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Nurs 136- MCA II > Week 2 - Pulmonary & Hematology > Flashcards

Week 2 - Pulmonary & Hematology Flashcards

1
Q

Pneumonia - acute infection of:

A

lung parenchyma

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2
Q

Pneumonia diagnostic

A

Chest X-ray
Sputum analysis
CBC
ABG’s
Pulse O2
BC
Thoracentesis
CRP
Procalcitonin
Expanded CURB-65 scale

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3
Q

Pneumonia categories

A

CAP [community]
HAP [hospital]
VAP [ventilator]

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4
Q

Pneumonia S&S

Dyspnea
Hypoxia
Cough
fever, chills
tachypnea
_________ chest pain
green/yellow/rust ___________
ALOC

A

Dyspnea
Hypoxia
Cough
fever, chills
tachypnea
pleuritic chest pain
green/yellow/rust sputum
ALOC

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5
Q

Pneumonia nursing management

O2
Abx
IVF
Antipyretics
Analgesics
Incentive spirometer
CDB [Cpugh, deep breathe]
I&O
Vaccine
Admission
Nutrition therapy

A

O2
Abx
IVF
Antipyretics
Analgesics
Incentive spirometer
CDB [Cpugh, deep breathe]
I&O
Vaccine
Admission
Nutrition therapy

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6
Q

Pneumonia complications

A

Sepsis/shock
Acute respiratory failure - intubation & MV

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7
Q

CURB-65 Scale scores

A

0-2 - low risk - outpatient
3-4 - medium - in patient
5-8- high risk - ICU

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8
Q

CURB-65 Scale

A

C- Confusion
U- BUN over 20
R- Resp over 30
B- BP under 90/60

Over 65 years old

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9
Q

Expanded Curb 65 factors

A

LDH over 230

Albumin under 3.5

Platelets under 100 x 10^9

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10
Q

Empiric Antibiotic Treatment (PNA)

A
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11
Q

Tuberculosis - infectious disease caused by ______________

A

Mycobacterium Tuberculosis

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12
Q

Tuberculosis classifications

A

Primary infection

Active

Latent

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13
Q

Tuberculosis S&S

______________ cough
fatigue
malaise
anorexia
weight loss
low-grade _____
______ sweats
dyspnea
____________ (late)
ALOC

A

Dry-productive cough
fatigue
malaise
anorexia
weight loss
low-grade fever
night sweats
dyspnea
hemoptysis (late)
ALOC

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14
Q

Tuberculosis diagnostics

Tuberculin _____ test
IGRAs
Chest _______

A

Tuberculin skin test
IGRAs
Chest X-ray

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15
Q

Tuberculosis nursing management

___________ isolation
immediate medical workup
identify & screen close ____________
patient teaching

A

airborne isolation
immediate medical workup
identify & screen close contacts
patient teaching

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16
Q

Tuberculosis drug therapy

Isoniazid (INH)
Rifampin (Rifadin)
Pyrazinamide
Ethambutol

A

Take all 4 drugs daily for 8 weeks

then take first 2 drugs for 7 months

[Risk for liver toxicity] - avoid alcohol, monitor for liver issues

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17
Q

Pulmonary Embolism (PE) - ______________ pulmonary arteries by a thrombus, fat, or air embolus, or tumor

A

blockage of 1+

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18
Q

Pulmonary Embolism (PE) risk factor

Virchow’s triad
Oral contraceptives
Afib

A

Virchows triad -
3 factors that predisposes to blood clot formation/ PE

Venous stasis
endothelial damage
blood hypercoagulability

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19
Q

Pulmonary Embolism (PE) S&S

Dyspnea, wheezing
Hypoxemia
Tachypnea, tachycardia
Hypo_______
Cough, chest pain
syncope
hypo________
shock
feeling of ____________

A

Dyspnea, wheezing
Hypoxemia
Tachypnea, tachycardia
Hypocarbia
Cough, chest pain
syncope
hypotension
shock
feeling of impending doom

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20
Q

Pulmonary Embolism (PE) diagnostics

D-______
CT( CTA)
V/Q Scan

A

D-dimer
CT( CTA)
V/Q Scan

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21
Q

Pulmonary Embolism (PE) nursing management

O2
_____-fowler
VS, pulse oximetry
cardiac monitor
ABGs
______ sounds
IV line, IVF
Heparin, Coumadin
Embolectomy

A

O2
Semi-fowler
VS, pulse oximetry
cardiac monitor
ABGs
lung sounds
IV line, IVF
Heparin, Coumadin
Embolectomy

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22
Q

Asthma = heterogenous disease characterized by a combination of clinical manifestations along with reversible expiratory airflow limitation or ______________ _____________

A

Asthma = heterogenous disease characterized by a combination of clinical manifestations along with reversible expiratory airflow limitation or bronchial hyperresponsiveness

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23
Q

Asthma complication

Status asthamaticus - an extreme form of asthma ____________ characterized by hypoxemia, hypercarbia, and secondary __________ failure

A

Status asthamaticus - an extreme form of asthma exacerbation characterized by hypoxemia, hypercarbia, and secondary respiratory failure

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24
Q

Asthma risk factors

Allergens
EIA
air pollutants
infections
Drugs
GERD
stress

A

Allergens
EIA
air pollutants
infections
Drugs
GERD
stress

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25
Q

Asthma S&S

cough
______ production
shortness of breath, dyspnea
wheezing
chest ___________
unpredictable/ variable

A

cough
mucus production
shortness of breath, dyspnea
wheezing
chest tightness
unpredictable/ variable

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26
Q

Asthma diagnostics

PEFR [peak exp. flow meter]
chest x-ray
oximetry

A

PEFR [peak exp. flow meter]
chest x-ray
oximetry

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27
Q

Asthma nursing management

_______ fowler’s
O2
Bronchodilators
corticosteroids
assess lung sounds
severe asthma- Iv Mg, intubate, MV

A

High fowler’s
O2
Bronchodilators
corticosteroids
assess lung sounds
severe asthma- Iv Mg, intubate, MV

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28
Q

Asthma- Drug therapy

-Short acting Beta Agonist (SABA) - ________

-Anticholinergics - Ipratropium

-Long acting Beta Agonist (LABA) - Salmeterol, Formoterol

-Methylxanthines (Theophylline)

-Inhaled corticosteroids (ICS) - Beclomethasone, Budesonide

-___________ modifiers - Zafirlukast, Montelukast, Pileuton

-Anti IgE - Xolair

A

-Short acting Beta Agonist (SABA) - albuterol

-Anticholinergics - Ipratropium

-Long acting Beta Agonist (LABA) - Salmeterol, Formoterol

-Methylxanthines (Theophylline)

-Inhaled corticosteroids (ICS) - Beclomethasone, Budesonide

-Leukotriene modifiers - Zafirlukast, Montelukast, Pileuton

-Anti IgE - Xolair

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29
Q

COPD - characterized by __________ ____________ caused by chronic bronchitis or emphyesema or both

A

airflow obstruction

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30
Q

risk factors for COPD

__________
air pollution
resp. ___________
A1-Antitrypsin deficiency

A

smoking
air pollution
resp. infection
A1-Antitrypsin deficiency

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31
Q

COPD S&S

Chronic bronchitis:
cough & sputum for 3+ months
Hypoxemia, wheezing
peripheral edema
hypercarbia, acidosis

Emphysema:
Alveolar destruction
dyspnea
purse lip breathing
underweight, anorexia
chronic fatigue
barrell chestr
polycthemia, cyanosis

A

Chronic bronchitis:
cough & sputum for 3+ months
Hypoxemia, wheezing
peripheral edema
hypercarbia, acidosis

Emphysema:
Alveolar destruction
dyspnea
purse lip breathing
underweight, anorexia
chronic fatigue
barrell chestr
polycthemia, cyanosis

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32
Q

COPD diagnostics

increased FRC due to auto PEEP

decreased FEV1

chest x-ray
ABGs
Sputum culture
CBC

A

increased FRC due to auto PEEP

decreased FEV1

chest x-ray
ABGs
Sputum culture
CBC

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33
Q

COPD- drug therapy

A
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34
Q

COPD complications

Pulmonary _____
Cor Pulmonale [______side heart disease]
Excacerbations of COPD
Acute _______ . failure
Peptic ulcer disease
depression/anxiety

A

Pulmonary HTN
Cor Pulmonale [right side heart disease]
Excacerbations of COPD
Acute resp. failure
Peptic ulcer disease
depression/anxiety

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35
Q

COPD nursing management

Fowlers/ lean forward
VS, BiPAP, meds, breathing techniques
if necessary, lung suction
Assess sputum
weight
small, freq. meals, high cal/protein
Fluids to thin secretions

A

Fowlers/ lean forward
VS, BiPAP, meds, breathing techniques
if necessary, lung suction
Assess sputum
weight
small, freq. meals, high cal/protein
Fluids to thin secretions

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36
Q

Anemia is the ___________ in either RBC, PRBC/hematocrit, or hemoglobin

A

reduction

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37
Q

Anemia S&S

fatigue
dyspnea
dizziness
cold hands and feet
pale
palpitations

A

fatigue
dyspnea
dizziness
cold hands and feet
pale
palpitations

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38
Q

Iron deficiency anemia S&S

General anemia S&S
pallor
glossitis (tongue)
Cheilitis (lips)
HA
burning on tongue

A

General anemia S&S
pallor
glossitis (tongue)
Cheilitis (lips)
HA
burning on tongue

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39
Q

Anemia diagnostics

H/H [HGB, HCT]
reticulocytes
iron, transferrin
bilirubin

A

H/H [HGB, HCT]
reticulocytes
iron, transferrin
bilirubin

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40
Q

Anemia nursing management

Correct _______
O2 if needed
______ (packed RBC)
IVF, lifestyle/diet changes
fatigue management/safety

A

Correct cause
O2 if needed
PRBC (packed RBC)
IVF, lifestyle/diet changes
fatigue management/safety

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41
Q

Iron deficiency anemia = most _______ type of anemia

A

common

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42
Q

Iron deficiency anemia etiology

diet
malabsorption
blood loss
hemolysis

A

diet
malabsorption
blood loss
hemolysis

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43
Q

Cobalamin (B12) deficiency etiology

____ surgery, Crohns/Celiac
Long term use ____ or H2 blockers
alcohol, poor diet
pernicious anemia

A

GI surgery, Crohns/Celiac
Long term use PPI or H2 blockers
alcohol, poor diet
pernicious anemia

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44
Q

Cobalamin deficiency (B12) S&S

general anemia S&S
Sore, red, beefy, shiny _______
A/N/V, Abd pain
Weakness, ___________
confusion, severe memory loss

A

general anemia S&S
Sore, red, beefy, shiny tongue
A/N/V, Abd pain
Weakness, paresthesia
confusion, severe memory loss

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45
Q

Cobalamin deficiency (B12) diagnostics

CBC
Vit B12 levels
________ test [cobalamin absorption measured with radioactive urine]

A

CBC
Vit B12 levels
Schilling test [cobalamin absorption measured with radioactive urine]

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46
Q

Cobalamin deficiency (B12) nursing management

dietary intake of ____
orar/parenteral/__________replacement

A

dietary intake of B12
orar/parenteral/intranasal replacement

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47
Q

Folic acid deficiency [B9] etiology

poor nutrition
malabsorption
alc, drugs

A

poor nutrition
malabsorption
alc, drugs

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48
Q

Folic acid deficiency [B9] S&S

General anemia S&S
Smooth, beefy ________
prone to mouth ________

A

General anemia S&S
Smooth, beefy tongue
prone to mouth sores

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49
Q

Folic acid deficiency [B9] diagnostics

_________ levels
CBC

A

Folic acid levels
CBC

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50
Q

Folic acid deficiency [B9] nursing management -

A

Dietary/oral replacement

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51
Q

Sickle cell anemia etiology

_________ disorder; homozygous Hb SS [from both parents]
formation of abnormal HGB chains; S shapes clump in capillaries
common in ______________

A

genetic disorder; homozygous Hb SS [from both parents]
formation of abnormal HGB chains; S shapes clump in capillaries
common in african americans

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52
Q

Sickle cell anemia; conditions causing ___________ of RBCs:

hypoxia
dehydration
infections
venous stasis
low env. body temp
acidosis
strenuous exercise
anesthesia

A

sickling

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53
Q

Sickle cell anemia S&S

Sickling criss
chronic anemia
pain
organ damage
jaundice
cholelithiasis

A

Sickling criss
chronic anemia
pain
organ damage
jaundice
cholelithiasis

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54
Q

Sickle cell anemia nursing management

PRBC
pain
O2
Abx
DVT prophylaxis
rest, IVF, electrolytes
_____ cell transplant, pt teaching

A

PRBC
pain
O2
Abx
DVT prophylaxis
rest, IVF, electrolytes
stem cell transplant, pt teaching

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55
Q

Thrombocytopenia - bone marrow doesnt make enough platements, or body _________ platelets

A

destroys

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56
Q

Thrombocytopenia S&S

Epistaxis
bleeding gums
petechiae
purpura, ecchymosis
prolonged bleeding
dizzy, tachycardia, faint
intracranial bleeding, blood in urine

A

Epistaxis
bleeding gums
petechiae
purpura, ecchymosis
prolonged bleeding
dizzy, tachycardia, faint
intracranial bleeding, blood in urine

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57
Q

Thrombocytopenia 3 types

ITP
TTP
HIT

A

Immune Thrombocytopenia Purpura - immune disorder; antiplatelet antibodies

Thrombotic Thrombocytopenic Purpura - enhanced aggregation of platelets that form microthrombi that deposit in arterioles/capillaries

Heparin-induced thrombocytopenia - 5-10 days after heparin therapy

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58
Q

Polycthemia Vera - overproduction of :

A

RBC, WBC, PLT

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59
Q

Polycthemia Vera etiology

______________ in single stem cell, JAK2 gene

A

DNA mutations

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60
Q

Polycthemia Vera S&S

HTN caused by hyperviscosity and hypervolemia
HA, vertigo
vision problems
itching, MI, HF, stroke, bleeding, gout

A

HTN caused by hyperviscosity and hypervolemia
HA, vertigo
vision problems
itching, MI, HF, stroke, bleeding, gout

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61
Q

Polycthemia Vera diagnostics:

A

RBC, PLT, WBC

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62
Q

Neutropenia is

A

low neutrophils under 1000

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63
Q

Neutropenia etiology

________/immunosuppressive therapy; autoimmune disease

A

chemo/immunosuppressive therapy; autoimmune disease

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64
Q

Neutropenia S&S

infection
treat fever aggresively
RISK: ________

A

infection
treat fever aggresively
RISK: sepsis

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65
Q

Neutropenia nursing management

monitor for __________
find cause
collect BC x2
Start Abx (broad spectrum until cause known)
may need antifungals, Neupogen
Reverse isolation

A

monitor for infection
find cause
collect BC x2
Start Abx (broad spectrum until cause known)
may need antifungals, Neupogen
Reverse isolation

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66
Q

Lobes of the lung

A

Right lung - 3 lobes
Left lung- 2 lobes

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67
Q

3 Mechanisms of the Respiratory System

  1. __________ : inhaling O2 , exhaling CO2 (very important for ventilation), Diaphragm
    important muscle (promotes ventilation
  2. ___________ : gas exchange occurs in alveoli, O2 and CO2 exchange
  3. ___________ : inhaled O2 is carried by RBCs and then transported to cells
A

3 Mechanisms of the Respiratory System

  1. Ventilation: inhaling O2 , exhaling CO2 (very important for ventilation), Diaphragm
    important muscle (promotes ventilation
  2. Diffusion: gas exchange occurs in alveoli, O2 and CO2 exchange
  3. Perfusion: inhaled O2 is carried by RBCs and then transported to cells
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68
Q

___________ : inhaling O2 , exhaling CO2 (very important for ventilation), Diaphragm
important muscle (promotes ventilation)

A

Ventilation

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69
Q

Diffusion: ______________ occurs in alveoli, O2 and CO2 exchange

A

gas exchange

70
Q

Perfusion: inhaled O2 is carried by _____ and then transported to cells

A

RBCs

71
Q

Inhale O2 -> Lungs -> Alveoli -> Gas Exchange occurs (O2 and CO2 from high concentration to low – diffusion) -> O2 now in RBC (each hemoglobin can bind 4 O2)

A

Inhale O2 -> Lungs -> Alveoli -> Gas Exchange occurs (O2 and CO2 from high concentration to low – diffusion) -> O2 now in RBC (each hemoglobin can bind 4 O2)

72
Q

●SpO2 (______________): measures amt of O2 saturated in the hemoglobin of the 4 hemes

● PaO2 (_______________): measures O2 outside RBCs,dissolved in blood

A

●SpO2 (Oxygen Saturation): measures amt of O2 saturated in the hemoglobin of the 4 hemes

● PaO2 (Partial Oxygen): measures O2 outside RBCs,dissolved in blood

73
Q

A patient with chronic obstructive pulmonary disease (COPD) has been eating very little and
has lost weight. Which intervention would be most appropriate for the nurse to include in the plan of care?

a. Encourage increased intake of whole grains.
b. Increase the patient’s menu order of fruits and fruit juices.
c. Offer high-calorie protein snacks between meals and at bedtime.
d. Assist the patient in choosing foods with high vegetable content.

A

c. Offer high-calorie protein snacks between meals and at bedtime.

Eating small amounts more often (as occurs with snacking) will increase caloric
intake by decreasing the fatigue and feelings of fullness associated with large
meals. Patients with COPD should rest before meals. Foods that have a lot of texture
such as whole grains may take more energy to eat and get absorbed and lead to
decreased intake. Although fruits, juices, and minerals are not contraindicated,
foods high in protein are a better choice.

74
Q

Which action should the nurse take to prepare a patient for spirometry?

a. Give the rescue medication immediately before testing.
b. Administer oral corticosteroids 2 hours before the procedure.
c. Withhold bronchodilators for 6 to 12 hours before the examination.
d. Ensure that the patient has been NPO for several hours before the test

A

c. Withhold bronchodilators for 6 to 12 hours before the examination.

Bronchodilators are held before spirometry so that a baseline assessment of airway function can be determined. Testing is repeated after bronchodilator use to determine whether the
decrease in lung function is reversible. There is no need for the patient to be NPO. Oral
corticosteroids should be held before spirometry. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.

75
Q

The nurse teaches a patient who has asthma about peak flowmeter use. Which action by the
patient indicates that teaching was successful?

a. The patient inhales rapidly through the peak flowmeter mouthpiece.
b. The patient takes montelukast (Singulair) for peak flows in the red zone.
c. The patient uses albuterol (Ventolin HFA) for peak flows in the yellow zone.
d. The patient calls the health care provider when the peak flow is in the green zone.

A

c. The patient uses albuterol (Ventolin HFA) for peak flows in the yellow zone.

Readings in the yellow zone indicate a decrease in peak flow. The patient should use
short-acting Beta 2-adrenergic (SABA) medications. Readings in the green zone indicate good
asthma control. The patient should exhale quickly and forcefully through the peak flowmeter
mouthpiece to obtain the readings. Readings in the red zone do not indicate good peak flow,
and the patient should take a fast-acting bronchodilator and call the health care provider for
further instructions. Singulair is not indicated for acute attacks but is used for maintenance
therapy

76
Q

The nurse provides dietary teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a low body mass index (BMI). Which patient statement indicates that the teaching has been effective?

a. “I will drink lots of fluids with my meals.”
b. “I will exercise for 15 minutes before meals.”
c. “I will decrease my intake of meat and poultry.”
d. “I can have ice cream as a snack every day.”

A

d. “I can have ice cream as a snack every day.”

High-calorie foods such as ice cream are an appropriate snack for patients with COPD. Fluid
intake of 3 L/day is recommended, but fluids should be taken between meals rather than with meals to improve oral intake of solid foods.

77
Q

The nurse determines that the patient understood medication instructions about the use of
a spacer device when taking inhaled medications after hearing the patient state what as the
primary benefit?

a) “I will pay less for medication because it will last longer.”
b) “More of the medication will get down into my lungs to help my breathing.”
c) “Now I will not need to breathe in as deeply when taking the inhaler medications.”
d) “This device will make it so much easier and faster to take my inhaled medications.”

A

b) “More of the medication will get down into my lungs to help my breathing.”

A spacer assists more medication to reach the lungs, with less being deposited in the mouth
and the back of the throat. It does not affect the cost or increase the speed of using the inhaler.

78
Q

Normal SpO2 is

A

95-100%

79
Q

●SpO2 (Oxygen Saturation): measures amt of _________________ in the hemoglobin of the 4 hemes

A

O2 saturated

80
Q

● PaO2 (Partial Oxygen): measures O2 outside RBCs, ________________

A

dissolved in blood

81
Q

2 Problems during Respiration

A

Physiological Dead Space

Intrapulmonary Shunt

82
Q

Resp Problem: Physiological Dead Space (area of no gas exchange): breathing in air, but _____________ is not occurring

Areas of Dead space
1. MOST COMMON: obstruction from Pulmonary Embolism/blood clot prevents RBC from picking up O2 in alveoli

  1. COPD (destruction of alveoli with emphysema)
A

gas exchange

83
Q

Intrapulmonary Shunt: occurs when ________ is filled with mucus, fluid or pus

Examples of Intrapulmonary Shunting
1. Pneumonia: filling alveoli with pus, no gas exchange
2. Pulmonary Edema
3. ARDS (Acute Respiratory Distress Syndrome)

A

alveoli

84
Q

Nasal Canula –> ____ L

Simple Mask –> _____ L

A

Nasal Canula –> 1-6 L

Simple Mask –> 6-12L

85
Q

Non-Rebreather –> ______ L/min,Pure O2, CO2 filtered out

A

10 -15

86
Q

CPAP –> Continuous___________airway- only one pressure provided

A

positive

87
Q

BiPAP –> Bilevel positive airway pressure (Noninvasive)
- High pressure Inhaling
- Lower pressure Exhaling (Pt does not have to overcome as much pressure when exhaling)
- Pressure forces _________ to ________ & facilitate mores oxygen exchange

A

alveoli to open

88
Q

High Flow Nasal Cannula
- Humidified to body temperature
- ___ L, does not provide pressure support like CPAP, BiPAP
- Less Restrictive

A

60L

89
Q

Pneumonia - Lower respiratory tract infection that causes inflammation of the _____________

A

alveoli sacs

90
Q

Types
* CAP: ___________ acquired
* HAP: _________ acquired
* VAP: ___________ associated

A
  • CAP: community acquired
  • HAP: hospital acquired
  • VAP: ventilation associated
91
Q

Pneumonia Risk factors

  • Prior infection
  • Smoking
  • Lung disease
  • Immunocompromised
  • Immobility
A
  • Prior infection
  • Smoking
  • Lung disease
  • Immunocompromised
  • Immobility
92
Q

Pneumonia Clinical Manifestations
* Dyspnea
* Hypoxia ( avevoli filled with mucus and pus)
* Cough
* Fever
* Chills
* Productive cough (purulent sputum)
* Increased RR, HR
* Chest pain
* Fever > 100.3, sweating/chills

A
  • Dyspnea
  • Hypoxia ( avevoli filled with mucus and pus)
  • Cough
  • Fever
  • Chills
  • Productive cough (purulent sputum)
  • Increased RR, HR
  • Chest pain
  • Fever > 100.3, sweating/chills
93
Q

Pneumonia Complications
* Sepsis, septic shock
* Acute respiratory failure
* MV

A
  • Sepsis, septic shock
  • Acute respiratory failure
  • MV
94
Q

Pulmonary Embolism: BLOCKAGE in one or more of the pulmonary arteries caused by _______________ that travel to the lungs from the deep veins. LIFE THREATENING!

A

blood clots

95
Q

Pulmonary Embolism S/S:
* Dyspnea
* Hypoxemia
* Wheezing
* Hypocarbia
* Chest pain
* Hypotension shock
* Feeling of impending doom
* Tachycardia

A
  • Dyspnea
  • Hypoxemia
  • Wheezing
  • Hypocarbia
  • Chest pain
  • Hypotension shock
  • Feeling of impending doom
  • Tachycardia
96
Q

Pulmonary Embolism Treatment

  • lovenox and coumadin (PT/INR)
  • Unfractionated heparin (aPTT)
  • TPA: clot buster
  • Embolectomy: surgery to remove the ______
A
  • lovenox and coumadin (PT/INR)
  • Unfractionated heparin (aPTT)
  • TPA: clot buster
  • Embolectomy: surgery to remove the clot
97
Q

Receptors in lung vs heart

A

Lung- B1 receptos
Heart- B2 receptors

98
Q

why is COPD associated with being underweight?

2 reasons

A

burning more calories due to breathing
hyperinflation = diaphragm stays flat - presses stomach = “full” sensation

99
Q

For COPD, be cautious giving too much oxygen, because it will reduce their ______________

A

drive to breathe

100
Q

WBC range

A

5,000 - 10,000 mm^3

101
Q

PLT platelets range

A

150 - 400 k/uL

102
Q

INR range

A

0.8 - 1.1

or

2 - 3 (warfarin)

103
Q

_________ - reduction in erythrocyes/RBC, hemoglobin OR volume of hematocrit (PRBC)

A

Anemia

104
Q

HGB range

A

12 - 16

105
Q

HCT range

A

37 - 52%

106
Q

HGB below ___ is really not good

A

7

107
Q

Iron deficiency anemia diagnostics

CBC
Serum iron
serum ferritin
TIBC total iron-binding capacity

A

CBC
Serum iron
serum ferritin
TIBC total iron-binding capacity

108
Q

Iron deficiency anemia nursing management

find cause
oral, IM or IV iron; with OJ before food [liquid stains teeth - use straw]
SE: constipation, black stool

A

find cause
oral, IM or IV iron; with OJ before food [liquid stains teeth - use straw]
SE: constipation, black stool

109
Q

Polycthemia Vera nursing management

phlebotomoy
balance hydration
low dose ASA, hydroxyurea

A

phlebotomoy
balance hydration
low dose ASA, hydroxyurea

110
Q

Immune Thrombocytopenia Purpura - immune disorder; antiplatelet __________

Thrombotic Thrombocytopenic Purpura - enhanced ____________ of platelets that form microthrombi that deposit in arterioles/capillaries

Heparin-induced thrombocytopenia - 5-10 days after _________ therapy

A

Immune Thrombocytopenia Purpura - immune disorder; antiplatelet antibodies

Thrombotic Thrombocytopenic Purpura - enhanced aggregation of platelets that form microthrombi that deposit in arterioles/capillaries

Heparin-induced thrombocytopenia - 5-10 days after heparin therapy

111
Q

Thrombocytopenia nursing management

ITP: corticosteroids, splenectomy, IV Immunoglobulins, platelets if under ____

TTP: plasma exchange/ plasmapheresis, corticosteroids, splenectomy or immusupp. meds, NO platelets (increased clotting)

HIT: D/C heparin, start Factor XA inhibitor: Arixtra, No platelet transfusion; NEVER receieve heparin/Lovenox again

A

ITP: corticosteroids, splenectomy, IV Immunoglobulins, platelets if under 10k

TTP: plasma exchange/ plasmapheresis, corticosteroids, splenectomy or immusupp. meds, NO platelets (increased clotting)

HIT: D/C heparin, start Factor XA inhibitor: Arixtra, No platelet transfusion; NEVER receieve heparin/Lovenox again

112
Q

Asthma: a chronic lung disease that cause inflammation and _______________________ and bronchioles

A

narrowing of the bronchi

113
Q

Pulmonary Embolism Prevention
* Educate the patient on ___________ to avoid
* Early ___________ post surgery
* Prophylactic ____________ medications

A
  • Educate the patient on risk factors to avoid
  • Early ambulation post surgery
  • Prophylactic anticoagulation medications
114
Q

Asthma Complication
Status Asthmaticus: acute, severe asthma that is ____________ to standard treatments

A

unresponsive

115
Q

Asthma Nursing Management:
* High fowlers (open lungs), O2
* Corticosteroids, bronchodilators
* Assess lung sounds
* Severe asthma – IV Mg (relax smooth muscle, monitor BP )
* Intubate (status asthmaticus)

A
  • High fowlers (open lungs), O2
  • Corticosteroids, bronchodilators
  • Assess lung sounds
  • Severe asthma – IV Mg (relax smooth muscle, monitor BP )
  • Intubate (status asthmaticus)
116
Q

Asthma Drug Therapy
Pnemonic AIM

A

Albuterol
Impatropium
Methylpredisolone

117
Q

COPD Progressive and chronic lung disease characterized by long term inflammation and ___________ in the ____________ , which leads to difficulty breathing and shortness of breath

There are 2 classifications of chronic bronchitis and emphysema

A

scarring in the airways

118
Q

Chronic Bronchitis –
chronic productive cough and sputum production for >3 months/ 2 consecutive years
* mucus secretion, airway obstruction

Pneumonic BLUE

A
  • B: big and blue skin (cyanosis)
  • L: long term productive cough
  • U: unusual lung sounds: crackles and wheezes
  • E: edema (due to cor pulmonale)
119
Q

Emphysema- occurs when the alveolar membrane breaks down

  • Chronic fatigue
  • Dyspnea
  • “pink puffers”

Pneumonic PINK

A
  • P: pink skin and pursed lip breathing
  • I: increased chest “barrel chest”
  • N: no chronic cough (minimal)
  • K: keep tripoding
120
Q

COPD Risk Factors
* SMOKING
* Advanced age
* Occupational exposure, air pollution , dust chemical exposure
* Alpha 1 antitrypsin deficiency

A
  • SMOKING
  • Advanced age
  • Occupational exposure, air pollution , dust chemical exposure
  • Alpha 1 antitrypsin deficiency
121
Q

COPD Treatment
* Oxygen therapy (NC or bipap)
* Encourage smoking cessation and avoid air pollutant
* Encourage coughing to remove excess mucus
* Monitor all respiratory parameters
* Medications à bronchodilators: relieve bronchospasm
à inhaled steroids: reduce inflammation
à antibiotics: infection * Non pharmacological management

A
  • Oxygen therapy (NC or bipap)
  • Encourage smoking cessation and avoid air pollutant
  • Encourage coughing to remove excess mucus
  • Monitor all respiratory parameters
  • Medications à bronchodilators: relieve bronchospasm
    à inhaled steroids: reduce inflammation
    à antibiotics: infection * Non pharmacological management
122
Q

____________ : process to stop and prevent bleeding

A

Hemostasis

123
Q
  • Iron Requirement = ____ mg daily
A

25

124
Q
  • 2 types of iron
    Heme (______ ; body absorbs more) and Non-Heme (_______ source)

*vegetarians develop iron deficiency anemia b/c notgetting enough heme (Meat)

A
  • 2 types of iron
    Heme (Meat; body absorbs more) and Non-Heme (plant source)

*vegetarians develop iron deficiency anemia b/c notgetting enough heme (Meat)

125
Q

Millions of Hgb in 1 RBC

  • Each Hgb = ___ hemes/irons
  • Each 4 hemes bind to ____
  • Body recycles iron (lifespan 120 days)
A
  • Each Hgb = 4 hemes/irons
  • Each 4 hemes bind to O2
  • Body recycles iron (lifespan 120 days)
126
Q

Main Storage of Iron = _______

A

Liver

127
Q

Hemochromatosis: Iron overload causes _____________

A

liver failure

128
Q

Storage

Ferritin & ____________ transport iron to cells for storage

A

Hemosiderin

129
Q

Following an Injury -> 3 Processes

  1. _____________ : leakage of blood by restricting vessel size and pressing endothelial surfaces together (keep
    vessel closed to allow for platelet response)
  2. _____________________ : platelet plug o Aspirin is an anti-platelet (good for heart attacks)
  3. _______________ due to fibrin:
    o Fibrin is a protein that forms a fibrous protein to stabilize the platelet plug and trap clotting factors, RBCs and Plts to promote formation
    o Fibrinogen: precursor to fibrin and essential for clotting
A
  1. Vasoconstriction : leakage of blood by restricting vessel size and pressing endothelial surfaces together (keep
    vessel closed to allow for platelet response)
  2. Platelet Aggregation: platelet plug o Aspirin is an anti-platelet (good for heart attacks)
  3. Coagulation due to fibrin:
    o Fibrin is a protein that forms a fibrous protein to stabilize the platelet plug and trap clotting factors, RBCs and Plts to promote formation

o Fibrinogen: precursor to fibrin and essential for clotting

130
Q

__________ converts Fibrinogen -> Fibrin

A

Thrombin

131
Q

_________ : Reduction in either the number of erythrocytes (RBC’s, the quantity of hemoglobin or volume of PRBC’s (hematocrit)

A

Anemia

132
Q

Anemia Causes
- _____________ /GI ____________
- __________ Problems (Erythropoietin from kidneys tells bone marrow to produce RBCs)
- Hemolysis: Sickle Cells, Trauma (RBC Destruction)
- Thalassemia: group of disease that decreases RBC production (decrease HgB and RBC)
- Aplastic Anemia: decreased production of RBC, WBC, PLTs
- Mild Anema: 10-12 HgB (asymptomatic)

A
  • Bleeding/GI Bleeding
  • Kidney Problems (Erythropoietin from kidneys tells bone marrow to produce RBCs)
  • Hemolysis: Sickle Cells, Trauma (RBC Destruction)
  • Thalassemia: group of disease that decreases RBC production (decrease HgB and RBC)
  • Aplastic Anemia: decreased production of RBC, WBC, PLTs
  • Mild Anema: 10-12 HgB (asymptomatic)
133
Q

Anemia Clinical Manifestations: Manifest Symptoms <___ HgB
- Fatigue
- Dyspnea
- Dizziness
- _______ Hands and Feet (blood keeps extremities warm)
- ______ (indicator of anemia)
- ______________ (heart compensating for low HgB)

A

Anemia Clinical Manifestations: Manifest Symptoms <7 HgB
- Fatigue
- Dyspnea
- Dizziness
- Cold Hands and Feet (blood keeps extremities warm)
- Pale (indicator of anemia)
- Palpitations (heart compensating for low HgB)

134
Q

Anemia Diagnostic Tests
- H/H (HgB/HCt is 1:3 ratio)
- Reticulocytes (____ Count)
- ____ (low iron = low HgB)
- Transferrin (transport iron to liver)
- Bilirubin (liver is main iron storing organ)

A
  • H/H (HgB/HCt is 1:3 ratio)
  • Reticulocytes (RBC Count)
  • Iron (low iron = low HgB)
  • Transferrin (transport iron to liver)
  • Bilirubin (liver is main iron storing organ)
135
Q

Anemia Nursing Management
- Correct ______ (if bleeding PRBC -> Surgery)
- Oxygen
- ________ infusion
- IV Fluid Replacement (to increase BP since the pt is bleeding out they have less volume)
- Lifestyle and dietary changes (educate on dieting)
- Fatigue management and safety issues (Fall Risk, Syncope)

A
  • Correct cause (if bleeding PRBC -> Surgery)
  • Oxygen
  • PRBC infusion
  • IV Fluid Replacement (to increase BP since the pt is bleeding out they have less volume)
  • Lifestyle and dietary changes (educate on dieting)
  • Fatigue management and safety issues (Fall Risk, Syncope)
136
Q

Iron Deficiency Anemia Etiology:
- Inadequate ______ (not enough Iron)
- Malabsorption (not able to absorb iron)
- _______ Loss
- Hemolysis (RBC destruction)

A
  • Inadequate Diet (not enough Iron)
  • Malabsorption (not able to absorb iron)
  • Blood Loss
  • Hemolysis (RBC destruction)
137
Q

Iron Deficiency Anemia Nursing Management
- _______ Replacement (PRBC)
- __________ (Iron Replacement: Food or Supplements)
- _______ Replacement: Oral, intramuscular (Z-track) or IV
- Take before food (one hour) with OJ (acid -> enhances iron absorption)
- Liquid stains teeth (use straw)
- Stool is ________ with increased iron intake (make sure to educate patient this is normal)
- Pts will also experience constipation -> offer stool softeners

A
  • Blood Replacement (PRBC)
  • Nutrition (Iron Replacement: Food or Supplements)
  • Iron Replacement: Oral, intramuscular (Z-track) or IV
  • Take before food (one hour) with OJ (acid -> enhances iron absorption)
  • Liquid stains teeth (use straw)
  • Stool is Black with increased iron intake (make sure to educate patient this is normal)
  • Pts will also experience constipation -> offer stool softeners
138
Q

Iron Deficiency Anemia Clinical Manifestations
- General anemia s/sx
- Production issue -> make less and cells are __________ (Microcytic)
- Pallor
- _________ (inflamed tongue)
- Cheilitis (inflamed lips)
- Headache
- Burning sensation of the ___________

A
  • General anemia s/sx
  • Production issue -> make less and cells are smaller (Microcytic)
  • Pallor
  • Glossitis (inflamed tongue)
  • Cheilitis (inflamed lips)
  • Headache
  • Burning sensation of the tongue
139
Q

Cobalamin Deficiency (Vitamin B12) Etiology
- GI ___________ (intrinsic factor works in GI)
- _________, Celiac
- Antibiotics
- Seizure Meds
- Long-term use of PPI’s or H2 Blockers (decreases acid essential for intrinsic factor absorption)
- Poor Nutrition
- _____________ Anemia (absence of __________ factor)
- Tetracycline abx (prescribed with vitamin B12 b/c it decreases B12 absorption)

A
  • GI Surgery (intrinsic factor works in GI)
  • Crohn’s, Celiac
  • Antibiotics
  • Seizure Meds
  • Long-term use of PPI’s or H2 Blockers (decreases acid essential for intrinsic factor absorption)
  • Poor Nutrition
  • Pernicious Anemia (absence of intrinsic factor)
  • Tetracycline abx (prescribed with vitamin B12 b/c it decreases B12 absorption)
139
Q

Cobalamin Deficiency (Vitamin B12) Clinical Manifestations
- General ________ S/Sx (Pallor, Fatigued)
- Sore, Red, Beefy and Shiny ________
- Weakness
- ___________ (vit B12 for normal nerve function)
- ___________ , Memory Loss (Severe)
- N/V and abdominal pain

A
  • General Anemia S/Sx (Pallor, Fatigued)
  • Sore, Red, Beefy and Shiny Tongue
  • Weakness
  • Paresthesia (vit B12 for normal nerve function)
  • Confusion, Memory Loss (Severe)
  • N/V and abdominal pain
140
Q

Cobalamin Deficiency (Vitamin B12) Nursing Management
- Adequate ___________ intake of B12 (meats and dairy)
- Oral, Parental, intranasal replacement (nothing PO bc not effective in GI)

A
  • Adequate dieatary intake of B12 (meats and dairy)
  • Oral, Parental, intranasal replacement (nothing PO bc not effective in GI)
141
Q

Folic Acid Deficiency

(Vitamin B9-helps make _____ )

A

RBCs

142
Q

Folic Acid Deficiency [Vitamin B9] Etiology

  • Poor Nutrition
  • ____________ problems
  • Medications
  • Chemo or arthritis drug – _____________
  • ____________ Abuse (ETOH decreases absorption of folic acid)
A
  • Poor Nutrition
  • Malabsorption problems
  • Medications
  • Chemo or arthritis drug – Methotrexate
  • Alcohol Abuse (ETOH decreases absorption of folic acid)
143
Q

Folic Acid Deficiency [Vitamin B9] Clinical Manifestations

  • General S/Sx of Anemia
  • Smooth, Beefy ________
  • Prone to Mouth _________
  • *No neuro conditions like B12 deficiency
A
  • General S/Sx of Anemia
  • Smooth, Beefy Tongue
  • Prone to Mouth Sores
  • *No neuro conditions like B12 deficiency
144
Q

Folic Acid Deficiency [Vitamin B9] Nursing Management

  • Dietary and Oral Replacement (foliage: ______________ vegetables, grains, OJ, oatmeal, peanuts avocado)
A
  • Dietary and Oral Replacement (foliage: green leafy vegetables, grains, OJ, oatmeal, peanuts avocado)
145
Q

Sickle Cell Anemia - Genetic disorder of abnormal formation of __________________ inside RBCs

A

hemoglobin chains

145
Q

Sickle Cell Anemia

● RBCs form _____ shape (Sickle cell shape) -> Low ____________ capacity (low O2 triggers sickle shape of RBCs)

A

● RBCs form S shape (Sickle cell shape) -> Low O2 carrying capacity (low O2 triggers sickle shape of RBCs)

146
Q

Sickle Cell Anemia Etiology

  • _________ Disorder
  • Predominant in _____________
  • Life-long management
  • Homozygous Hb SS (inherited HgB S from both parents)
  • Formation of abnormal hemoglobin chains
  • S-shaped clump in the capillaries
A
  • Genetic Disorder
  • Predominant in African Americans
  • Life-long management
  • Homozygous Hb SS (inherited HgB S from both parents)
  • Formation of abnormal hemoglobin chains
  • S-shaped clump in the capillaries
147
Q

Sickle Cell Anemia Conditions that Cause Sickling
- Hypoxia
- ___________ (common)
- Infections
- Venous Stasis
- Low Environmental Body Temperatures (Hypothermia)
- Acidosis
- Strenuous ___________
- Anesthesia (RBC adapt to survive malaria)

A
  • Hypoxia
  • Dehydration (common)
  • Infections
  • Venous Stasis
  • Low Environmental Body Temperatures (Hypothermia)
  • Acidosis
  • Strenuous exercise
  • Anesthesia (RBC adapt to survive malaria)
148
Q

Sickle Cell Anemia Clinical Manifestation

  • Sickling Crisis (develop ____________ )
  • Chronic _________ (can’t carry O2)
  • _______ (sickle cells passing through vessels)
  • Organ damage (thrombus)
  • Jaundice
  • Cholelithiasis
A
  • Sickling Crisis (develop blood clot)
  • Chronic Anemia (can’t carry O2)
  • Pain (sickle cells passing through vessels)
  • Organ damage (thrombus)
  • Jaundice
  • Cholelithiasis
149
Q

Polycythemia Vera Etiology

  • Disease caused by a _______________ mutation in a single stem cell
  • __________ production of red blood cells
  • Excessive leukocyte production
  • Excessive production of platelets
  • Combined = “_________ blood” high viscosity and blood volume -> increased HTN, hyper viscosity, hypervolemia, hyper coagulopathies predisposing pt to clotting or thrombus (RBC+PLT)
A
  • Disease caused by a chromosomal mutation in a single stem cell
  • Massive production of red blood cells
  • Excessive leukocyte production
  • Excessive production of platelets
  • Combined = “thick blood” high viscosity and blood volume -> increased HTN, hyper viscosity, hypervolemia, hyper coagulopathies predisposing pt to clotting or thrombus (RBC+PLT)
149
Q

Polycythemia Vera Clinical Manifestations
- ______ caused by hyper viscosity and hypervolemia (lots of fluid in the body!)

A
  • HTN caused by hyper viscosity and hypervolemia (lots of fluid in the body!)
149
Q

Polycythemia Vera Nursing Management
- ___________ (only treatment = reduces hematocrit)
- Balance Hydration (Don’t give more _______ , already hypertensive
- Low dose _________ (prevent clotting, inhibits platelet aggregation)
- Hydroxyurea (tells bone marrow to stop producing more RBCs)

A
  • Phlebotomy (only treatment = reduces hematocrit)
  • Balance Hydration (Don’t give more fluids, already hypertensive
  • Low dose Aspirin (prevent clotting, inhibits platelet aggregation)
  • Hydroxyurea (tells bone marrow to stop producing more RBCs)
149
Q

Polycythemia Vera Common complication
- Stroke or MI ( _______ )

A

clots

150
Q

Thrombocytopenia

Platelets are one of the most important components of hemostasis to _______ bleeding and promote clotting
- _________ are Thrombocytes
- Platelets are produced in bone marrow and stored in ________ (Normal: 150K-450K)

A

Platelets are one of the most important components of hemostasis to stop bleeding and promote clotting
- Platelets are Thrombocytes
- Platelets are produced in bone marrow and stored in spleen (Normal: 150K-450K)

151
Q

Neutropenia Etiology

  • _______ (reduces WBC count) and immunosuppressive therapy (prevents bone marrow producing more WBCs)
  • _____________ diseases (attacking WBCs)
A
  • Chemo (reduces WBC count) and immunosuppressive therapy (prevents bone marrow producing more WBCs)
  • Autoimmune diseases (attacking WBCs)
151
Q

Thrombocytopenia Etiology

1) The _____________ doesn’t make enough platelets
OR
2) The body destroys the platelets or body is making platelets without ang reason

A

1) The bone marrow doesn’t make enough platelets
OR
2) The body destroys the platelets or body is making platelets without ang reason

152
Q

Neutropenia clinical Manifestations

  • Infection (major risk b/c of low _____ , any simple bacteria could be lethal)
  • Treat Fever (any number change in temperature take seriously)
  • Risk: _______ (once sepsis starts -> septic shock -> death)
A
  • Infection (major risk b/c of low WBC, any simple bacteria could be lethal)
  • Treat Fever (any number change in temperature take seriously)
  • Risk: Sepsis (once sepsis starts -> septic shock -> death)
152
Q

Thrombocytopenia Clinical Manifestations

  • _________ (Nose Bleed) and Gums Bleeding
  • Petechiae (Red pinpoint spots)
  • Purpura (larger bruising like areas)
  • Ecchymosis (Bruising)
  • Prolonged bleeding
  • Intracranial Bleeding
  • Blood in the Urine
  • Dizziness, Faintness
  • Tachycardia (b/c of bleeding, compensating for low blood volume)
A
  • Epistaxis (Nose Bleed) and Gums Bleeding
  • Petechiae (Red pinpoint spots)
  • Purpura (larger bruising like areas)
  • Ecchymosis (Bruising)
  • Prolonged bleeding
  • Intracranial Bleeding
  • Blood in the Urine
  • Dizziness, Faintness
  • Tachycardia (b/c of bleeding, compensating for low blood volume)
152
Q

Thrombocytopenia

Platelet activation then make a clot -> travels to small capillary beds in skin -> blocking blood flow -> when they burst -> bleeding in skin surface area

A

Platelet activation then make a clot -> travels to small capillary beds in skin -> blocking blood flow -> when they burst -> bleeding in skin surface area

152
Q

Neutropenia Nursing Management

  • Monitor for S/Sx of _________ (94.1 F -> 94.3 F EMERGENCY)
  • Start Abx (Broad Spectrum until cause is known) -> kills most bacteria including gut bactiera (at risk for C.Diff.)
  • May need anti-fungals (if fungal infection)
  • Neupogen (increase neutrophils = protein to stimulate WBC growth in bone marrow)
  • __________ Isolation (keep pt safe from infection)
    o Visitors must wear PPE
    o No fresh fruits or flowers
    o All foods must be cooked
A
  • Monitor for S/Sx of infection (94.1 F -> 94.3 F EMERGENCY)
  • Start Abx (Broad Spectrum until cause is known) -> kills most bacteria including gut bactiera (at risk for C.Diff.)
  • May need anti-fungals (if fungal infection)
  • Neupogen (increase neutrophils = protein to stimulate WBC growth in bone marrow)
  • Reverse Isolation (keep pt safe from infection)
    o Visitors must wear PPE
    o No fresh fruits or flowers
    o All foods must be cooked
153
Q

Cobalamin (Vitamin B12) Function

  • Stored in ________
  • ________ Failure: Vitamin B12 deficiency
  • w/o Cobalamin admin, pt will die in 1-3 years
A
  • Stored in liver
  • Liver Failure: Vitamin B12 deficiency
  • w/o Cobalamin admin, pt will die in 1-3 years
154
Q
  • w/o Cobalamin [deficiency] admin, pt will die in _________
A

1-3 years

155
Q

Vitamin B9-helps make _______

A

RBCs

156
Q

Sickle Cell Anemia Nursing Management

  • RBC
  • LOTS of ______ Meds (Priority)
  • O2 (if hypoxic to control suckling)
  • Abx (prevent and treat infection)
  • _____ Prophylaxis (Lovenox to prevent)
  • Rest
  • IV Fluids and electrolytes (prevent sickling -> no fluids can cause cells to be sticky)
  • _____ cell transplant (only curable tx)
  • Patient teaching
A
  • RBC
  • LOTS of Pain Meds (Priority)
  • O2 (if hypoxic to control suckling)
  • Abx (prevent and treat infection)
  • DVT Prophylaxis (Lovenox to prevent)
  • Rest
  • IV Fluids and electrolytes (prevent sickling -> no fluids can cause cells to be sticky)
  • Stem cell transplant (only curable tx)
  • Patient teaching
157
Q

Polycythemia Vera
↑____,
↑_____,
↑_____
(_______)

A

↑RBC,
↑WBC,
↑PLTs
(THICK)

158
Q

A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of
a. iron.
b. folic acid.
c. cobalamin (vitamin B12).
d. ascorbic acid (vitamin C).

A

b. folic acid.

Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid supplements is the usual treatment. The other nutrients would not correct folic acid deficiency, although they would be used to treat other types of anemia.

159
Q

Methotrexate use can lead to _________ deficiency.

A

Methotrexate use can lead to folic acid deficiency.

160
Q

Which statement by a patient indicates good understanding of the nurse’s teaching about prevention of sickle cell crisis?

  1. “Home oxygen therapy is frequently used to decrease sickling.”
  2. “There are no effective medications that can help prevent sickling.”
  3. “Routine continuous dosage narcotics are prescribed to prevent a crisis.”
  4. “Risk for a crisis is decreased by having an annual influenza vaccination.”
A
  1. “Risk for a crisis is decreased by having an annual influenza vaccination.”

Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered. Although continuous dose opioids and oxygen may be administered during a crisis (pain management is a priority), patients do not receive these therapies to prevent crisis. Hydroxyurea (Hydrea) is a medication used to decrease the number of sickle cell crises.

161
Q

Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura (ITP)?

a. Assign the patient to a private room.

b. Avoid intramuscular (IM) injections.

c. Use rinses rather than a soft toothbrush for oral care.

d. Restrict activity to passive and active range of motion.

A

b. Avoid intramuscular (IM) injections.

IM or subcutaneous injections should be avoided because of the risk for bleeding. A soft toothbrush can be used for oral care. There is no need to restrict activity or place the patient in a private room.

162
Q

Which action will the admitting nurse include in the care plan for a patient who has neutropenia?

a. Avoid intramuscular injections.
b. Check temperature every 4 hours.
c. Omit fruits or vegetables from the diet.
d. Place a “No Visitors” sign on the door.

A

ANS: B Check temperature every 4 hours.

The earliest sign of infection in a neutropenic patient is an elevation in temperature. Although unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or cooked are acceptable. Injections may be required for administration of medications such as filgrastim (Neupogen). The number of visitors may be limited and visitors with communicable diseases should be avoided, but a “no visitors” policy is not needed.

163
Q

A patient with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets?

a. Platelet count is 42,000/uL.
b. Petechiae are present on the chest.
c. Blood pressure (BP) is 94/56 mm Hg.
d. Blood is oozing from the venipuncture site.

A

ANS: A. Platelet count is 42,000/uL.

Platelet transfusions are not usually indicated until the platelet count is below 10,000 to 20,000/L unless the patient is actively bleeding. Therefore the nurse should clarify the order with the health care provider before giving the transfusion. The other data all indicate that bleeding caused by ITP may be occurring and that the platelet transfusion is appropriate.

Nurs 136- MCA II (12 decks)

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