkalosis
pH: 7.32
CO2: 53
HCO3: 30
partially compensated respiratory acidosis
pH: 7.36
CO2: 36
HCO3: 25
normal
pH: 7.36
CO2: 47
HCO3: 27
fully compensated respiratory acidosis
pH: 7.54
CO2: 37
HCO3: 31
uncompensated metabolic alkalosis
pH:7.28
CO2: 31
HCO3: 16
partially compensated metabolic acidosis
pH: 7.59
CO2: 43
HCO3: 38
uncompensated metabolic alkalosis
pH: 7.2
CO2: 49
HCO3: 29
partially compensated respiratory acidosis
what does amantadine (symmetreal) treat
parkinsons disease
what should be monitored when taking amantadine (symmetreal)
- renal function
- mental status including psychosis, hallucinations, depression, suicidal ideations, and dizziness
- blood and urine test, patients may become agitated, irritable, or display abnormal behaviors
what does rimantadine (flumadine) treat
used to prevent flu A in patients older than 17
rimantadine (flumadine) side effects
extreme drowsiness, suddenly fall asleep, lightheadedness
how long should rimantadine (flumadine) be prescribed for
5-7 days, do not miss any doses
what is ribavirin (rebetol) used to treat
hepatits C
what are contraindications of ribavirin (rebetol)
heart problems
when taking ribavirin (rebetol) let your doctor know if this symptom presents
chest pain
what can ribavirin (rebetol) lead to in patients with heart issues
heart attack
what does zanamivir (relenza) used to treat
infection caused by the flu virus
dosing for zanamivir (relenza)
inhale at least 12 hours apart and at the same time daily
zanamivir (relenza) adverse effects
SOA, trouble breathing, wheezing
what is oseltamivir (tamiflu) used to treat
infections caused by viruses
how long does a patient have to start oseltamivir (tamiflu) after being exposed to the flu
2 days
oseltamivir (tamiflu) adverse effects
agitation, irritability, abnormal behaviors
what does penicillin treat
infection caused by bacteria
when should you take penicillin
take with a full glass of water on an empty stomach 1 hour before meals or 2 hours after meals
penicillin adverse effects
anaphylaxis, hives, rash, itching
what does cephalosporins treat
wide range of infections from gram-positive to gram-negative bacteria
what should be monitored for when taking cephalosporins
superinfection and rash
adverse effects of cephalosporins
seizures and encephalopathy
what does isoniazid treat
TB or to prevent its return
isoniazid adverse effects
tired and weak
what doe rifampin treat
TB
when should rifampin be taken
1 hour before meals or 2 hours after
what can happen to body fluids when taking rifampin
turn orange/ reddish color
what is pyrazinamide used to treat
used to kill growth of bacteria that causes TB
pyrazinamide adverse effects
fever, joint pain, swelling, easy bruising, nausea, dark urine, feeling tired, not hungry, upset stomach, stomach pain, light colored stools, vomiting, yellow skin/eyes
what is ethambutol used to treat
kills certain bacterias that causes TB
ethambutol contrainindications
kidney disease, gout, eye disorders such as cataracts
ethambutol adverse effects
blurry vision, red/green color blindness, loss of vision, numbness, tingling, burning pain, weakness, skin rash
what is streptomycin sulfate used to treat
active TB
what should you not do during streptomycin sulfate therapy
get pregnant
streptomycin sulfate adverse effects
damage to hearing and sense of balance
what is amphotericin B used treat
serious and potentially life threatening fungal infections
amphotericin B adverse effects
n/v, fever, hypertension, hypotension, hypoxia
what is prednisone used to treat
asthma, allergic reaction, arthritis, inflammatory bowel diseases, adrenal/ blood/ bone marrow disorders
what does prednisone do to the immune system
may decrease your ability to fight infection and may prevent you from developing symptoms if you get an infection
prednisone adverse effects
elevated blood sugar, mood swings, memory/ behavior issues, confusion, delirium, upset stomach
what is prednisolone used to treat
allergies, blood disorders, skin diseases, inflammation, infections, certain cancers, prevent organ rejection after a transplant
how to prevent stomach upset when taking prednisolone
take with breakfast
prednisolone side effects
hunger, retain water
what is triamcinolone used for
topical treatment for itching, redness, dryness, crusting, scaling, inflammation, discomfort of various skin conditions, psoriasis
what issue is associated with triamcinolone
adrenal gland issues
what is methylprednisolone used for
inflammation, severe allergies, adrenal problems, arthritis, blood or bone marrow problems, eye or vision issues, lupus, skin conditions, kidney problems, ulcerative colitis, flare ups of MS
methylprednisolone contraindications
liver, kidney, heart, or intestinal disease
what can methylprednisolone cause changes in
mood or behavior
what is dexamethasone used for
relief from inflamed areas of the body
when should you take dexamthasone
in the mornings to avoid messing with sleep
what can happen with longterm dexamethasone use
thinner bones, eyesight problems, slower growth in children and teens
what is albuterol used to prevent/treat
wheezing, difficulty breathing, chest tightness, coughing d/t lung diseases ( asthma, COPD)
what should be monitored during albuterol therapy
RR, O2, lung sounds
albuterol adverse effects
tachycardia, palpitations
what is ipratropium used to manage
symptoms of lung diseases such as asthma, chronic bronchitis, and emphysema
what should you do while inhaling ipratropium
close your eyes so it dont get in them
ipratropium adverse effects
eye pain or discomfort, blurred vision, seeing halos
what is salmeterol used for
to PREVENT asthma attacks, treat COPD
how/when to use salmeterol
same time every day, twice daily every 12 hours
salmeterol adverse effects
welts, rash, angioedema, bronchospasm, headache, tremors, anaphylaxis
what are patients that use salmeterol at risk for and how to prevent it
thrush, rinse mouth after use
what is Flonase use for
seasonal allergies, yearlong allergic and non allergic nasal symptoms such as stuffy nose, itching, and sneezing
Flonase adverse effects
nosebleeds, nasal ulcers, headaches, sore throat, nausea, cough, nasal burning/ itching
what is Flovent used for
helps prevent asthma symptoms by reducing inflammation in the airways
how to use flovent
- breathe in a deep breath
- hold for 10 seconds
- breathe out
- rinse mouth with water without swallowing after each inhalation
Flovent adverse effects
rash, itching/ swelling of face, tongue, or throat, severe dizziness, trouble breathing
what is guaifenesin used for
to help clear mucus or phlegm from the lungs
guaifenesin adverse effects
headache, n/v, rash, itching/swelling of face, tongue, throat, severe dizziness, trouble breathing
what is dextromethorphan used for
temporally relieve cough caused by the common cold, flu, or other conditions
who should not use dextromethorphan for cough
- chronic cough from smoking
- asthma
- emphysema
- if there are unusually large amounts of mucus with cough
what is inhaled epinephrine used for
temp relief for mild symptoms of a weak type of asthma
inhaled epi adverse effects
pulmonary edema, chest pain, difficult/ fast/ noisy breathing, blue lips or fingernails, pale skin, increased sweating, cough (may be pink frothy sputum), swelling in legs or ankles, sudden worsening of breathing problem/ asthma
what are calcium channel blockers used for
to treat conditions of the heart and blood vessels such as hypertension, angina, some abnormal heart rhythms, and Raynaud’s phenomenon
calcium channel blocker adverse effects
ankle swelling, flushing, and palpitations, constipations, dizziness, fatigue
what is bosentan used for
first line treatment for pulmonary artery hypertension
bosentan adverse effects
liver damage, pain/tenderness in the upper stomach, pale stool, dark urine, loss of appetite, n/v, yellow eyes/skin
what is treprostinil used for
certain types of pulmonary arterial hypertension
treprostinil dosing
take when you wake up, no more than every 4 hours
treprostinil adverse effects
SOA, fainting, dizziness, diarrhea, flushing
what is sildenafil used for
relax blood vessels in the lungs to allow blood to flow easily, ED
how often can you take sildenafil
once a day
what can you not have while taking sildenafil
grapefruit juice
sildenafil adverse effects
headache, flushing, dyspepsia, abnormal vision, nasal congestion, back pain, nauseam dizziness, rash
what is bumex used for
swelling from the heart, kidneys, liver disease by making you pee more to remove salt and excess water from your body
bumex adverse affects
unusual bleeding, bruising, black tarry stools, blood in urine or stool, pinpoint red spots on your skin, muscle cramps
what is furosemide used for
treat edema
how should you take furosemide
on empty stomach, 1 hour before food or 2 hours after due to food interfering with absorption
adverse affect of furosemide
severe stomach pain which could reach through to the back
how long is blood type and crossmatch good for before and after a transfusion
before: up to 30 days
after: 72 hours after the first unit
what is the max blood administration time
4 hours
how long before blood infusion should pre infusion meds be administered
30 minutes
type O can receive blood from
only type O
type A can receive blood from
A and O
type B can receive blood from
type B and O
type AB can receive blood from
AB, A, B, and O
Rh+ can receive blood from
Rh+ and Rh-
Rh- can receive blood from
only Rh-
mild to moderate blood transfusion reactions
mental status change, itching, anxiety, changes in vital signs, n/v, flushing, headache
severe blood transfusion reactions
increased heart rate, fever, anxiety, n/v, back pain, chest tightness, SOA, dyspnea
what to do during a suspected blood transfusion reaction
- STOP THE TRANSFUSION
- disconnect the IV tubing from the patient
- obtain new IV tubing to run NS
- obtain a set of vital signs
- assess respiratory and cardiac status
- notify provider
- notify blood bank
- monitor cardiac, respiratory, and urinary status
- document reaction, treatment, and response
- advise patient to report reaction to future providers
at what times should vitals be check during a blood transfusion
- before
- 15 minutes after started
- every hour thereafter
what is the only solution you can run with blood during a transfusion
NS
