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