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Adult Health I Test I > Week 1 Material > Flashcards

Week 1 Material Flashcards

1
Q

what is a thoracentesis?

A
  • Procedure involving surgical perforation of chest wall and pleural space for specimen collection, diagnostic evaluation, medication instillation into pleural space, and fluid removal
    • Performed under local anesthesia using large bore needle
      • Best practice - ultrasound guidance
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2
Q

indications for a thoracentesis

A
  • Transudates (HF, cirrhosis, nephritic syndrome, hypoproteinemia)
  • Exudates (inflammatory, infectious, neoplastic)
  • Empyema
  • Pneumonia
  • Chest trauma (blunt, penetrating, crushing) or invasive thoracic procedures
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3
Q

assessment findings for a thoracentesis

A
  • Large amounts of fluid in pleural space
    • SOB, chest pain, cough
  • Abnormal breath sounds
  • Dull percussion sounds
  • Decreased chest wall expansion
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4
Q

diagnostics and labs involved with a thoracentesis

A
  • COCA of fluids aspirated
  • Cell counts, protein/glucose content, abnormal cells
  • Enzymes
    • Lactate dehydrogenase, amylase
  • Culture
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5
Q

Pre-Procedure Nursing Interventions for a Thoracentesis

A
  • May be necessary for nurse to assist client into and to maintain position necessary for thoracentesis
  • Ensure client signed consent form
  • Gather required supply
  • Obtain pre-procedure CXR (locate pleural effusion, ID needle site)
  • Client positioning
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6
Q

how to position a client for a thoracentesis?

A

Sitting upright with arms and shoulders raised and supported on pillows or overbed table, feet and legs well supported

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7
Q

client education to be done before a thoracentesis

A
  • Client to remain absolutely still
  • Client not to speak or cough
    • Mitigate risk of accidental needle damage
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8
Q

intraprocedure nursing actions for a thoracentesis

A
  • Assist provider with procedure
    • Maintain strict surgical aseptic technique
  • Prepare client for feeling of pressure
  • Monitor VS, skin color, O2 saturation for changes
  • Measure and record amount of fluid removed
    • Label specimens at bedside and send to lab
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9
Q

post procedure nursing interventions for a thoracentesis

A
  • Apply dressing over puncture site
  • Monitor VS and Resp status (hourly for several hours post procedure)
    • rate/rhythm, breath sounds, oxygenation status
    • Auscultate for reduced breath sounds on side of procedure
  • Encourage client to deep breathe
    • Assists with lung expansion
  • CXR post-procedure
    • Resolution of pleural effusion
    • R/O pneumothorax
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10
Q

list possible complications of a thoracentesis

A
  • mediastinal shift
  • pneumothorax
  • bleeding
  • infection
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11
Q

explain mediastinal shift as a complication of a thoracentesis

A
  • shift of thoracic structures to one side of body
  • Diagnostics
    • Monitor VS
    • Auscultate lungs for decrease/absence of breath sounds
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12
Q

explain pneumothorax as a complication of thoracentesis

A
  • collapsed lung (injury to lungs during procedure)
  • Diagnostics
    • Monitor for Pneumothorax manifestations
      • Diminished breath sounds, distended neck veins, respiratory distress, cyanosis, chest wall asymmetry
    • CXR
  • Education: educate client on S/S pneumothorax, which can occur up to 24 hours post procedure
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13
Q

explain bleeding as a complication of peumothorax

A
  • from client movement during procedure, esp. w/ increased risk for bleeding
  • Diagnostics
    • Monitor for coughing, hemoptysis
    • Assess thoracentesis site for bleeding
    • Monitor VS/labs
      • Hypotension, decreased HGB levels
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14
Q

explain infection as a complication of thoracentesis

A
  • compromised surgical asepsis
  • Diagnostics:
    • Monitor client temperature
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15
Q

Pathology of Rhinitis

A
  • Inflammation of the nasal mucosa and often the mucosa in the sinuses that can be caused by infection (viral or bacterial) or allergens)
  • Common cold (coryza) is caused by viruses spread from person to person in droplets from sneezing and coughing or direct contact
  • Often coexists with other such as asthma and allergies
  • Presence of allergen causes histamine release and other mediators from WBC in nasal mucosa - mediators bind to blood vessel receptors causing capillary leakage → edema and swelling
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16
Q

expected findings of rhinitis

A
  • Excessive nasal drainage, runny nose, nasal congestion
  • Purulent nasal discharge
  • Sneezing and pruritus of the nose, throat and ears
  • Itchy, watery eyes
  • Sore, dry throat
  • Red, inflamed, swollen nasal mucosa
  • Low grade fever
  • Diagnostic testing can include allergy tests to identify possible allergens
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17
Q

nursing care for rhinitis

A
  • Encourage rest and increased fluid intake
  • Encourage use of humidifier or breathing steamy air
  • Promote proper disposal of tissues and cough etiquette
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18
Q

name the classes of medications used to treat rhinitis

A
  • antihistamines
  • leukotriene inhibitors
  • mast cell stabililzers
  • decongestants
  • intranasal glucocorticoid sprays
  • antipyretics
  • antibiotics
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19
Q

name the antihistamines, leukotriene inhibitors, and mast cell stabilizers used to treat rhinitis

How do they work?

A
  • antihistamines: bromepheniramine/pseudoephedrine
  • leukotriene inhibitor: montelukast
  • mast cell stabilizers: cromolyn
    • Used to block the release of chemicals from WBC that bind with receptors in nasal tissues which prevent edema and itching
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20
Q

nursing considerations for antihistamines, leukotriene inhibitors, and mast cell stabilizers (used to treat rhinitis)

A
  • Older adults ADRs - vertigo, hypertension and urinary retention
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21
Q

name the decongestant used to treat rhinitis

how does it work?

nursing considerations?

A
  • phenylephrine
  • Constrict blood vessels and decrease edema
  • Nursing considerations - use as prescribed to avoid rebound nasal congestion
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22
Q

what is the most effective prevention and treatment of seasonal and perennial rhinits?

A

intranasal glucocorticoid sprays

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23
Q

when to use antipyretics for rhinitis?

when to use antibiotics for rhinitis?

A
  • Antipyretics - use if fever is present
  • Antibiotics - if bacterial infection can be identified
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24
Q

client education for rhinitis

A
  • Hand hygiene
  • Complementary therapies such as echinacea, larger dose of vit C, and zinc preparations can be useful to promote immune response
  • Limit exposure to others
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25
Q

epistaxis

A
  • Often a complication of a HTN crisis, coagulation disorder
  • need to stop the bleeding!
    • have pt lean forward and apply pressure to nose for 10 min
  • should investigate:
    • use of blood thinners (coumadin, aspirin)
    • drug use
  • can utilize nasal tampons or silver nitrate
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26
Q

deviated septum

A

Can often be associated with sinusitis

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27
Q

what is seasonal influenza?

A
  • “flu”
  • Epidemic, usually in the fall or winter months
  • Highly contagious acute viral infection
  • Population: children and adults of all ages
  • Can be caused by several virus families–varies yearly
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28
Q

when are adults contagious with seasonal influenza?

A
  • 24 hours before manifestations begins
  • Up to 5 days after manifestations begin
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29
Q

pandemic influenza

A
  • viral infection among animals or birds that has mutated and is becoming infectious to humans
  • H1N1: swine flu
  • H5N1: avian flu
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30
Q

assessment for influenza

A
  • Severe HA and muscle aches
  • Chills
  • Fatigue, weakness
  • fever
  • Severe diarrhea and cough (avian flu)
  • Hypoxia (avian flu)
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31
Q

diagnostic procedures for influenza

A

AV Avantage A/H5N1 Flu Test

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32
Q

nursing care for influenza

A
  • Maintain droplet and contact precautions for clients with pandemic influenza
  • Give saline gargles
  • Monitor hydration, I&O
  • Administer fluid therapy (as prescribed)
  • Monitor respiratory status
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33
Q

name the antivirals to treat and prevent influenza

A

Amantadine, Rimantadine, Ribavirin

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34
Q

name the antivirals to shorten the duration of influenza infection

A
  • Zanamivir (oral inhalant)
  • Oseltamivir (oral tab)
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35
Q

client education for antivirals to treat influenza

A
  • tell clients to begin antiviral meds w/in 24-48 hours after onset of manifestations
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36
Q

trivalent vaccines for influenza

A
  • prepared yearly depending upon the suspected strain of influenza expected to appear
  • IM injection of Fluvirin or Fluzone
  • Live attenuated influenza vaccine by intranasal spray
    • DO NOT use for patients with co-morbidities, immunocompromised
  • Client Education:
    • Vaccination encouraged for everyone older than 6 mos
    • Higher risk and require vaccination: clients with hx of pneumonia, chronic medical conditions, and those over 65, pregnant, and health care providers
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37
Q

H1N1 vaccine

A

for general population

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38
Q

H5N1 vaccine

A

stockpiled for distribution if pandemic occurs

39
Q

interdisciplinary care involved with influenza

A
  • Respiratory services: consulted for respiratory support
  • Community health officials: notified of outbreaks
  • Public health officials: containment and prevention of directives during pandemic influenza
40
Q

client education for clients with influenza

A
  • Encourage annual vaccines
  • Wash hands and follow cough etiquette
  • Avoid places where ppl gather, avoid close contact
  • If develop flu manifestations: inc fluid intake, rest, stay home
  • Avoid travel to areas where pandemic flu is identified
  • Be aware of public health announcements
41
Q

complications of influenza

A
  • Pneumonia:
    • especially affecting older adults and clients who are debilitated or immunocompromised
42
Q

patho for sinsuitis

A
  • AKA rhinosinusitis
  • Patho: inflammation of the mucous membranes of 1 or more of the sinuses (usually maxillary or frontal sinuses)
    • Swelling of the mucosa can block the drainage of secretions–>sinus infection
    • Commonly caused by: Streptococcus pneumoniae, Haemophilus influenzae, diplococcus, bacteriodes
43
Q

risk factors for sinusitis

A
  • Often occurs after rhinitis
  • Deviated nasal septum
  • Nasal polyps
  • Inhaled air pollutants or cocaine
  • Facial trauma
  • Dental infections
  • Loss of immune fcn
44
Q

assessment findings for sinusitis

A
  • Nasal congestion
  • HA
  • Facial pressure or pain (worse when head is tilted forward)
  • Cough
  • Bloody or purulent nasal drainage
  • Tenderness to palpation of forehead, orbital and facial areas
  • Low grade fever
45
Q

diagnostic procedures for sinusitis

A
  • CT scan or sinus x-rays: confirm diagnosis
  • Endoscopic sinus cavity lavage/surgery: relieve obstruction and promote drainage
46
Q

nursing care for sinusitis

A
  • To relieve sinus congestion/pain: use steam humidification, sinus irrigation, saline nasal sprays, hot/wet packs
  • Inc fluid intake and rest
  • Discourage air travel, swimming, and diving
  • Encourage cessation of tobacco
  • Teach client how to correctly irrigate sinuses and administer nasal sprays
47
Q

list the medication classes used to treat sinusitis

A
  • nasal decongestants
  • broad spectrum antibiotics
  • pain relief medications
48
Q

nasal decongestants to treat sinusitis

A
  • Ie. Phenylephrine
  • Used to reduce swelling of mucosa
  • Nursing Considerations:
    • Begin OTC decongestant at first sign of sinusitis
    • If decongestants used more than 3-4 days, may develop rebound nasal congestion
49
Q

broad spectrum antibiotics to treat sinusitis

A
  • Ie. Amoxicillin
  • Used on a limited basis for a confirmed causative bacterial pathogen
50
Q

pain relief meds to treat sinusitis

A

NSAIDs, acetaminophen, aspirin

51
Q

client education for sinusitis

A
  • Sinus irrigation and saline nasal sprays: alternative to antibiotics for relieving nasal congestion
  • Contact provider if experience severe HA, neck stiffness (nuchal rigidity), and high fever
52
Q

complications of sinusitis

A
  • Meningitis and Encephalitis:
    • Can occur if pathogens enter the bloodstream from the sinus cavity
53
Q

patho pneumonia

A
  • An inflammatory process in the lungs that produces excess fluid
  • Triggered by infectious organisms or by the aspiration of an irritant such as fluid or foreign object
  • Inflammatory process in the lung parenchyma results in edema and exudate that fills the alveoli
  • Can be primary or complication
54
Q

risk factors of pneumonia

A
  • Young and old
  • Immunocompromised
  • Immobility and inactivity
  • Recent exposure to viral, bacterial or influenza infections
  • Lack of current immunizations
  • Exposure to plant pollen, molds, animal dander, foods, medications and enviro contaminants
  • Tobacco smoke
  • Substance abuse
  • COPD
  • Presence of a foreign body
  • Conditions that increase risk of aspiration (dysphagia)
  • Mechanical ventilation
  • Impaired ability to mobilize secretions
55
Q

Community Acquired Pneumonia (CAP)

A

Most common

Usually a complication of the flu

56
Q

Health Care Associated Pneumonia (HAP)

A

Higher mortality rate

More likely resistant to antibiotics

57
Q

Expected Findings of Pneumonia (Subjective Findings)

A
  • anxiety
  • fatigue
  • weakness
  • chest discomfort due to coughing
  • confusion from hypoxia
58
Q

what is the most common manifestation of pneumonia in older adults?

A
  • confusion from hypoxia
59
Q

Physical Assessment findings of Pneumonia

A
  • fever
  • chills
  • flushed face
  • diaphoresis
  • shortness of breath or difficulty breathin
  • tachypnea
  • pleuritic (sharp) chest pain
  • sputum production (yellow tinged)
  • crackles and wheezes
  • coughing
  • dull chest percussion over areas of consolidation
  • dec O2 sats
  • purulent blood tinged or rust colored sputum (not always present)
60
Q

laboratory tests necessary for pneumonia

A
  • sputum culture and sensitivity
  • CBC
  • ABGs
  • blood culture: to rule out organisms in the blood
  • serum electrolytes: to identify causes of dehydration
61
Q

sputum culture and sensitivity test for Pneumonia

A
  • obtain specimen before starting antibiotics
  • obtain specimen by suctioning if the client is unable to cough
  • older adult clients have a weak cough reflex and dec muscle strength
    • so may have trouble expectorating–>can lead to difficulty breathing and make specimen retrieval difficult
62
Q

what are the expected results of a CBC and ABGs when client has pneumonia?

A
  • CBC: elevated WBC count (not always present in older adults)
  • ABGs: hypoxemia (dec PaO2 less than 80 mmHg)
63
Q

diagnostic procedures for pneumonia

A
  • chest x ray
  • pulse oximetry: if have pneumonia, SpO2 <95%
64
Q

what are the expected findings for a chest x-ray on a client with pneumonia?

A
  • will show consolidation
  • might not indicate pneumonia for a few days after manifestations
  • important to use b/c early manifestations of pneumonia are often vague in older adults
65
Q

nursing care for a client with pneumonia

A
  • put pt in High Fowler’s (to maximize ventilation)
  • encourage coughing or suctioning
  • administer breathing tx and meds
  • administer O2 therapy
    • monitor for skin breakdown from O2 device
  • encourage use of incentive spirometer to prevent alveolar collapse
  • determine clients physical limits and include periods of rest during activity
  • promote adequate nutrition and fluid intake
66
Q

what is important to remember about promoting adequate nutrition and fluids for a client with pneumonia?

A
  • inc work of breathing (WOB) requires additional calories
  • proper nutrition aids in prevention of secondary respiratory infections
  • encourage fluid intake of 2-3 L/day to promote hydration and thinning of secretions, unless contraindicated
67
Q

name the classes of medications used to treat pneumonia

A
  • antibiotics
  • bronchodilators
  • anti-inflammatories
68
Q

antibiotics for use in tx of pneumonia

A
  • given to destroy infectious pathogens
    • esp. penicillins and cephalosporins
  • often given IV then switched to oral form
  • important to obtain culture specimens prior to giving 1st dose of antibiotics
69
Q

nursing considerations for antibiotics given for pneumonia

A
  • observe clients taking cephalosporins for frequent stools
  • monitor kidney function, esp in older adults taking penicillins and cephalosporins
70
Q

client education for clients taking antibiotics for pneumonia

A
  • encourage clients to take penicillins and cephalosporins with food
    • some penicillins should be taken 1 hour before meals or 2 hours after
71
Q

why are bronchodilators given for use in tx of pneumonia?

A
  • given to reduce bronchospasms and reduce irritation
72
Q

what are the 3 types of bronchodilators used for pneumonia tx?

A
  • short acting beta 2 agonists
  • cholinergic antagonists/anti-cholinergic meds
  • methylxanthines
73
Q

short acting beta 2 agonists taken for pneumonia

A
  • type of bronchodilator
  • ie. albuterol
  • provide rapid relief
  • nursing considerations:
    • watch for tremors and tachycardia
  • client education:
    • encourage inc fluid intake
74
Q

anticholinergic medications taken for pneumonia tx

A
  • type of bronchodilator
  • ie. ipratropium
    • block the parasympathetic NS and allow for inc bronchodilation and dec pulmonary secretions
    • nursing considerations:
      • observe for dry mouth
      • monitor HR
      • ADRs: HA, blurred vision, palpitations
    • client edu:
      • suck on hard candies to moisten mouth
      • encourage inc fluid intake
75
Q

methylxanthines taken for pneumonia tx

A
  • type of bronchodilator
  • ie. theophylline
    • nursing considerations:
      • monitor serum med levels closely
      • ADRs: tachycardia, nausea, diarrhea
    • client edu:
      • encourage inc fluid intake
76
Q

anti-inflammatories for use in the treatment of pneumonia

A
  • dec airway inflammation
  • glucocorticosteroids (like fluticasone and prednisone)
    • prescribed to reduce inflammation
    • ADRs: immunosuppression, fluid retention, hyperglycemia, hypokalemia, poor wound healing
77
Q

nursing considerations for clients taking anti-inflammatories for pneumonia

A
  • monitor for dec immune function
  • monitor for hyperglycemia
  • report black, tarry stools
  • observe for fluid retention and weight gain
  • monitor throat and mouth or aphthous lesions (canker sores)
78
Q

client education for clients taking anti-inflammatories for pneumonia

A
  • drink plenty of fluids
  • take glucocorticosteroids with food
  • avoid d/c glucocorticosteroids abruptly
79
Q

interdisciplinary care involved with pneumonia

A
  • respiratory services: consult for inhalers, breathing tx, suctioning
  • nutritional services: contacted for weight loss or gain related to meds
  • rehab care: consult if client has prolonged weakness
80
Q

client education for those with pneumonia

A
  • educate client on importance of continuing pneumonia tx
  • maintain hand hygiene
  • avoid crowded areas
  • tx and recovery can take time
  • encourage immunizations for influenza and pneumonia
  • promote smoking cessation
81
Q

list the possible complications of pneumonia

A
  • atelectasis
  • bacteremia (sepsis)
  • acute respiratory distress syndrome
82
Q

explain atelectasis as a complication of pneumonia

A
  • airway inflammation and edema lead to alveolar collapse and inc the risk of hypoxemia
  • client reports shortness of breath and exhibits findings of hypoxemia
  • client has diminished or absent breath sounds over affected areas
  • chest x ray shows area of density
83
Q

explain bacteremia (sepsis) as a complication of pneumonia

A
  • occurs if pathogen enters the bloodstream from infection in the lungs
84
Q

explain acute respiratory distress syndrome as a complication of pneumonia

A
  • hypoxemia persists despite O2 therapy
  • dyspnea worsens as bilateral pulmonary edema develops that is non cardiac related
  • chest x ray: shows area of density with a ground glass appearance
  • blood gas findings demonstrate high arterial blood levels of CO2 (hypercarbia) even though pulse ox shows dec saturation
85
Q

what is pleural effusion?

A
  • Abnormal accumulation of fluid in the pleural space
  • often an indication for a chest tube
  • may be a sign of a PE
  • must obtain a chest x-ray to verify resolution of pleural effusion
86
Q

assessment findings for pleural effusion

A
  • Dyspnea
  • Distended neck veins
  • Pleuritic chest pain
  • Cough
  • Absent or reduced breath sounds on affected side
  • Dullness or flatness on percussion of affected side
  • Asymmetrical chest wall motion
87
Q

diagnostic procedure for pleural effusion

A
  • thoracentesis
    • must obtain a preprocedure x ray to locate the pleural effusion and determine needle insertion site
88
Q

what puts a patient at increased risk for the flu?

A
  • presence of a co-morbidity such as DM (even if well controlled)
89
Q

what color sputum indicates a viral or bacterial infection?

A

yellow-green sputum

90
Q

what color sputum indicates allergies

A

white sputum

91
Q

what does having a cough that worsens at night indicate?

A

post nasal drip (PND)

92
Q

nasal turbinates in allergies vs. infection

A
  • allergies: swollen, pale, boggy, bluish
  • infection: red, swollen, inflamed
93
Q

use of Afrin

A
  • used as a nasal decongestant (it is a nasal spray)
  • should not used for more than 3 days
    • longer use can cause rebound nasal congestion and make symptoms worse

Adult Health I Test I (5 decks)

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