NUR 141 EXAM 1
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Erickson stages Middle adult | 40-60, achieving a sense of generativity while avoiding self absorption and stagnation.
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| generativity | getting out more, giving of yourself
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| Stagnation | thinking of self
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| Chinese use | holistic, exercise, western/eastern meds, hot/cold therapy, mental illness is unacceptable
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| common illnesses of the Chinese | heart disease, circulatory probs, cancer due to smoking
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| common diseases of the Chinese due to close living | TB, hepatitis A, lactose intolerant
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| Chinese sick practices | very passive, accept care, family makes decisions, very polite, no direct eye contact, very positive, same sex caregivers
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| Chinese communication | no touch, nod/bow in politeness means they understand
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| Chinese...family is first, pt is second, older family makes decisions, children are not disciplined until age of understanding, children have to study hard |
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| Chinese nutrition | white meat, use a lot of oil, sodium
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| Chinese and death | based on ancestor worship, fear death, dont talk about it
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| Erickson stages older adult | over 65, ego integrity vs despair
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| ego integrity | sense of worth, travels, does not fear death, life experiences
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| despair | feels worthless, powerless, focus on past failures, angry, loneliness, irritable, fears death
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| Maslows 5 levels of needs | Basic physiological (pain), safety & security, love & belonging, self esteem, self actualization
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| local signs of inflammation | Redness
Heat
Pain
Swelling
Loss of function
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| How deep does a partial thickness wound extend? | extend thru the epidermis into the dermis.
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| Superficial wounds | epidermis only
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| Full-thickness | involve SQ tissue and can extend into the fascia, muscle, tendon, or bone
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| the three phases of healing for wounds repairing by primary intention | 1. initial (inflammatory) 2. granulation (proliferative) 3. maturation/scar formation (contraction)
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| total separation of wound layers with protrusion of organs through the wound opening. | Evisceration
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| ESCHAR | Black necrotic tissue. needs to be removed so that epithelial tissue will grow from wound edges to meet in the middle.
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| effect of smoking on wound healing? | vasoconstriction. higher daily requirement for vitamin C which is essential for collagen formation. impairs oxygenation
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| most common site for pressure ulcers to develop & tell me why. | sacrum. pressure friction & shear positioning moisture
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| parameters assessed with the Braden scale | sensory perception moisture activity mobility nutrition friction and shear
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| Maceration | exposure of the skin to moisture. The skin softens, turns white, and is easily broken down or infected.
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| characteristics of a stage one pressure ulcer? | intact skin with nonblanchable redness
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| isolation precautions are ordered for a patient with Tuberculosis? | AIRBORNE isolation which includes HEPA masks, and negative pressure, door closed, and handwashing.
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| Which drug is the standard for treatment of latent TB and is included in multi-drug protocols designed to reduce resistance? | isoniazid Caution: can damage liver so liver function labs ordered at intervals and teach patient to avoid ETOH.
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| What nursing intervention should be done both before and after a suctioning pass | Oxygenate the patient
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| Exposure to contaminated soil is a significant risk for which type of respiratory infection? | Fungal infections: Histoplasmosis Aspergillosis cryptococcosis
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| Respiratory defense mechanisms: | Air filtration mucociliary clearance system cough reflex reflex bronchoconstriction alveolar macrophages
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| Restrictive disease: | impaired lung or chest wall compliance that creates a problem with lung expansion and reduces lung volumes. Inspiration problem.
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| Obstructive disease | increased resistance in the airways that causes air trapping and increased residual volume. Expiration problem.
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| orthopnea | difficulty with breathing while lying flat.
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| Name a symptoms that is suspicious for cancer of the larynx that should be referred to a physician immediately | persistent hoarseness voice changes “lump” in the throat painless lesions (leukoplakia/erythroplakia
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| Briefly explain how biologic and targeted therapy drugs work to treat cancer. | These classes of medications interfere in some way with cancer cell growth or replication by interfering with a particular biologic signal. Examples: Tarceva inhibits enzyme in GF receptor Avastin inhibits angiogenesis
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| What is the difference between Chronic Bronchitis and Emphysema? | Chronic bronchitis is damage to airways.
Emphysema is damage to alveoli.
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| Asthma | obstructive disease. episodic and variable inflammation
REVERSIBLE
traps air, exhaliation probs
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| COPD | obstructive disease. progressive limitation of expiratory airflow
NOT REVERSIBLE
traps air, exhaliation probs
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| What type of sputum test is ordered with suspicion of TB | ACID-FAST BACILLI ( need samples 3 days in a row
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| Anticholinergics | block the effect of parasympathetic nervous system . short acting: ipratropium (Atrovent) long acting: tiotropium (Spiriva)
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| Leukotriene modifiers | interfere with inflammatory mediators that cause airway constriction and edema. Prevent bronchospasm and inflammation. montelukast (Singulair) zafirlukast (Accolate
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| device can be used to monitor disease progression and effectiveness of medications/treatments for pts with obstructive respiratory disease? | Peak flow meters measure the exhalation volume.
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| Corticosteroids | medications can be used IV, oral, nebulized, or per MDI to prevent and treat airway constriction and edema?
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| Aspiration pneumonia | develops most often in the dependent portions of the right lung as the right bronchi is straighter.
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| What techniques can be taught to patients with COPD that can increase the length of expiration and reduce resp rate and airway collapse? | Pursed lip breathing
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| Structural changes of aging | decreased expiratory muscle strength stiffening of chest wall (↓compliance) ↑AP diameter of the chest (barrel shape) decreased elastic recoil decrease in functioning alveoli spinal changes (↓compliance)
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| family in later life | accepting shifting of generational roles, maintain intereests in spite of physiological decline, retirement, deal w losses.
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| NS intervention for family in later life | indentify and support caregiver, explore respit care, meals
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| sandwich generation | middle adult, meet needs of younger/older adults
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| primary disease prevention | true prevention, preceeds any disease, good nutrition, immunizations, excerise, stop smoking/drinking, safe sex, seat belts, gloves, washing hands
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| secondary prevention | early detection and treatment
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| tertiary prevention | rehab and restoration, had problem and now minimizing the effects of
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| what can prevent UTI | vit C
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| to absorb b12 you need | acid in stomach and intrinsic factor
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| no intrinsic factor equals.... | anemia
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| 60 yo needs a varivax shot to prevent | shingles
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| exercise for 50yo female | 3-5xwk x30 min, wtb to raise P and R.
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| exercise for 80 yo male | ask dr first, walk, pool therapy, wtb x5-10 min
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| vacs for middle adult | Tdap q 10 yrs, Hept B series x3, pneumovac, flu, hept A
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| vacs for elder adult | Tdap q 10 yrs, flu, pneumovac x5-10yrs
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| medicare part A | inpt procedures
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| Medicare part B | physician services and equip
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| Medicare part D | drugs
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| sequential reaction to cell injury | inflammatory response
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| inflammatory response roles | neutralizes/delutes inflam agent, removes necrotic material, establishes environment for healing and repair
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| inflammatory mediators that cause vasodilation and inc capillary permiability | cytokines, histamines, prostaglandins, leukotrienes
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| clinical manifestations to response | vasoconstriction, inc WBC with shift to left of neutrophils, exudate forms, malaise, N and anorexia, inc P/R, fever
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| signs of local response of inflammation | redness, heat pain swelling, loss of function
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| wound classification | the cause, duration, depth
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| superficial depth | involves epidermis
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| partial thickness wound | goes into dermis
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| full thickness wound | involves the subcutaneous tissue and may extent into fascia, muscle, tendon and bone
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| replace lost tissue with same type | regeneration (liver)
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| replace with connective tissue, various types | repair
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| type of healing that occurs when wound margins are approximated | primary intention= surgical incisions, paper cuts
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| 3-5 days approximation, migration, fibrin meshwork | initial phase (primary intention)
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| 5 days to 3 weeks, fibroblasts, surface pink vascular, edges begin to regenerate and migrate | granulation phase (primary intention)
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| collagen organized/remodeled avascular scar forms | maturation and scar contraction
(primary intention)
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| repair secondary intention | healing of wounds with large amounts of exudate, wide irregular margins, excessive tissue loss, edges cant b approximated
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| secondary intention | wounds related to trauma, ulceration, infection, more inflam, granulation from edges inward, bottom upward
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| tertiary intention | wound contaminated, healing occurs w delayed suturing of wound, larger/deeper scar
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| collection of blood underneath tissues | hemmorrhage
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| skin/tissue separate due to poor wound healing | dehiscence
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| separation of wound layers w protrusio of viceral organs | evisceration-cover w sterile towel soaked in NS, NPO status
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| abnormal passage between 2 organs or organ and outside of the body | fistula
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| complications of healing | hemorrhage, infection, dehiscence, evisceration, fistula
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| factors delaying healing | corticosteroids-impair WBC and fibroblast function, dec granulation and contraction
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| vit A and zinc | aids in process o9f epithelialization
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| vit B | coenzymes for metabolic reactions
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| vit C | promotes formation of collagen fibers and capillary develpment
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| protein | provides amino acids for tissue repair
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| carbohydrates | inc metabolic energy
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| fats | aids in synthesis of fatty acids and trglycerides
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| inc fluids | loss from perspiration and exudate
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| multidrug resisitant pathogens | MRSA-methicillin resisitant Staph aureus; VRE-vancomycin resistant enterococci
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| contact precautions | private room, HW entering/leaving room, visitor same thing
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| best for cleaning wounds | NS
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| secondary intention red wounds | granulating, protect wound, sterile dressing
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| secondary intention yellow wound | slough or soft necrotic tissue, dressing to absorb exudate
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| secondary intention black wound | necrotic tissue called eschar, wet to dry
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| peroxide kill granulation tissue |
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| injury over boney prominence from pressure, sheer/friction, secondary intention | pressure ulcers
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| most common site for pressure ulcers | sacrum, heels
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| stage one pressure ulcer | intact skin w nonblanchable redness
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| stage 2 | partial thickness loss of dermis w red-pink granulation, may have serum filled blister, popped blister
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| stage 3 | full thickness tissue loss, subQ fat may b visible, undermining/tunneling
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| stage 4 | full thickness tissue loss w exposed bone, tendon or muscle, slough or eschar, undermining and tunneling. can get osteomylitis
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| unstageable ulcer | full thickness tissue loss w base of ulcer covered by slough or exchar in wound bed
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| braden scale | assesses pt for risk of developing a pressure ulcer. range 6-23. lower score=higher risk for ulcer
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| removal of nonviable, necrotic tissue | debridement
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| an abnormally firm/hard area on the skin | induration-firm swelling
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| skin is consistently wet, skin softens, turns white and can easily get infected | maceration-wet tissue, white skin like been in the tub too long
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| a narrow, elongated channel in the body that allows the escape of fluid | sinus tract
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| yellow or white stringy substance attached to wound bed | slough
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| a chronic skin ulcer having overhanging margins, caused by bacterial infection | undermining
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| black or brown necrotic tissue that must be removed for healing | eschar
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| upper airway | nose, pharynx, adenoids, tonsils, epiglottis, larynx, trachea
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| Lower airway | Bronchi
Bronchioles- in the lungs
Alveolar ducts
Alveoli
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| Ventilation | air moves from area of high concentration to low
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| Inspiration | active): muscles contract = ↑intrathoracic volume
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| Expiration | (passive): air expelled as volume ↓
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| Elastic recoil | ↓chest size & ↑pressure = air movement out of chest
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| Compliance | ease of expansion, diseases can ↑ or ↓
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| Diffusion | O2 & CO2 move across alveoli-capillary membrane, hi to low
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| surfactant | Surface tension of alveoli, ↓ inflation pressure, ↑strength, Secretion triggered by sighing and DB, deficit leads to ATELECTASIS
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| Control of respiration | brainstem response, signals move from medulla thru spinal cord thru phrenic nerve
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| (acidosis | = ↑resp rate and volume
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| alkalosis | ↓resp rate and volume)
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| Mechanical receptors: carotids, respond to | ↓ PaO2 & pH or↑ PaCO2
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| Clearance mechanisms: | Cilia, Cough reflex,
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| Reflex bronchoconstriction | prevents entry of irritants
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| Alveolar macrophages | phagocytize foreign particles, removed by cilia or lymph
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| Some contaminants can’t be removed | coal dust, silica
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| Alterations in structure due to ageing | Decreased elastic recoil & expiratory muscle strength, Stiffening of chest wall, Increased AP diameter, Decreased functioning alveoli, Spinal changes
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| Reduced defense mechanisms | Decreased immunity, cilia function, cough force, alveolar function
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| Impaired resp control RT reduced response to changes in gases | Decreased response to hypoxemia (↓PaO2), hypercapnia (↑Pa CO2)
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| CALCUALTED IN PACK YEARS | One pack/day X 20 yrs = 20 pack years
two packs/day X 10 yrs = 20 pack years
Half pack/day X 40 yrs = 20 pack years
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| Classification of respiratory disease RESTRICTIVE | Decreased lung expansion, compliance/capacity,
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| OBSTRUCTIVE (obstruction or narrowing) | Increased compliance, airway resistance,
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| Restrictive airway disease | Anatomy affected: lung tissue or thorax
Breathing difficulty: Inspiration
Pathophysiology: ↓lung or thoracic compliance
Lung function: ↓lung volume/capacities
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| Restrictive pulmonary disease | scarring or inflammation limits lung expansion & impairs gas exchange. “Stiff” lungs have lower volumes. (PNEUMONIA, FIBROSIS, SILICOSIS, ASBESTOSIS, TUMORS)
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| Restrictive pulmonary disease | Impaired expansion of chest wall can limit lung expansion as well. (SCOLIOSIS, OBESITY, KYPHOSIS, LORDOSIS)
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| Pneumonia | Entry of organisms:
ASPIRATION (often flora from upper airway)
INHALATION (microbes present in the air)
HEMATOGENOUS SPREAD (primary infection elsewhere)
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| COMMUNITY-ACQUIRED Pneumonia | Onset in the community or first 2 days of hospitalization
Most common cause is Streptococcus pneumoniae
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| HOSPITAL-ACQUIRED pneumonia | Onset 48 hrs or longer after hospital admission or other contact with health care system (eg.: clinic, ECF, IV antibiotics
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| ASPIRATION pneumonia | Mechanical obstruction – inert substances into airway (barium)
Chemical injury – acidic GI contents
Bacterial – most common (aerobic & anaerobic organisms)
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| OPPORTUNISTIC pneumonia | Occur in individuals with altered immune response (HIV, malnourished, chemo, LT steroids)
Often more gradual onset
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| stage 1 of pneumonia | Congestion
Fluid response in alveoli, microbes multiply & spread to adjacent alveoli. Fluid impairs gas exchange.
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| stage 2 | Red hepatization
Capillaries dilate, alveoli fill with organisms, WBCs, RBCs, & fibrin. Lungs look red and granular.
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| stage 3 | Gray hepatization
Blood flow decreases & WBCs & fibrin consolidates in affected area.
Fibrin deposits & phagocytosis.
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| stage 4 | Resolution
Exudate processed by macrophages, healing occurs, and lung tissues restored & gas exchange returns to normal.
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| Clinical manifestations: pneumonia | Fever, chills, SOB, cough with purulent sputum, pleuritic chest pain, confusion or ↓mental function
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| Diagnosis of pneumonia | chest xr, sputum gram stain
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| inflammation of pleura (painful, teach splinting) | Pleurisy
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| fluid in pleural space | Pleural effusion
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| collapsed, airless alveoli | Atelectasis
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| bacterial infection in blood | Bacteremia
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| Infectious disease caused by Mycobacterium tuberculosis, 2nd most deadly infectious disease worldwide | Tuberculosis
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| Spreads person-to-person via small airborne droplets, The immune response walls off the bacteria, scars, and forms granulomas in the lungs – can be seen on x-ray | Tuberculosis
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| Latent TB infection | : bacteria are inhaled but immune response effective & no active disease develops (usually have + skin test)
However, it is possible to develop active disease later.
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| Active TB infection | : bacteria multiply and cause clinical disease
clinical/X-ray evidence of disease & significant reaction to skin test
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| Clinical manifestations of tb | Fatigue & malaise
Anorexia & weight loss
Low –grade fever
NIGHT SWEATS
Cough (can have purulent sputum and progress to hemoptysis in advanced stages)
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| Diagnosis of TB | Mantoux skin tests=Read by 48 – 72 hrs
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| drug therapy for latent tb | isoniazid (INH) once daily for 6 – 9 months, rifampin if resistant to isoniazid
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| Active TB | up to 6 months, isoniazid (INH)
rifampin
pyrazinamide
ethambutol
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| teaching with tb treatment | Side effects: hepatic damage, orange body fluids with rifampin, vision damage with ethambutol
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| TB precautions | Airborne isolation if suspected: neg pressure room, HEPA masks, handwashing
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| Pulmonary fungal infections | no isolation precautions, Amphotericin B is drug of choice for severe illness, IV only
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| Obstructive airway disease increases resistance. It’s a PRESSURE problem. | Anatomy affected: airways
Breathing difficulty: expiration
Pathophysiology: ↑airway resistance
Lung function: ↓airway flow rates, ↑residual volume due to trapped air
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| Obstructive pulmonary diseases | the diameter of the airway is reduced and the air flow becomes more turbulent. (ASTHMA, COPD (Chronic bronchitis & Emphysema), CYSTIC FIBROSIS, BRONCHIECTASIS)
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| chronic episodes of variable inflammation leading to airway obstruction; usually reversible | ASTHMA
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| progressive limitation of expiratory airflow | COPD (chronic obstructive pulmonary disease
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| Asthma | Clinical manifestations: (S/S worse at noc/early am, unpredictable, variable)
Wheezing
Breathlessness & prolonged expiration
Chest tightness
Cough
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| asthma can cause respiratory acidosis |
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| meds for asthma | Beta-adrenergic agonists
Inhaled anti-cholinergics
Corticosteroids – oral or IV
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| productive cough for 3 months in 2 successive years in pts in whom other causes of cough have been ruled out damage to larger airways | Chronic bronchitis
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| abnormal permanent enlargement of airspaces distal to terminal bronchioles , with wall destruction and without obvious fibrosis damage to alveoli | Emphysema
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| COPD Etiology= impaired EXHALATION | CIGARETTE SMOKING and/or occupational chemicals/dust/pollution
Infection: recurrent inflammation & colonization
Genetics: ɑ-Antitrypsin deficiency
Aging
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| Clinical manifestations copd | Gradual onset (classic = 50 + yrs of age and 20 pack yr hx)
Cough, sputum, SOB, exposure to risk factors
Dyspnea is persistent and progressive
Fatigue and limited ADLs
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| Complications of copd | Cor pulmonale: right sided heart failure due to pulmonary HTN, Exacerbations, Acute respiratory failure, Depression & anxiety
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| Treatment of COPD | Smoking cessation, Medications, Surgery (lung volume reduction, Breathing retraining pursed lips, diaphramic breathing, Airway clearance techniques
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| Goals for oxygen use | ↓work of breathing, ↓workload of heart, keep SaO2 >90 % with rest, sleep, & exertion. 2ml for copd
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| Medications for O2 uptake problems | Expectorants
Antitussives
Mucolytics
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| anti-inflam durgs for copd | Corticosteroids: Inhibit the release and action of inflammatory mediators (-ONES)
IV: Solumedrol
Oral: prednisone
Inhaled (ICS) (use spacer & rinse mouth): Pulmicort, Azmacort, Flovent
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| Leukotriene modifiers | These meds block production or action. Dilate & ↓inflammation. (-kast)
Prevention & maintenance; not for acute attacks
Meds (oral): montelukast (Singulair), zafirlukast (Accolate)
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| Antihistamines | directly blocks histamine receptor
Sedating : diphenhydramine (Benadryl)
Nonsedating: DON’T CROSS THE BLOOD/BRAIN BARRIER
loratidine (Claritin), cetirizine (Zyrtec)
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| Beta-adrenergic agonists (beta agonists): Bronchodilators | act on receptors in the bronchiole & produce dilation & promote mucociliary clearance (-OL). OVERUSE CAN CAUSE REBOUND BRONCHOSPASM & ↓ EFFECTIVENESS, Short-acting
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| short acting bronciodilators | albuterol, levalbuterol (Xopenex), pirbuterol (Maxair)
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| long acting bronciodilators | salmeterol (Serevent), formoderol (Foradil)
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| relax bronchial smooth muscle, ↑diaphragm contractility, CNS stimulant | Methyxanthine derivatives (theophylline family):
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| block the parasympathetic NS (-pium) | Anticholinergics: Cause dry mouth
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| Leading cause of cancer-related deaths in the US | Pulmonary tumors
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| a tumor that arises from new, abnormal growth and invades surrounding tissue or metastasizes | Cancer
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| risk factors for cancer | Heredity
Lifestyle
Environment
Age related
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| cancer CAUTION | Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge from any body orifice
Thickening or a lump in the breast or elsewhere
Indigestion or difficulty in swallowing
Obvious change ina wart or mole
Nagging cough or
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| May be used to debulk a tumor prior to surgery or to eliminate submicroscopic cancer cells. | Chemotherapy
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| Alkylating agents | damages DNA by causing breaks in the double-strand helix.
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| Antibiotics | modifies function of DNA and interferes with transcription of RNA
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| Antimetabolites | interferes with synthesis of DNA by mimicking certain essential cellular metabolites that cell incorporates into synthesis of DNA
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| Hormonal agents | alters hormonal status in tumors or inhibits enzyme responsible for activating estrogen.
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| Mitotic inhibitors | interrupt/interfere with mitosis.
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| Nitrosources | similar to alkylating agents and also blocks specific enzymes needed for the synthesis of purine.
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| Corticosteroids | Disrupts the cell membrane, inhibits mitosis and synthesis of protein
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| Interferons | Naturally occurring complex proteins
3 types
Inhibits DNA and protein synthesis in tumor cells. Modulates the immune response.
Cannot be taken orally and one type cannot be interchanged with another type
Side effects : flulike symptoms
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| Interleukins | Family of biological agents that perform many functions related to the immune system e.g. activation of the immune system and alteration in the functional capacity of cancer cells
Not given orally
Major toxic reaction called capillary leak syndrome (int
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| Monoclonal Antibodies | Antibodies or immunoglobulines produced by B lymphocytes that are capable of binding to specific target tumor cells.
Administered by infusion method
Anaphylactic reaction can occur – medical emergency.
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| Treatment of low neutrophils | neupogen
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| Treatment of low RBC | epogen
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| Treatment of low platelets | neumega
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| Nursing Interventions | Flulike symptoms – tylenol before treatment and every 4 hours
Severe chills – IV Demerol
Assist with activities of daily living
Perform nursing activities to allow for periods of rest
Assess vital signs and general assessment for side effects/therapeu
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| Autologous marrow transplant | patient’s own bone marrow that was harvested and stored before chemotherapy began. The bone marrow is then infused into the patient when needed after intensive chemotherapy or radiation therapy
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| Allogeneic marrow transplants | infused bone marrow is acquired from a donor who has been determined to be human leukocyte antigen matched to the recipient in terms of tissue typing.
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| Syngeneic marrow transplant | obtaining stem cells from an identical twin and infusing them into another.
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| CHRONIC PYELONEPHRITIS | THINK INFECTION. Bacteria- renal pelvis-inflammatory response-edema, tissue swelling-fibrosis, scars.(usually extension of infection elsewhere - ex: cystitis)With repeated inflammation, scarring, renal tissue permanently damaged.Often due to freq. cyst
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| Chronic GLOMERULONEPHRITIS | THINK IMMUNE REACTION.ANTIGEN-ANTIBODY REACTION with glomerular tissue;swelling & death to capillary cells,enzymes released & attack glomerluar basement membrane. Gradual destruction of glomeruli kidneys atrophy to ESRD in 10-30 yrs Intermittent bouts of
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| PREVENTION OF CHRONIC RENAL FAILURE Preventative Measures: | Limit catheter use; Sterile technique with caths, Aggressively treat DM, HTN, Acute GN, UTI’s Watch for low UO & BP; report promptly, (Prevent ACUTE RENAL FAILURE), Monitor Nephrotoxic meds carefully
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| tx for esrd | dialysis,Fluid Restrictions (Plan Amts. each shift) Monitoring: I&O, Daily Wt, VS, lab values
Dietary Restrictions (Na & K) Meds
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| HEMODIALYSIS- Blood circulates through Artificial Kidney by dializer to | Remove waste products & excess fluid
Restore electrolyte and acid base balance
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| OSMOSIS | Glucose in dialysate is hypertonic so pulls fluid from blood
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| DIFFUSION | Particles move from Greater to Lesser concentration
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| ULTRAFILTRATION | Fluid moves due to pressure gradient between blood and dialysate & is removed
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| NURSING CARE DURING HEMODIALYSIS | hold most meds (BP, H2O soluable),
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| risk for bladder cancer | Smoking, chemicals, hi fat, lo fiber diet, sedentary lifestyle
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| s/s bladder cancer | Intermittent painless hematuria, Freq cystitis, Anemia, Suprapubic pain
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| post op care after bladder cancer surgery | Increase Fluids to internally irrigate /prevent clots
Catheter to Prevent stress on sutures (cath care) - may also have supra-pubic cath
Small capacity (60cc) initially
Call Dr for UO < 30cc / hr
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