Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Complex exam 2
| Question | Answer |
|---|---|
| Bronchoscopy nursing care | assess anticoagulant use, remove dentures, maintain NPO, administer anxiolytic, lidocaine throat spray, assess gag reflex |
| Thoracentesis nursing care | x-ray, position pt upright with arms on pillow, moniotr for pneumothorax |
| Obtaining ABG's | Allen's test for ulnar circulation, obtain heparinized syringe, hold pressure for 5 min, asses bleeding and perfusion, sample sent on ice |
| ARDS definition | release of inflammatory mediators leading to damage of the alveoli capillaries, rapid pulmonary edema |
| ARDS risk factors | Direct insults: pneumonia, aspiration of gastric contents, inhalation injuries, drowning Indirect: sepsis, burns, drug overdose, tranfusions, trauma |
| ARDS signs/symptoms | Early signs: dyspnea and tachypnea Progressive signs: increased rr, intercostal retractions, accessory muscles used, crackles, cyanosis, "ground glass" x-ray, refractory hypoxemia, agitation, confusion |
| ARDS nursing interventions | treat cause, mechanical ventilation, prone position, enteral nutrition, decrease O2 demands |
| When can a an ARDS pt not be prone? | chest incision or increased ICP |
| ARDS complications | MODS, DIC, pulmonary fibrosis |
| Hemothorax symptoms | decreased breath sounds, hypotension, respiratory distress |
| Hemothorax treatment | chest tube |
| Pneumothorax symptoms | respiratory distress, absence of breath sounds, chest pain, hypotension, tracheal deviation to unaffected side |
| Pneumothorax treatment | needle decompression, chest tube |
| Rib fracture and flail chest symptoms | paradoxical chest movement, increased wob, tachypnea, hypoxia |
| Rib fracture and flail chest treatment | intubation, ventilation, prevent pneumonia, pain control |
| Chest tube indications | pneumo/hemothorax, post op drainage, pleural effusion, pulmonary emphysema |
| Chest tube management | first chamber: drainage collection second chamber: water seal third chamber: suction control -breathing sounds, vitals, abg's, chest x0ray, insertion site, crepitus |
| Chest tube interventions | keep drain below chest, encourage cough, document drainage, don't strip tube if tube is dislodged from chest: apply occlusive dressing if tube is dislodged from drain: submerge in sterile water |
| Complications of high flow oxygen | oxygen toxicity: nonproductive cough, substernal pain, nasal stiffness, N/V, fatigue, sore throat |
| Ventilator indications | hypoxemia <60 hypercapnea >50 pH < 7.25 surgery support |
| Ventilator mode assist/control | ventilator doing all the work |
| Ventilator mode synchronized intermittent | spontaneous breaths between mandatory breath |
| Ventilator mode continuous spontaneous | everything initiated by patient |
| Ventilator nursing care | secure to prevent unplanned extubation, assess skin, section secretions, HOB >35, oral care, manage wrist restraints, avoid ventilator desynchrony |
| Ventilator meds | analgesics- morphine, fentanyl sedatives- propofol, precedex, benzos paralytics-nimbex, pancuronium ulcer preventing agents- famotidine, pantoprazole antibiotics |
| Ventilator complications | barotrauma (too much pressure), fluid retention, oxygen toxicity, hemodyna,oc compromise, aspiration, VAP, GI ulcer |
| Ventilator weaning | assess: is underlying cause resolved, oxygenation adequate, fiO2 0.4-0.5, peep 5 Spontaneous breathing trials: pt awake and participating, must tolerate up to 120 minutes Terminal wean: extubation, morphine to help with air hunger |
| Normal pH | 7.35-7.45 |
| Normal PaCO2 | 35-45 |
| Normal PaCO3 | 22-26 |
| Normal PaO2 | 80-100 |
| Metabolic acidosis causes and symptoms | -too much acid causes: DKA, shock (lactic acid), renal failure, diarrhea, starvation, liver failure Symptoms: weakness, fatigue, headache, dysrhythmias, kussmaul respirations |
| Metabolic alkalosis causes and symptoms | -too much bicarb causes: vomiting, hypokalemia, GI suctioning, TPN, antiacids, blood transfusions symptoms: dizziness, decreased respirations, decreased peripheral sensation |
| Respiratory acidosis causes and symptoms | -too much acid from CO2 build up causes: respiratory failure, COPD exacerbation, hypoventilation, sedatives, pneumonia, coma, asthma, thoracic injury, drug overdose symptoms: anxiety, confusion, headache, restlessness, blurry vision |
| Respiratory alkalosis causes and symptoms | -not enough CO2 causes: hyperventilation, anxiety, fear symptoms: dizziness, dry mouth |
| Full vs partial compensation | Full: opposite system out of range and pH within normal range Partial: both systems out of range and pH out of range |
| Organ transplant pharm | corticosteroids for inflammation antiproliferative/antimetabolite inhibit b and t cells |
| organ transplant nursing care | high risk for infection, teach pt about hand hygiene, kidney organ rejection symptoms of fever, hypertension, pain at transplant site, oliguria |
| Guillain barre syndrome causes | infection, flu vaccine, epstein barr virus, HIV |
| What is diabetes insipidus | lack of ADH production bc of neurologic condition or lack of kidney response to ADH, large volumes of dilute urine excreted daily |
| Diabetes insipidus assessment findings | insatiable thirst, polyuria, polydipsia, nocturia, fluid volume deficit |
| Diabetes insipidus nursing care | monitor vs, urine output, I+O, urinalysis, daily weight, avoid caffeine, monitor constipation, soft toothbrush, encourage drinking to match volume output |
| Labs for diabetes insipidus | increased Hct, Na+, K+ decreased urine specific gravity and osmolality |
| Complications of diabetes insipidus | dehydration, hypovolemia, hypernatremia |
| DI pharm | Antidiuretic hormone- vasopressin |
| What is SIDH | excessive release of ADH, fluid retention, caused by tumors, head injury, meningitis, antidepressants, SSRI's, increaded thoracic pressure |
| SIDH assessment findings | decreased urine output, hyponatremia, fatigue, anorexia, N/V, twitching, change in LOC, weakness, tachycardia, tachypnea, bounding pulses |
| SIDH labs | dilutes blood, decreaed hct, hgb, na+ concentrated urine |
| SIDH nursing care | restrict fluids 500-1000mL, sodium chloride to flush enteral tubes, auscultate lung sounds, daily weights, monitor mental status, reduce stimuli, seizure precautions |
| What is Addison's disease | -adrenal insufficiency Primary: idiopathic Secondary: steroid withdrawal |
| Addison's disease assessment findings | weakness, weight loss, N/V, abdominal pain, cravings for salt, gastroenteritis, dark pigmented knees and elbows, hypoglycemia, dehydration |
| Addison Crisis: Acite adrenal insuffciency | life threatening, rapid onset, due to adrenal hemorrhage, steroid withdrawal, sepsis, or trauma |
| Addison's disease nursing care | IV fluids, administer hydrocortisone sodium, treat hyperkalemia, famotidine for ulcer prevention, vasopressors for bp |
| Treatment of hyperkalemia | -administer insulin and dextrose -administer calcium to protect the heart -administer kayexalate to absorb k+ -administer loop/thiazide diuretic |
| What is cushings disease | -too much cortisol Disease: adrenal or pituitary problem Syndrome: long term use of glucocorticoids |
| Cushing's disease assessment findings | -hirsutism, acne, HTN, moon face, insulin resistance, hyperglycemia, infection risk, increased inflammation, thinning scalp, thin skin, salt and water retention, amenorrhea, deepening voice |
| Cushing's labs | increased glucose and Na decreased WBC's, K+, calcium |
| Cushing's disease nursing care | monitor I+O, weight, assess hypervolemia, prevent infection, monitor GI bleed, encourage physical activity, monitor WBC |
| Hyperglycemia range and consequences | >100 fasting, >140 not fasting short term- dehydration long term- vascular damage, neuropathy, htn, pvd |
| Hypoglycemia range and concequences | <70 hunger, headache, irritable, death |
| 15-15 rule | 15g fast acting carbs (glucose tabs, 4oz juice, 1tbsp sugar, syrup) wait 15 min and check, if still below 70 repeat, at 70 provide protein and carb |
| What is DKA | lack of insulin, undiagnosed/untreated type 1 dm, starving cells trigger fat to ketones casuing acidosis |
| DKA assessment findings | hyperglycemia, polyuria, polydipsia, polyphasia, kussmaul respirations, ketones present, increased BUN + creatinine, consufion, coma, acetone breath |
| DKA nursing care | IV fluids, check k+ and treat hypokalemia, regular insulin, NPO, monitor bg hourly, don't lower too fast-cerebral edema, administer 5% dextrose when glucose is 250-300, monitor cardiac rhythm |
| Diabetes sick day rules to prevent DKA | notify provider, monitor bg 2-3 hrs, test urine for ketones even in range, prevent dehydration, eat meals, call if persistant n/v, ketones, increased bg after insulin, increased fever or >24hrs |
| What is HHNS | -type 2 dm gradual onset, no ketones, some insulin, everything else but acidosis |
| Biggest risk factor for DKA | infection |
| What is acute kidney injury | sudden deterioration of renal function causing oliguria and aztoemia (nitrogen wastes in blood) |
| AKI treatment | dialysis |
| AKI risk factors | trauma, surgery, infection, hemorrhage, HF, liver disease, lower urinary tract obstruction, contrast dye, drugs, children with insufficiency |
| AKI causes | prerenal: decreased blood supply- hypoperfusion, shock intrarenal: tubular necrosis, clot, antibiotics (vencomyocin), NSAIDS, dye, rhabdo, trauma postrenal: obstruction, kidney stone, bph |
| Hemolytic uremic syndrome | -in childhood, combination of AKI, hemolytic anemia, thrombocytopenia -due to ecoli, glomeruli become inflamed, rbc clog kidney and tpxins destroy rbc -treatment of transfusion, dialysis |
| AKI phases | Onset: onset of event, ends when oliguria develops Oliguria: urine output 100-400ml in 24hrs Diuresis: kidneys recover, diuresis of large amounts of fluid Recovery: until kidney function fully restored |
| AKI assessment findings | HTN, fluid overload, SOB, crackles, lethargy, muscle twitching, dry skin |
| AKI labs | decreased Na and calcium increased phosphate, K+, BUN, creatinine |
| What is chronic kidney disease | -progressive and irreversible, can manifest with stress like infection or surgery -end stage when 90% of nephrons are destroyed |
| Stages of CKD | 1. minimal damage GFR in range 2. mild gfr 60-89 3. moderate 30-59 4. severe 15-29 5. end stage <15 |
| What is normal GFR | 90-120 |
| CKD assessment findings | -lethargy, tremors, ataxia-edema JVD, HTN peaked t-wave- SOB, tachypnea, kussmaul, crackles- anemia, ecchymosis- ulcers in mouth, foul breath- osteodystrophy- protein in urine- yellow skin, itchy, uremic frost- delayed growth in children- amenorrhea |
| AV dialysis access nursing care | avoid taking bp, assess bruit and thrill, avoid venipuncture, assess site |
| Dialysis complications | volume depletion, hypotension, hypoxemia, vasulcar assess infection, disequilibrium syndrome causing cerebral edema and increased icp, manifests as N/V, change in loc, agitation |
| Complications of peritoneal dialysis | peritonitis, protein loss, poor inflow or outflow due to obstruction |
| Renal diet | low sodium 2g/day, more carbs less protein, vitamin D supplements, decrease potassium and phosphorus |
| Acute and chronic inflammatory bowel diseases | Acute: appendicitis, gastroenteritis, peritonitis Chronic: crohns, ulcerative colitis, diverticulitis |
| Appendicitis assessment findings and treatment | Findings: pain in RLQ, fever, tachycardia, abdominal rigidity, n/v, decreased/absent bowel sounds Treat: appendectomy, antibiotics, fluids, NG tube for decompression |
| Gastroenteritis findings and treatment | Findings: vomiting and diarrhea triggered by infection Treat: fluid electrolyte replacement |
| Peritonitis findings and treatment | Findings: n/v, fever, abdominal pain, bloating, rigid abdomen Treat: antibiotics |
| What is Crohn's disease | -inflammation and ulceration of GI tract -onset in young adults |
| Crohn's findings | RLQ pain, fever, diarrhea, 5 loose stools with mucus/day, abdominal distention, high-pitched bowels, steatorrhea (clay colored stool) |
| What is ulcerative colitis | just in colon, peaks in teen/young adults |
| Ulcerative colitis findings | LLQ pain, fever, diarrhea 15-20/day, stools contain mucus/blood/pus, high-pitched bowel sounds, rectal bleeding |
| Pt education for crohn's and UC | -seek care for signs of obstruction or perforation -long exacerbation: NPO and TPN given -avoid caffeine and alcohol, take multivitamin with iron, frequent small meals -high protein, low fiber, weigh 1-2 times a week |
| What is diverticulitis | inflammation of bowel mucosa caused by bacteria, food, trapped fecal matter in diverticula |
| Diverticulitis findings | LLQ pain, fever, chills, tachycardia, abdominal distention |
| Diverticulitis education | -clear liq until manifestations subside -progress to low fiber as solid food tolerated then to high fiber when inflammation resolves -avoid seeds that are indigestible (nuts, popcorn) -avoid foods and drinks that irritate bowel |
Created by:
yeaitsliv