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Med Surg II

Pulmonary Function Tests Most accurate test for asthma; evaluates lung mechanisms, gas exchange, acid-base, lung volumes, ABGs
pH 7.35-7.45
CO2 35-45
CO3 22-27
O2 80-100mm Hg
<85% Comprised oxygen to tissues
<70% Life threatening
Incentive Spirometer Sit upright, mouth on device, inhale & keep between 600-900, hold breath 5s, exhale through pursed lips; repeat 10x/day
Women Greater responsiveness to environmental irritants; risk for a more rapid decline in lung function
Dark skinned individuals 3-5% lower saturation
Pulmonary Pain Feels like something is rubbing inside on deep inhalation or at end of inhalation/exhalation; not made worse by touching
Bronchoscopy Conscious sedation; CBC/platelet before, NPO 4-8h prior; benzocaine numb pharynx; lidocaine preferred
Benzocaine Can induce methemoglobinemia (altered iron state so less O carrying capacity)
Non-Rebreather Mask 60-100%; most oxygen. Valves open expiration and close on inspiration
Oxygen Delivery Nasal V Simple Non-Rebreather
Droplet Precautions Mask w/n 3 ft, disinfect equipment, mask with transportation, cohort w/ same organism, door can be open and special air handling not necessary
Hypoxia lack of oxygen to tissues
Hypoxemia decreased arterial oxygen (O2 <50)
Hypoxia Causes Decreased cardiac output, arterial supply, anemia, carbon monoxide poisoning
Kidney, Brain, Heart Organs sensitive to hypoxia
Hypoxia symptoms Early RAT (Restless anxiety tachyHR/R) is Late to BED (BradyHR Extreme restlessness Dyspnea)
Pediatric Hypoxia Symptoms FINES (Feeding difficulty Inspiratory stridor Nasal flare Expiratory grunting Sternal retractions)
Chronic Hypoxia Clubbing, polycythemia (increased Hgb), hypercarbia/capnia (increased CO2)
Obstructive Sleep Apnea Characterized by recurrent episodes of upper airway obstruction and a reduction in ventilation
OSA Risk Factors Obesity, male, postmenopausal, larger neck circumference, increased amounts of fat, structural issues, advanced age
OSA S Hypercapnia, hypoxia, >5/hour, abrupt awakening, 3 S's (snoring, sleepiness, significant other)
OSA Complications personality changes, HTN, dysrhythmias, polycythemia, enuresis
Epistaxis Tx Nasal decongestants (vasoconstriction), caudery, cotton tampon, petroleum jelly/gauze If bleeding unidentified
Epistaxis Education no exercise several days, hot/spicy foods, tobacco, nose blowing, picking, high altitudes
Pneumonia Excess fluid in lungs from inflammation (community or nosocomial)
Sepsis if organisms of pneumonia move into blood stream
Empyema If pneumonia infection extends into pleural cavity; stiffens lung and decreased vital capacity
Atelectasis Early (dyspnea, cough, sputum) Late (TachyHR/R, decreased O sat, pleural pain, central cyanosis)
Atelectasis Care Reposition, encourage deep breathing, coughing, incentive spirometer, monitor for resp. acidosis, and chest physiotherapy
Chest Physiotherapy (CPT) In morning (1h AC 2-3 PC) Stop if in pain, bronchodilators q15min before, percuss 1-2 minute and vibrate
Pneumonia S Increased Na/BUN/Creatinine (r/t dehydration), Crackles, wheezing (narrowed airways), rhonchi (secretions in large airways), fremitis increased, percussion dull, chest expansion diminished, o.hypo, dysrhythmias (r/t hypoxia)
Pneumonia Tx Timely antibiotics w/n 4h ABGs w/n 24h-blood cultures prior to antibiotic; smoking risk factor, flu vaccine (oct-jan)
Pleural Effusion R/t hydrostatic pressure; pleural fluid has large protein amounts and results in fluid shift out of capillaries
Asthma Recurrent attacks of dyspnea, with wheezing due to spasmodic constriction of bronchi; inflammation and hyperresponsiveness leads to bronchoconstriction
Asthma Irritants cold air, dry air, fine airborne particles, microorganisms, ASA, NSAIDS
Asthma Risk Factors Males, family hx, onset before 12
Asthma S Hypoxemia (tachyHR/R), cough, SOB, mucus, wheeze, CO2 retention decrease early increase late, prolong expiration, retractions, barrel chest (air trapping) O2 decrease
Incentive Spirometry FVC, FEV1 (1st second), PEFR (peak expiratory flow rate)
Asthma Bronchodilators beta agonists, cholinergic antagonists, methylxanthines
Status Asthmaticus Life threatening; intensifies and doesn't respond to common therapy, may develop pneumothorax/cardiac arrest/resp arrest
Pack Years years x #/day
COPD Emphysema & Chronic bronchitis; c/b bronchospasm and dyspnea; not reversible
Emphysema Loss of lung elasticity and hyperinflation of lung; increased R, air trapping and collapse of small airways; alveolar problem; air hunger CO2 retained and O2 drops
Chronic Bronchitis Airway problem; exposure to irritants (especially smoking); produces thick mucus
COPD Risk Factors cigarette smoking, alpha1-antitrypsin (AAT) deficiency, air pollution
AAT Helps regulate proteases; recessive; proteins degrade proteases to destroy/eliminate particulates and organisms inhaled during breathing; when present in large amounts damage small airways by breaking down elastin
COPD Drug Therapy Beta agents, cholinergic antagonists, methylxanthines, steroids, NSAIDS, mucolytics
Pleural Effusion dull percussion and absent/decreased sounds
Pneumonia dull percussion and crackles
Bronchiesctasis Abnormal dilation a/w necrotic infection and occurs usually as complication of recurrent resp infections, cystic fibrosis, etc
Bronchiesctasis S Cough with foul sputum, coughs with change in position, affects ability to hold job, fetid breath, clubbing, weight loss
Bronchiectais Tx Drain cavities (can't heal them), elevated food, 3-4L/day, avoid URI, high calorie/protein, antibiotics
Lung Biopsy sterile dressing after procedure
Pneumonectomy operative side
Lobectomy either side
Segmental Resection unoperative side
Pneumonectomy increased pressure in RV and PA, no chest tube
Air Drained by tube near apex
Liquid Drained by tube near base
Call HCP CT 70-100 mL/h < or bright red drainage, tracheal deviation, dyspnea suddenly, o sat <90%, drainage stops
Suction Chamber 20cm H20, barely bubble
Post-OP CT NSAIDS, Opiods, PVCs, Afib/flutter (regular pattern)
Water Seal Chamber 2cm, one-way valve, moves with breathing (up-inhalation), bubbles indicate leak
Tension Pneumothorax if tubing enters fluid drainage stops and can lead to this
CT disconnects from drainage system reconnect quickly and reinforce with tape (tip in sterile water)
CT pulls out of chest Cover with Vaseline or dry gauze - watch for pneumothorax
Pt transfer Disconnect suction and send drainage system with pt below chest level - don't clamp
No tidaling in water seal chamber Lung has expanded or kinks/clots
Drainage stopped collecting lung has expanded or clots
Bubbling in water seal chamber clamp near insertion site and move down tube until leak found
Clamp CT Changing to new system, looking for leaks, orders
Pneumothorax Open (atm air enters into pleural cavity) closed (air enters pleural space from w/n lung), tension (pulseless electrical activity)
Pneumothorax S Sudden sharp pain, SOB, decreased breath sounds one side, decreased chest movement, subcutaneous emphysema, cyanosis, trachea deviated to unaffected side
Isotonic Dehydration isonatremic; ringers and NS
Hypotonic dehydration hypoNa dehydration; shift from EC to IC; burns, prolonged dehydration, renal dx; D5W, 1/2NS, 0.33 NS
Hypertonic dehydration HyperNA, ICF to ECF; DI, IVF, overload tube feedings; 3% NS, protein solutions, colloids
Solvent liquid that can hold another substance
Solute Substance dissolved in a solution
Hourly UO
Na 135-145
K 3.5-5
Ca 8.6-10
Appropriate Rehydration Pedialyte, rehydralyte, ceral-based, infalyte, home made
Inappropriate Rehydration water, soft drinks, fruit juice, broth, sports drinks
Gastroenteritis <5 years 2 episodes/year; caused by rotavirus, salmonella, diarrhea, gluten sensitivity, lactose, antibiotics, iron; rotavirus most common
Rotavirus Causes watery diarrhea (18-36h after eating), prevent dehydration, spread by contaminated hnds
Diarrhea Priority Goal Correct f&e imbalances - avoid antidiarrheals
HyperNa Children with dev. delay don't perceive thirst, [high sugar], inadequate breast milk, DI; decreased LOC
HypoNa H20 intoxication, swallowing pool water, kidney probs
HyperK Kidney probs, K in IV, blood transfusion, false + heel stick; muscle weakness
HypoK Anorexia, bulemia
Pediatric Respiratory Long floppy epiglottis, larynx&glottis higer (risk for aspiration) fewer muscles
Pediatric URI Common due to immature resp tract; mucous membranes can't produce enough mucous to warm/humidify inhaled air
Funnel chest rickets or marfans
Wide nipple space Turner's syndrome
Newbrn resp rate 30-60
1-3 year resp rate 20-40
6-10 year resp rate 16-22
apnea cessation of resp for longer than 20s
Oxygen Tent 30-50% O, loss greater at bottom
Oxygen Hood 40% O, used with smaller infants, must be able to breath on own
Cystic Fibrosis Mutation on chromosome 7; reduced ability to regular Cl channels to transport NaCl; increased viscosity of mucous and abnormal mucociliary action
Cystic Fibrosis Digestion Issues Excrete undigested food; bulky stool (foul,frothy fatty - steatorhea), pancreatitis, diabetes, vitamin def A D E K, anemia, rectal prolapse
Earliest Sign CF Meconium ileus
CF Diagnosis FTT, recurrent infections, mec. ileus, pilocarpine (sweat test) of 60
CF Tx CPT, flutter device, chest wall oscillation, + expiratory P, ibuprofen qd, higher dose antibiotics, high cal high protein diet
Lactulose Helps with intestinal obstruction a/w CF
Asthma S Tripod position, short speech, restless, orthopnea, prolonged expiration
Peak Flow Meter Stand, deep breath, meter in mouth close lips, hard expiration, highest of 3; tongue not in way don't puff cheeks, redo if cough
Acute Asthma Attack Assess, O, Quick relief meds, IV, radiograph prep, abg blood sample
Rescue Medications Beta agonist, corticosteroids, anticholinergics (bronchospasm)
Asthma Controller Medications Beta agonist, methylxanthines, mast cell inhibitors, corticosteroids, leukotriene modifers, NSAIDS
Exercise induced Asthma Peaks 5-10 mins after exercise, more easy on cold dry day, give Albuterol 10-15 min before exercise to prevent
Croup Worse at night, viral, winter months; mucosa swelling, secretions, and muscle spasms
Croup Tx Nebulized epi (vcxr - decrease swelling), heliox (decrease work of breathing) NPO to prevent aspiration
Acute Epiglottitis Medical emergency r/t H.influenzae, ages 2-8; abrupt onset
Acute Epiglottitis S Drooling, dysphonia, dysphagia, difficulty breathing; restless and frog like croak on inspiration
Croup S Bark cough, stridor, crackles/wheezes, increased R
Bacterial Tracheitis R/t staph or group A strep; common in children immunized against H. influenza, drooling rare; child on back, not improved with nebulized epi, antibiotics
Respiratory Syncytial Virus Most common cause of bronchiolitis; r/t parainfluenza; classic sign of wheezing and secretions; transmission hands and droplets
RSV under 2 S Fever, cough, wheezing, abnormal breathing
RSV older children Common cold, runny nose, sore through, headache, mild fever
RSV tx Riboflavin (antiviral aerosol - no pregnant ppl near and dangerous to HCP) Synagis (IM give winter and spring) elevate 30-40
AOM Invasion through Eustachian tube, sudden and short duration; ear pain
OME (Effusion) Middle ear inflammation with fluid behind TM and no signs of infection
Chronic OM Inflammation of middle ear longer than 3mo; found via exam on asymptomatic child
Pediatric Eustachian Tubes Shorter, wider, straighter, positioned horizontally
Nonverbal expressions OM Pulling on ear, covering with hair, laying on ear and refusing to move, not responding
OM Tx 1st - Amoxil 2nd - Augmentin
OM Prevention avoid second hand smoke, immunizations, no horizontal feeding, breastfeeding
Tonsillitis Children more prone r/t more lymphoid tissue, frequent URI, infected children; sore throat, dysphagia, fever
Tonsillitis Tx Viral - warm saline gargle, non-ASA analgesics; bacterial - same with antibiotic
Post-op tonsillectomy Don't blow nose or cough, no straws, cool non-carb non-acid beverages, soft food 3 weeks, lots of fluid, limited activity
Tonsillectomy Recovery Membrane forms first few post-op hours, 4-10 days begins to pull apart (risk for hemorrhage), heals 3 weeks
Simple Pneumothorax Trachea midline, decreased expansion and breath sounds, normal or hyperresonant percussion
Tension Pneumothorax Trachea on unaffected side, decreased chest expansion or fixed hyperexpansive, air hunger, agitated, hypotension, tachyHR
Created by: TedMed
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