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NUR171 Test 2
Study walk about material for block 2 test 2
| Question | Answer |
|---|---|
| Explain why calcium and phosphorous are indirectly related. | A reciprocal relationship exists between phosphorus and calcium in that a high serum phosphate level tends to cause a low calcium concentration in the serum |
| What patient teaching is very important when a patient is to take glucocorticoid | maintenance and preventative only, report sore throat, horseness, and fungal infections. Report sudden weight gain and swelling. Rinse mouth to avoid thrush or coating on tongue |
| Causes “tunnel Vision”? | Primary open angle glaucoma can causes tunnel vision by gradually eroding the peripheral field of view leaving only a small center viewing field. |
| What classes of drugs can be ototoxicity? | mycins. also, aspirin, furosemide (lasix), the aminoglycosides, and certain cancer chemotherapy drugs |
| Why is creatinine a more accurate determination of renal function than BUN? | Creatinine is produces by muscle breakdown and is excreted by the kidneys. High serum levels indicate poor kidney clearance and effected kidney function. 0.5-1.5 normal creatinine levels. |
| Do you know urine tests | Specific gravity, ph, protein, osmolality |
| Urine test normal values? | - specific gravity= 1.003-1.030. - Urinary ph= 4-8 average 6, 6 is normal - Protein= 0-150mg/24hours - (no glucose, ketones, bilirubin, occult blood, casts, organisms cultured should be present) - osmolality= 300-1300mOsm/kg. rbc=0-4 wbc=0-5 |
| Compare and contrast the similarities and differences between UTI and Pyelonephritis? | Pyelonephritis is just kidneys. UTI is in ureters and bladder and other urinary output areas. Pyelonephritis is inflammation of the renal parenchyma and collecting system and is more of a concern and can cause lasting effect. |
| PH 7.2? | acidosis |
| List the classic side effects of corticosteroids? | Hypokalemia, thirst, glucose intolerance to DM, mood and behavior changes, delayed healing, infection, increased blood pressure, protein deletion, peptic ulcer disease, fat redistributed to trunk and face, muscle atrophy and weakness. Inhaled- thrush. |
| What role does the kidney have in the production of RBCs? | The process of RBC production (Erythropoiesis) is controlled by erythropoietin which is a glycoprotein growth factor synthesized and released by the kidney. |
| Why is Vitamin D often included in a calcium supplement? | Vitamin D is needed in the GI tract in order for calcium supplements to be effectively absorbed. |
| What nursing care is essential with a person who experiences vision loss? | Announcing self, protect from injury, orient patient to surroundings, organize self care items, call light within easy reach. Stay in client’s fOV. Explain what you’re doing before touching patient. Tell patient when you’re leaving. |
| Glaucoma is a group of 3 disorders? Name the 3 | 1=Primary open angle 2=Primary angle-closure AKA “Closed angle” 3=Secondary glaucoma. |
| Explain pre-op protocol for eye surgery. | - Come in a three hours at least early for consents, prep, questionnaire, iv’s, meds…. Cataract surgery is local, |
| What types of drops might be used for eye surgery. | Dilator Paralyze Steriods Anitbiotics |
| A common glaucoma medication is timolol. What class of medication is this and why is it prescribed for the glaucoma patient. | B1 and B2 -adrenergic =non cardio selective blocker that probably decreases aqueoushumor production. Side effects= discomfort, blurred vision, photophobia, eyelid inflammation, decreased BP. |
| How does treatment vary between open angle and closed angle glaucoma? | OPEN- drug therapy, surgical, and trabecullectomy. CLOSED- Topical agents, hyperosmotic agents, Laser peripheral iridotomy, and surgical iridectomy. focus is to keep IOP low enough to prevent the patient from developing optic nerve damage. |
| Why does an ear infection with fluid build up cause dizziness? | lymphatic Fluid build up can cause pressure differences between inner and outer ear which can cause dizziness, vertigo, and loss of balance. |
| What is normal Ca+ level | - Total = 4.5-5.5 mEq/L or 8.5-10.5 mg/dl. - Ionized= 56% of total calcium (2.5 mEq/L or 4.0-5.0 mg/dl) |
| What’s the difference between osmolality and osmolarity? | - Osmolality = a measure of the total solute concentration per kilogram of solution. (mOsm/KG) Osmolality is used to describe fluids inside the body and osmolarity pertains to fluids outside the body. |
| What is the purpose of corticosteroid therapy (treatment and meds?) | - corticosteroids= any natural or synthetic adrenocortical hormones such as those produced by the cortex of the adrenal gland. Corticosteroids -primarily inhibit or help control inflammatory response |
| How does the creatinine clearance determine renal function? | - It is a 24 hour urine collection test to determine glomerular filtration rate (GFR). Normal findings= 85-135 ml/min. Creatinine clearance = (urine creatinine x urine volume) / Serum creatinine. |
| Explain the treatment differences between complicated and uncomplicated UTI | Uncomplicated you treat the infection. (antibiotics and fluids) With complicated you also have to treat the cause. |
| Name 3 alternative ways of reducing thirst for the renal insufficiency patient? | Suck on ice cubes, lemon, or hard candy. (lewis pg 1216) |
| Why is pyelonephritis serious? | - Acute Pyelonephritis (an inflammation of the renal parenchyma and collecting systems) usually caused by bacterial infection or other organisms, can lead to a scarred, poorly functioning kidney or chronic Pyelonephritis. Can lead to kidney failure. |
| Explain the rennin-angiotensin- aldosterone system. | Renin is produced by juxtaglomerular cells of the kidneys, splits andiotensinogen into angiotensin 1, converts into Angiotensin II by Angiotensin-converting enzymes which stimulates the release of aldosterone causing H20 retention |
| How do ACEI and ARBs work in this cycle? | ARBs= Angiotensin II receptor blockers- Block the receptors that would bind with Angiotensin II - ACEI= Angiotensin- Converting enzyme inhibitor- stops the conversion of angiotensin I to angiotensin II |
| “-pril” | ACE inhibitors |
| “-tan” | ARB's Angiotensin II receptor blockers- antihypertensives |
| Name 6 risk factors for primary hypertension? | 1- Increased SNS activity 2- Overproduction of sodium retaining hormones and vasoconstrictors, 3- increased sodium intake, 4- greater than ideal body weight, 5- diabetes mellitus, 6- excessive alcohol consumption. |
| What patient teaching is very important for the patient taking ANY sulfa drug? | Allergic reactions since they are common with these type drugs. Reduce the efficacy of oral contraceptives. |
| acute angle gluacoma | - Acute angle AKA angle-closure glaucoma occurs when outflow channels are blocked by lens bulging forward or pupil dilation in patients with anatomically narrow angles. Acute angel=ocular emergency requiring immediate intervention with meds and surgery. |
| open angle glaucoma | The outflow of aqueous humor is decreased in the trabeculae meshwork and fluid backs up increasing pressure. This glaucoma is usually managed primarily with medications. 90% of cases |
| Pulmonary edema can be life threatening. Why? | fluid in the alveoli and interstitial spaces of the lung. Interferes with gas exchange and can cause pt to suffocate. |
| You asses the chest tube and determine there is an “air-leak”. What does this indicate? | This indicates that tubing or drainage site is not sealed correctly or has sprung a leak. This can mean that the suction system will not work efficiently or not at all depending on the amount of air leaking into the system. |
| List 3 important questions to ask the patient prior to starting an IV? | (1) Identify patient (2) Ask about allergies (3) Ask about any conditions ex. Mastectomy, dialysis shunt, graft, etc. |
| How does the nurse confirm placement of a nasogastric tube? | (1) The nurse would listen for bubbles in the stomach when administering air down the tube (2) Aspirate stomach contents and check the pH (3) Have an X-Ray taken. |
| What is pursed lip breathing? | Exhalation through mouth with lips pursed together (like whistling) to slow exhalation and thereby preventing bronchiolar collapse and air trapping. Exhalation should be at least 3 times as long as inhalation. |
| What is a DASH diet? (Dietary approaches to stop hypertension) | This diet involves eating several servings of fish a week, eating plenty of fruits & veggies, whole grains, low fat dairy, limiting sugar sweetened foods and beverages, limited red meat and added fats, increasing fiber intake and drinking a lot of water. |
| List 4 reasons a patient would have a pleural effusion? | (1) Increased production of fluid due to decreased oncotic pressure (2) Increased production of fluid due to increased capillary permeability (3) Bleeding into the space (4) Decreased lymphatic clearance of pleural fluid (5) infection |
| Explain the differences between asthma and COPD | COPD- obstructive pulmonary disease-progressive limitation in airflow- increased resistance to airflow due to airway obstruction/narrowing. Asthma- chronic inflammatory lung disease of airflow obstruction- pt has normal periods between exacerbations. |
| Explain pre-treatment with asthma | |
| What would an elevated eosinophil count indicate on a WBC differential? | An allergic reation- Eosinophils primary functions is to engulf antigen-antibody complexes formed during an allergic response. They also defend against parasitic infections. |
| Describe communication strategies with one who is vision impaired? | Active Listening, allow pt to express anger and grief. Communicate in a normal conversational tone and manner. Always address the patient, not the family member that might be with the patient. Introduce oneself when coming in and say goodbye when leaving |
| What is the cause of cor pulmonale? | Is the enlargement of the right ventricle secondary to diseases of the lung, thorax, or pulmonary circulation. The most common cause of Cor Pulmonale is COPD. |
| What diet is recommended for someone with COPD? | High protein, high calorie, nutritious finger foods and drinks that can be readily consumed to provide adequate calories and protein that do not require much energy to consume. |
| What important teaching will you include about diet and energy conservation for your COPD patient? | Eat high protein, high calorie food- easy to consume. nutritional supplement drinks to ensure adequate nutrition. Exercise training of the upper extremities to improve muscle function and dyspnea. Teach energy saving practices |
| Why are beta blockers used with caution with asthmatic patients? | In patients with asthma, beta blockers can cause increased bronchial obstruction and airway reactivity, and resistance to the effects of inhaled or oral beta receptor agonists (such as albuterol or terbutaline) |
| If a chest tube is inadvertently pulled out should the nurse apply and occlusive or dry dressing. why? | The nurse should use an occlusive dressing so that air will not enter the pleural cavity |
| What is a more accurate indicator of renal function, BUN or creatinine, why? | Creatinine! Creatinine is a waste product produced by muscle breakdown and all creatinine in the blood is normally excreted by the kidneys. Rate is usually constant unless there is something wrong with the kidneys. (normal range 0.5-1.5mg/dl) |
| Your going to start and IV, list 4 ways to dilate the veins? | 1 Gravity- position the extremity lower than the heart for several minutes 2) clenching/pumping fist- open and closing on the fist or squeezing a rubber ball 3) stroking the vein or use light tapping 4) warm compress to extremity for 10 minutes. |
| Explain the things you might do If you know your patient is hard of hearing? | Make sure patient can see your face when talking Maintain eye contact Move closer to better ear Speak normally and slowly Use simple sentences |
| What is the purpose of inflating the cuff on a tracheostomy tube? | A trach tube with an inflated cuff is used if the patient is at risk of aspiration or needs mechanical ventilation. Because and inflated cuff exerts pressure on tracheal mucosa, it is important not to inflate the pressure over 20mmHg. |
| Define dysuria? | Painful or difficult urination *** possible sign of UTI |
| Explain dietary and fluid restrictions for the renal population? | Important to provide adequate calories to prevent catabolism despite the restrictions req. to prevent electrolyte and fluid disorders. Energy should primarily be from carbs and fat sources. Fluid usually restricted |
| What is the procedure for collecting a 24 hour urine? | Start 24hr test by urinating and do NOT collect or save this 1st urine. Every time after you should save, label & date container and put in the refrigeration. Exactly 24 hrs after 1st urination you will end the test with one last urination. |
| Why is squeezing the hand multiple times during lab draw contraindicated? | This can build up pressure and can cause rupture of old fragile veins. Or too much pooling can cause blood to hemolize before lab draw is done. More likely to infiltrate during stick |
| What’s the normal reference value for phosphorus? | 2.5-4.5mg/dl |
| What quick relief meds are used for asthma? | Short acting inhaled B2 adrenergic agonists (ex albuterol) Anticholinergics (inhaled) (ex: Atrovent) |
| What gauge needle is best for; blood transfusion? ; Maintenance fluids? Pg 326 IV book | Blood transfusion – 18 gauge Maintenance fluids- 20 gauge |
| Name 2 nandas for the patient with glaucoma? | Risk for injury related to visual acuity deficits Acute pain related to pathopyhsiologic process and surgical correction |
| When and ABG indicates a client is acidotic with a PCO2 of 50, what nursing care might be indicated? | Improve resp. acidosis by treat the cause of hypoventilation. This would decrease the PCO2, decrease H+ and increase pH. Drugs that open the airways (bronchodilators, such as albuterol) may help |
| Post op instructions given to patient with eye procedures to decrease ICP would include? | Avoid activities that increase the IOP such as bending or stooping, coughing or lifting. |
| Is D5W hypotonic or isotonic, defend your answer. | It is isotonic when in the bag but once infused and the dextrose is metabolized it becomes hypotonic. This can increase the risk of fluid overload in patients |
| What type of diet is recommended for respiratory patients? | Eat lots of protein, whole grain products, fresh veggies & fruits. Avoid foods with lots of additives such as sulfites and monosodium glutamate. Limit salt intake to 6 gm a day. |
| Why is important to practice holistic nursing, ie: physical, mental, psychological, spiritual? | nurses we have to treat the person as a whole, not just their disease when providing care. |
| Describe your assessment with the geriatric population when starting an IV? | Verify order, indentify the patient, ask for allergies, assess LOC & understanding of the procedure. Assess arm/skin-bruising, recent punctures,IV sites, dialysis shunt, graft or mastectomy. Is pt taking anticoagulant-avoid tournequet. |
| List 4 verbal aids that can be used to communicate with the hearing impaired patient? | 1-Speak clearly and naturally 2-Attract the listeners attention 3- position yourself where the person can see your face and lips 4-Restate your message if necessary |
| How can an untreated strep throat lead to heart damage? | Strep throat can lead to Rheumatic fever which can lead to scarring of the heart's valves. Valve damage can lead to a rheumatic heart disease, which can lead to congestive heart failure.It can also cause glomerulonephritis |
| Describe respiratory drive in a healthy person. | Its controlled by carbon dioxide levels. Each time the PaCO level gets high the brain stem stimulates respiratory muscles increasing respiration. |
| Describe respiratory drive of someone with emphysema? | In a person w/ emphysema or COPD the (low) PaO2 level is what stimulates the resp drive. Supplement O2 to levels just enough to give the pt adequate oxygen without decreasing the rep drive, by giving too much. |
| Why is suctioning sterile when the upper airways are not sterile? | Because one of the potential complications associated with suction is infection. We do not want to introduce any more bacteria or other foreign matter into the resp system. |
| What is a cataract? | A cataract is opacity in the lens of one or both eyes. Most are age related. Also factors such as trauma, maternal rubella, UV light, radiation, DM, and long term use of corticosteroids. |
| What information will you include in your post op eye discharge instructions? | Should have no pain. Slight ache ok. Keep patch on eye. Dr visit next day then 14 days.antibiotic drops to prevent infection and corticosteroid drops to reduce inflammation. Keep IOP down Use extra pillows, don’t bend over, no straining, no coughing |
| Describe the best way to assess fluid volume deficit and overload. | Weighing yourself daily at the same time in the am, after urinating, and naked is the best way. |
| What patient teaching is important with all autoimmune disorders? | That the immune system is there to protect us but instead it attacks our own cells. There will be exacerbations and periods of wellness. Try to stay healthy. Steroids are used for inflammation. |
| Why are bronchodilator inhalers administered before anticholinergic or corticosteroid inhalers? | That’s not really taught anymore but the idea was that if you used the bronchodilator first the bronchioles would dilate and the other medications could get in there better. |
| Why would a person taking inhaled glucocorticoids rinse the mouth? | There is a risk of developing a fungal infection (thrush). |
| When preparing to care for a patient with kidney stone, what assessments are most important? | Pt Hx-pain flank and abdominal pain and distention, blood in urine, fever, chills, n&v, strain urine, send retrieved stones to the lab. Watch for renal colic, hematuria, sepsis, and obstruction. Give pain meds, infection meds and lots of water. |
| How can one preserve their kidney function, if told they have CRI? | CRI= function is declining and they need to be monitored. decrease protein. Watch out for renal toxic meds and contrast dyes. |
| Why is the female more at risk for UTI than a man? | A woman has a shorter urethra and the bacteria from the anus can get into the urethra of a woman easier. |
| A totally opaque lens that creates an appearance of a white pupil is? | |
| What are some misconceptions about hypertension? | #1 HTN has symptoms- Wrong-High blood pressure has NO symptoms. It’s often called the “silent killer.” #2 These days everyone has high blood pressure. #3 I feel better so dont need meds. |
| Formulate 3 nandas for someone with chronic renal insufficiency? | 1-Excess fluid volume related to inability of kidneys to excrete fluid and excessive fluid intake 2-Grieving related to loss of kidney function 3-Imbalanced nutrition :less than body requirements |
| What is the purpose of the collection chamber in the atrium chest tube system? | Fluids drain directly into chamber, calibrated in ml fluid with a write on surface to note level and time. |
| List side effects of bronchodilators? | Dry or irritated throat or a dry mouth, nervousness or restlessness and trembling,bad taste in the mouth, coughing, dizziness or lightheadedness, drowsiness, headache, sweating, muscle cramps, nausea, vomiting, diarrhea, sleep problems |
| Ph <7.35 PCO2 >45? | Ph <7.35 is low end of normal PCO2 >45 is high = borderline respiratory acidosis. |
| Define “invasive”? | having the quality of invasiveness. involving puncture of the skin or insertion of an instrument or foreign material into the body. Also-Marked by the tendency to spread. |
| What teaching would the nurse provide for a patient to prevent increasing IOP after eye surgery? | Use Pillows to keep head elevated, don’t bend over, try to avoid coughing, sneezing, no straining. wear loose clothing, drink plenty of water. |
| Explain the tripod position. | The way one sits or stands leaning forward and supporting the upper body with hands on the knees or on another surface. |
| When is the tripod position useful | often assumed by people who are in respiratory distress (such as COPD patients) or who are simply out of breath. the tripod position optimizes respiration by takes advantage of the accessory muscles, neck and upper chest to get more air into the lungs. |
| What would a “left shift” indicate in a WBC differential? | It means that the bands or stabs have increased, indicating an infection in progress. acute bacterial infection or acute appendicitis or cholecystitis. |
| An EKG can detect 4 problems, what are those problems? | Valvular abnormalities, congenital cardiac defects, wall motion, ejection fraction, and cardiac function |
| Where does the pleural space lie? | The tiny area between the two layers of the pleura (the thin covering that protects and cushions the lungs) |
| What does pleural space contain? | The pleural space is normally filled with a small amount of fluid known as pleural fluid, which allows the pleurae to slide effortlessly against each other during ventilation and provides for surface tension keeping lungs open. |
| Compare and contrast cardiac pain and pleural pain? | cardiac chest pain stems from a lack of bloodflow and oxygen to the heart tissue, whereas pleuritic chest pains stems from inflammation and irritation of the pluera. Nitro relieves cardiac pain not plueral. |
| In the patient taking phenazopyridine (Pyridium), what should the nurse include in teaching? | Your urine may turn a red-orange or brown; this effect is harmless. It can stain clothing. You still need to see the doctor. Drink lots of fluids. |
| How would the nurse care for the patient post lithotripsy? What teaching is important? | Increase fluids 2000-3000 mls. Provide pain relief, i/o’s, strain urine. Feel like punched in the side, bruised, poss bleeding, sunburn like area, diet high calcium Low oxalates and purines |
| Define tachypneic? | Rapid breathing |
| Justify topical corticosteroid administration (via inhaler) over oral corticosteroid administration for the treatment of asthma. | Inhaler would be going just to the lung while an oral steroid is systemic. Inhaled steroids are used daily as a preventative or maintenance therapy. Oral steroids are usually prescribed for an asthmatic exacerbation. |
| How do Bronchodilators work to help asthma symptoms? | Bronchodilators cause bronchodilation by action on β2 (pulmonary) receptors by increasing cAMP, which relaxes smooth muscle; produces bronchodilation |
| How do mast cells work to help asthma symptoms? | Mast cell stabilizers are asthma drugs that treat the underlying inflammation of asthma. They do so by blocking mast cells in the bronchial tubes and keep them from releasing the substances that cause inflammation. |
| How do anticholinergics cells work to help asthma symptoms? | Anticholinergics Inhibit interaction of acetylcholine at receptor sites on the bronchial smooth muscle, resulting in decreased cGMP and bronchodilation |
| When a ABG indicates a client is acidotic with a PCO2 of 50, what nursing care might be indicated? | Monitor vitals, abg’s, reorient the pt. provide calm setting, assess color of nails skin, assess mental status. Improve ventilation (chest PT, coughing and deep breathing, inspirometer, respiratory treatments with bronchodilators) |
| List 4 potential problems that can occur with a patient and their chest tube. | 1-Malposition (watch for tidaling)=good 2-Reexpansion pulmonary edema can occur 3-Vasovagal response with systematic htn 4-Infection at the skin site |
| Explain nursing care with CBI | CBI is to prevent clotting after someone has a surgery. Usually normal saline is used 3000 ml/bag. Watch output closely for full bags. |
| calculation of true urine duriung CBI | True urine is found by measuring output, subtracting input. Answer is true urine |
| Ph> 7.45 HCO3>26? | Borderline alkalosis. High end of both but still in range. |
| What are the symptoms of left sided heart failure? | ventricular dysfunction-blood backs up into pulmonary veins= pulmonary edema. LV heaves, strong and weak pulses, +HR, -mental status, confusion, restlessness, weakness, fatigues easily, anxiety, depression, shallow respirations due to fluid accumulation. |
| What are the symptoms of right sided heart failure? | Causes a backup of fluid into the venous circulation. heaves, murmurs, jugular vein distention, weight gain, increased HR, ascites, anasarca (massive generalized body edema), hepatomegaly (liver enlargement), fatigue, anxiety, depression. |
| What is renal colic | Severe and acute pain caused by the stimulation of the nerves around the ureters when passing a stone. Pain may originate in the flank and radiates. |
| Explain respiratory drive- healthy person | healthy an increase of PaCO2 of more than 3 mmHg or a drop in pH stimulates the respiratory centers in the brain to increase respiratory rate. |
| Explain respiratory drive- COPD person | their respiratory centers in their brain is desensitized to the increased PaCO2 because they continuously have an increased PaCO2 so their brains do not send out the signal to increase the rate. |
| What class of inhalers is used for emergency treatment of asthma? Why? | Short acting inhaled beta-2 agonist during the acute phase of the asthma attack b/c it dilates the airways, bronchial and vascular structures and restore the airways. |
| What are some meds for emergency treatment of asthma | Albuterol (ventolin), formoterol (Foradil) epinephrine, metaproterenol (Alupent). |
| What are common side effects of albuterol (ventolin) that you’d teach your patient about? | May cause palpations, tremors, headache, dry throat, cough, and hyper or hypotension. |
| What type of meds would a patient with heart failure and A-fib be placed on? | diuretics (lasix)-to increase excretion of fluid, vasodilators (ace inhibitors)- reduce SVR, positive inotropes (dig) increases forces and contraction, ARB’s-decreasing afterload and vascular, antidysrhythmic (adenosine) used for hr conversion |
| What is the primary NANDA for the patient with renal colic? | Acute pain |
| Define rhonchi? | Continuous rumbling, snoring rattling sounds from obstruction of large airway with secretions, most prominent on expiration. Seen in patients with COPD, cystic fibrosis, pneumonia, bronchiectasis. |
| What is the pathophysiology of asthma? | inflammation of the airways, make airways hyperresponsive, airways become restricted. trigger causes immune system activation and mast cell degranultion. results in vascular congestion, edema, mucus, bronchial muscle spasm and thickening of airway walls. |
| What are early signs/symptoms of inadequate oxygenation? | S/S are cyanosis (blue hue), drowsiness, confusion, restlessness, anxiety, slow shallow difficult or irregular breathing. Pt’s with COPD may have “aerophagia”: air hunger. |
| What do you teach the heart failure patient about “ongoing monitoring” | need to monitor weight gain/loss everyday and report a change of 2lbs in a day or 3lbs in 2 days. They will also need so have some I&O monitoring. Follow-up appointments, medications, diet as well as worsening symptoms. |
| Prior to suctioning the patient, what assessment will be completed? | assess the need for suctions the tracheostomy every 2 hours indications that suctioning is needed will be coarse crackles, rhonchi, moist cough, restlessness, or agitation if accompanied by decreased SpO2 or PaO2 . |
| What is a peak flow meter? | A simple device used for pts w/ asthma to monitor how well their lungs are working. Allows for day-to-day changes in breathing , helps track asthma control, shows how well treatment is working, recognize s/s of a flare up. |
| How do you use a peak flow meter? | Pt’s inhale hold meter parallel to ground blow into meter to get a reading of the speed at which the patient can blow air out. 3 zones: Green (80-100% of personal best) Yellow (50-79% of personal best) Red (medical emergency below 50% of personal best) |
| What 3 nandas for the asthma patient? | Ineffective Airway clearance r/t tracheobronchial narrowing, excessive secretions Anxiety r/t inability to breathe effectively, fear of suffocation Ineffective breathing pattern r/t decreased lung expansion. |
| Should there be “tidaling” in the water-seal chamber? Why or why not? | Yes initially when there is a pneumothorax is evacuated. Then intermittent bubbling can also be seen during exhalation, coughing, or sneezing due to an increase in the pt’s intrathoracic pressure. None when patient better |
| Why is teaching your patient the incentive spirometer so important? | It helps to ensure that the alveoli do not collapse and move secretions to the larger airway for expectoration, it also provides the pt with visual feedback of respiratory effort. Helps prevent pneumonia! |
| Another word for “fatty Plaque” is? | Atheromas. They are fatty deposits that have a preference for the coronary arteries which lead to atherosclerosis. The deposits start off soft and harden with age/ time. |
| Explain the gender differences between men/ women with hypertension? | Men: more common before the age of 55, more likely to suffer and MI than stroke Women: appears more often in women than men after the age 55, rise in BP blamed on menopause related factors |
| Loss of central vision? | Caused by Age-related macular degeneration, causes irreversible central vision in persons over age 60. There are 2 forms 1-dry: (nonexudative) 90% 2-Wet: more severe |
| Name the diagnostic procedure that removes pleural fluid? | Thoracentesis: used to obtain specimen of pleural fluid for diagnosis, to remove pleural fluid or to instill medications. CXR is always obtained after procedure to check for pneumothorax. |
| Write 3 appropriate nursing diagnosis for the glaucoma patient? | Deficient knowledge r/t treatment and self-care for disease Disturbed sensory perception: visual r/t increased intraocular pressure Social isolation r/t altered state of wellness, inability to see |
| The medical term used for “narrowing”? | Stenosis can be of the aorta, pulmonary valve, pyloric, or of the spine. |
| What is the nurse’s responsibility when assisting the physician with the chest tube placement? | Positioning of the patient, monitor vitals, prepare site with antiseptic solution and local anesthetic |
| Explain wet suction? | Wet: water level needs to be monitored b/c of evaporation of water, need to keep a muffler on to prevent rapid evaporation as well as muffle the noise of the bubbling water, should have bubbling, no bubbling= indicates suction loss or air leak. |
| Explain dry suction? | Dry: visual orange bellows need to be seen to ensure suction is at appropriate amount, orange bellow is the visual indicator of suction, no water or evaporation. |
| Teach you patient about oxygen and petroleum based products? | Even though the patient’s nose gets very dry the petroleum based products are combustible and should not EVER be used when the patient is on oxygen therapy. |
| Normal value for HCO3? | 22-26 affected by kidneys diseases, some lung diseases and some metabolic conditions. |
| Explain the assessment a nurse would complete for a patient with a continuous bladder irrigation? | Assess for pain due to bladder spasms, assess color and clarity of drainage, the amount of inflow and outflow need to be constantly monitored. |
| Normal creatinine level is? | 0.5-1.5 Creatinine is end product of muscle and protein metabolism and is liberated at a constant rate. |
| Name 3 indicator that a patient needs suctioning? | Noisy rattling breathing sounds, secretions that are visible and filling the opening of the trache, signs of respiratory distress, or before eating and drinking. |
| Teach your patient how to measure his/her peak flow meter? | stand or sit up straight, make indicator is at bottom. take deep breath in, fill the lungs. Bite lightly on mouth piece. Blow air out completely as hard and fast as they can in a single blow. rpt 3 times. |
| What is the first sign of impending respiratory failure? Explain | The initial indication of respiratory failure is a change in the pt’s mental status, this is b/c the cerebral cortex is so sensitive to variations in oxygenation, arterial CO2 levels and acid-base balance |
| What is the function of corticosteroids? | Corticosteroids are used for treatment mild and persistent asthma as a daily long-term control medication. They are also used in pt’s with intraocular inflammation to reduce the inflammation. |
| What do we teach our patients post thoracentesis? | Lay on unaffected side and splint site when coughing or sneezing. |
| Define hypercapnia? | Increased CO2 levels cause by ineffective removal of CO2, increase in arterial CO2 tension. Tested with SBGs also can use pulse ox intermittently or continuously. |
| Another word for air in the lung? | Respiration? Or maybe pneumothorax. |
| Explain the difference between acute angle and open angle glaucoma. | Acute angle-trabecular meshwork is blocked. Open angle-trabecular meshwork is clogged. |
| What patient teaching is very important when a patient is to take a glucocorticoid? | Taper off medications Watch glucose levels Rinse mouth after use if inhaled Increased risk of infection |
| List the classic side effects of corticosteroids. | Increased glucose Suppressed immunity Swelling/edema Accelerated bone loss Thinning of skin |
| eye surgery. What types of drops might be used? | Dilator Paralyze Steriods Anitbiotics |
| timolol. | Beta-blocker used to decrease pressure in eye |
| Explain the treatment differences between complicated and uncomplicated UTI | Uncomplicated you treat the infection. (antibiotics and fluids) With complicated you also have to treat the cause. |
| What info will you include in your post-op eye discharge instructions? | Aching is normal. Pain should not be felt. Head of bed elevated. Extra pillows. No bending straining. |
| Describe the best way to assess fluid volume deficit and overload | Daily weights are the most accurate way. |
| What would a “left shift” indicate in a WBC differential? | Infection |
| Define tachypnic | Rapid breathing >20 resp/min |
| What are early signs/symptoms of inadequate oxygenation? | Restlessness, confusion, irritability |
| Another word for “fatty plaque” is possibly | atherosclerosis |
| “narrowing” | stenosis |
| Pulmonary edema can be life threatening. Why? | Fluid buildup in lungs causing hypoxemia |
| Explain the differences between asthma and COPD | -Asthma is a chronic inflammatory disorder that is usually reversible -COPD is an obstructive pulmonary disease with progressive limitation in airflow that is not fully reversible |
| What is the cause of cor pulmonale? | Right sided heart failure |
| What important teaching will you include about diet and energy conservation for your COPD patient? | Small meals throughout the day with emphasis on protein |
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