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186 Cards in this Set
- Front
- Back
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What are the cardinal symptoms of a respiratory problem?
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fatigue, cough, night sweats, sputum, chest pain, fever, chills
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What are some things you'll see upon inspection of someone with a respiratory problem?
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change in respiratory rate and depth, cyanosis (LATE), decreased LOC
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What does crackles mean?
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fluid in alveoli
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What do rhonchi mean?
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from secretions, clear with cough
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What does a wheeze mean?
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narrowed airways, high pitched
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What are some diagnostics done for respiratory problems?
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ABGs, Chest Xray, Sputum C & S, CBC, pulmonary function tests, thoracentesis, MRI, bronchoscopy, lung scan
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If you're testing sputum for AFB, the dr. thinks the pt. has...?
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TB
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What is the Allen Test?
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test the arteries before you stick the radial. When you put pressure on and release the ulnar artery, you should receive a flushing color
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What is increased WBC
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leukocytosis
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What is a thoracentesis?
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aspiration of fluid or air from the pleural space
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What do you do before a thoracentesis?
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consent, positioning, VS
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What do you do during thvoracentesis?
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at the bedside, sitting up and leaning over
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What do you do after a thoracentesis?
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chest xray!! check lung sounds and for bleeding
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What is a bronchoscopy for?
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visualization of airways, remove secretions, obtain biopsy
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What do you do before a bronchoscopy?
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NPO, consent, allergies, pulse oximetry, sedation meds, remove dentures
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What do you do after a bronchoscopy?
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VS, hemoptysis, lung sounds, NPO until gag reflex returns
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How big is the pleural space?
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3-5 mm
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Where do you keep the vacuum for a thoracentesis?
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below the insertion site
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What is pneumonia caused by?
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organisms, droplet inhalation, aspiration, community acquired, health care acquired
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Where does pneumonia inflammation occur?
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in bronchioles and alveoli
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What can pneumonia cause?
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atelectasis (collapse of alveoli NOT of lung) and hypoxemia, even septicemia
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What is septicemia?
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infection in the blood
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What does pneumonia show on an x ray?
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consolidation or infiltrate
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Who has the highest incidence of pneumonia?
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older adults, ECF residents and ventilated patients
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When is pneumonia most prevalent?
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Fall/winter
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What is the 5th leading cause of death in the US?
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pneumonia
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Pneumonia mortality increases with?
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age and comorbidity
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What are some medicines you give for pneumonia?
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antitussive, bronchodilators, antibiotics, mucolytics, corticosteroids
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What does an antitussive do?
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help with cough, codeine
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What do bronchodilators do?
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open airways
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What do corticosteroids do?
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decrease inflammation
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What do mucolytics do?
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expectorant
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When do you monitor peak and trough?
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aminoglycoside antibiotics
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What is latent TB?
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exposed and the body took care of it and it didn't spread. If you have a low immune system for some reason, it may become active
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What will a latent TB infection show?
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QFT positive, negative chest x ray, negative sputum, no symptoms, cannot spread
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What does active TB show?
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positive chest xray, positive sputum for AFB, symptomatic, can spread
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What causes TB?
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Mycobacterium tuberculosis
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How is TB transmitted?
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airborne
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When does TB multiply?
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when it reaches the bronchi or alveoli
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What surrounds TB inflammation?
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collagen, fibroblasts, and lymphocytes
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What happens in TB?
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caseation necrosis turns into necrotic tissue and then a Ghon tubercle when present on chest xray and the caseation areas reabsorb and fibrose, necrotic areas may calcify or liquefy
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Is TB exposed the same as disease?
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no
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What are some S and S of TB?
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fatigue, lethargy, nausea, anorexia, weight loss, low grade fever, night sweats, cough, sputum production
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What type of organism is TB?
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aerobic
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Who is at risk for developing TB?
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recently infected, with clinical conditions that increase their risk of progressing from LTBI to TB, underweight, malnourished, injection drug, HIV
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How long do you take meds for TB
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6-9 months
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How is TB diagnosed?
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positive for AFB (M. tuberculosis) at least 3 times, positive chest x ray
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When is the Mantoux or PPD test read?
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48-72 hours
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What is indicated as positive for an Mantoux test for those with HIV in close contact with infectious cases?
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5 mm induration
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What is considered positive on Mantoux test for most people?
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10 mm induration
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What is considered positive Mantoux test for kids?
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15 mm
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How do you determine between boosted TB reaction and reactions due to infection?
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two step testing
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What occurs in 2 step testing?
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If first positive, consider positive: If first negative give second in 1-3 weeks
If second positive consider infected: If second negative, consider uninfected at baseline |
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How do you administer the TB test?
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inject 0.1 mL of 5 TU PPD tuberculin solution intradermally on volar surface of lower arm using a 27 gauge needle and produce a wheal 6 to 10 mm in diameter
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What do you measure in TB test?
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induration, not erythema
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How do you record TB test results
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in mm
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When do you want to collect a sputum sample?
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AM: get 1 in AM and the other 2 within same 24 hours if need to
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When does a smear result show?
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next day
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If you have a positive PPD and negative x ray, give?
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INH and Vitamin B 6 for 6 months
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If you have a positive PPD and positive chest x ray and sputum for AFB, give?
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4 drugs until cultures return then adjust normally
usually lasts 6-9 months |
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When do you take Vitamin B6?
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INH
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Do you need to take all medications for TB?
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yes
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When are you usually noninfective after being treated for TB?
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2-3 weeks
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Do you need special isolation for TB at home?
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no
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What would happen if peak and trough levels were not monitored for patients on Vancomycin for pneumonia?
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could blow out the kidneys
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What if the TB patient stopped taking prescribed meds after only 4 weeks?
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could be drug resistant
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What is the pt with TB taking INH did not also take Vitamin B6?
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they could have neuropathy
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What is a subtype of acquired pneumonia which occurs in people who are mechanically ventilated via endotracheal tube or tracheostomy tube for at least 48 hours?
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ventilator associated pneumonia
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Where does VAP occur?
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infection fills alveoli
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What is VAP
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pneumonia that occurs in a patient who was intubated and ventilated 48 hours before the onset of the pneumonia
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what is a ventilator
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a device to assist or control respiration continuously, inclusive of the weaning period, through a tracheostomy or by the endotracheal tube
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What is the mortality rate of VAP?
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40%
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what are some serious complications of VAP?
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ARDS and acute lung injury
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What is the leading cause of morbidity and mortality in ICU?
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VAP
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What can happen with VAP?
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tracheal intubation interrupts normal physiologic defenses against aspiration and oral secretions pool, and pathogens colonize on teeth and oral mucosa
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When is oral care imperative?
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with a ventilator
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What is often difficult to diagnose?
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VAP because patient is often sedated
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What are some parts of ZAP THE VAP?
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Elevation of the HOB 30-45 degrees, sedation vacation, peptic ulcer prevention (antacid), DVT prevention (SCD or Lovenox), oral care, and nutrition evaluation
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With VAP, when should you do oral care?
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every 2 hours
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What is a composite of knowledge, skills, and attitudes that help one reason, think, and evaluate ideas as well as solve problems?
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critical thinking
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50-85% of hospitalized patients every year are...?
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over 65 years old
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What are some risk factors that negatively impact aging?
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alcohol abuse, smoking, depression, lack of exercise, obesity
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What are some activities to promote wellness in the elderly?
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flu and pneumonia vaccines, tetanus and booster every 10 years, seat belts, avoid smoking, smoke detectors, hazard free environment, prescriptions as prescribed, Physical education, decreased fat, increased complex carbs and fiber, increased calcium, 10-15 min in the sun 3 xs a week, exercise, reminisce, socialize
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What are some physical changes with aging that affect nutrition
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diminished sense of taste, tooth loss and poorly fitting dentures, dehydration and electrolyte imbalance
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What are some nutritional needs for the elderly in the hospital and nursing home?
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anorexia and weight loss, undernutrition from drugs, chewing difficulty, immobility, infections, Alzheimer's
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Why do elderly get constipation?
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decreased salivation causing difficulty swallowing and decreased GI motility
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What are some benefits of regular exercise for the elderly?
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decreased incidence of falls, increased strength, reduced pain from arthritis, fewer emotional problems resulting from depression, increased longevity, and lower risk of diabetes and CAD
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What are necessary for the elderly for adaptation tot he changes that occur in later years?
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coping skills
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What are a primary cause of decreased mobility in the elderly?
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accidents
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What is a device or medication that prevents the client from moving freely?
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restraints: physical and chemical
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What is important to note in the elderly and the effects of drugs on older adults?
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they have lower reserve capacity in most organ systems, so they have a higher risk for side effects and toxic effects exist
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What is the policy for drugs in the elderly?
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start low, go slow
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What is usually a short term condition that is a reversible behavioral change?
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delirium
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What are some causes of delirium?
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metabolic, infections, nutritional, meds, circulatory
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Can a person have dementia and delirium?
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yes
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Can you have dementia and depression?
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yes
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What is the failure to provide basic needs to elderly?
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neglect
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What is the use of physical force that results in bodily injury to elderly?
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physical abuse
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What is mismanagement or misuse of property or resources?
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financial abuse
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What is intentional use of threats, humiliation, intimidation, and isolation?
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emotional abuse
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What is geriatric syndrome?
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one symptom or a complex of symptoms that result from multiple disease and risk factors
INSTABILITY, COGNTIVE IMPAIRMENT, UI, CONFUSION |
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Why are the elderly more susceptible to infection?
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threat of morbidity, decreased defenses, loss of reserve, chronic illness
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How many deaths a year does hospital acquired cause?
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300,000/ year
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What occurs with pain in the elderly?
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response may be decreased due to decreased touch sensation
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What occurs with temp in elderly?
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1 degree lower
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What are some subtle signs of infection in elderly?
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change in mental status, increased RR, tachycardia, change in color or facial appearance
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What occurs in the heart with aging?
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decreased CO, HR, and SV
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What are some changes in the lungs with aging?
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decreased vital capacity, decreased gas exchange, decreased cough reflex
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What are changes in integumentary system with aging?
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decreased protection against trauma and exposure and decreased secretion of natural oils and perspiration
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What are some changes in MSK with aging?
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loss in bone density, decreased muscle strength, prone to falls, decreased joint cartilage
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What are some changes in nervous system with elderly?
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decreased nerve conduction, increased confusion with illness, decreased cerebral circulation
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What are some changes in mens genitourinary with aging?
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enlarged prostate
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What are some changes with GU in women?
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vaginal dryness, stress incontinenece
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What are some changes in visual with aging?
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decreased ability to focus, inability to tolerate glare, decreased ability to distinguish colors
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A pt with dehydration, what would the skin be like? the LOC? and the pulse?
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the skin would be dry and tenting, the LOC would be disoriented and the pulse would be tachycardic
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What would the urine be like in a dehydrated person? Sp Gravity? Na? HCT? BUN
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dark, high, high, high, high
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What is the most important to monitor in dehydration?
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urinary output
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what is the minimum urinary output
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30 mL/hr
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What is not always an adequate indicator of fluid status in elderly?
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skin turgor
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What happens to thirst with aging?
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decrease
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what happens to kidney function with aging
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decrease
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what happens to renal concentration with aging?
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decrease with an increase in water loss
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What is a daily minimum fluid intake for the elderly?
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1500-2000 cc
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What is fluid volume excess?
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hypervolemia; may result in movement from intravascular space to interstitial space
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What are some causes of fluid volume excess?
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too much fluid intake: oral or IV, renal failure, CHF, cirrhosis, medications (steroids)
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Some interventions for fluid volume excess?
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monitor body system status, prevent further overload, restore normal fluid balance, administer diuretics, restrict fluid and sodium intake, monitor I adn O and weight, monitor electrolyte values and prepare to administer meds to treat imbalance if present
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What is the major cation of the ECF and the major determinant of ECF osmolality?
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sodium
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What does Na do?
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maintain irritability and conduction of nerve and muscle tissue and helps maintain acid base balance
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What is responsible for excreting excess Na?
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kidney
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What is hyponatremia?
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serum sodium below 135 mEq/L
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What are some causes of hyponatremia?
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Na loss/ fluid retention
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What is treatment for hyponatremia?
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restrict fluids
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What are signs and symptoms of hyponatremia?
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headache, irritability, dizziness, confusion, seizures, increased HR
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What is treatment for hyponatremia?
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treat cause, discontinue diuretics, replace fluids, restrict fluids depending on cause
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What is a last resort for hyponatremia?
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hypertonic saline (3% saline)
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What are some causes of hypernatremia?
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excessive water loss, osmotic diuretics, increased aldosterone, increased sodium intake
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What are some signs and symptoms of hypernatremia?
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thirst, fatigue, restlessness, agitation, coma, flushed skin
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How do you treat hypernatremia?
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increase fluids and may restrict Na
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Potassium
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primary intracellular cation
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What regulates potassium balance?
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kidneys
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When is K released?
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when cells/tissues are broken down
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Hypokalemia
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below 3.5
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What are some causes of hypokalemia?
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poor dietary intake, renal loss, diuretics, increased aldosterone, upper and lower GI loss, steroids, antibiotics
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What are some signs and symptoms of hypokalemia?
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fatigue, muscle weakness, leg cramps, nausea and vomiting, parethesia, cardiac rhythm problems, ileus d/t decreased Gi motility
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What does low K do to GI motility?
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decrease it
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What do you do with K liquid?
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give with juice
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Do you ever give K IV push?
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NO, NEVER!!!!!!!!!!!
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What is the highest K infusion pump rate?
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20 mEq/hr but preferred is 5-10
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What do you do BEFORE giving K?
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check urinary output/renal function
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What is the most K per 24 hour?
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60 mEq
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What do you do with K IV site?
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check frequently, can get irritated, infiltrated, or phlebitis
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What is a K+ rider?
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small dose 20 mEq in 250 cc
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What are some causes of hyperkalemia?
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high dietary intake with decreased renal function, renal failture, extracellular shifts (acidosis, hyperglycemia), trauma/sepsis/burns, meds (ACE inhibitors, chemo)
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What does insulin do with K?
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help keep K inside cell
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What are some signs and symptoms of hyperkalemia?
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irritability, pareshesia/weakness, abdominal cramps, colic Diarrhea, bradycardia, cardiac standstill, tall T waves on EKG
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What do you do with hyperkalemia?
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give fluids if tolerated and diuretics if tolerated, give kayexalate (as long as pt. has stool after), insulin/bicarb/glu, calcium chloride IV, dialysis
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WHat EKG shows with hyperkalemia?
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tall tented T waves
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What are foods high in K+?
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avocado, banana, carrot, cantaloupe, fish, mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, tomatoes
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What is Ca needed for?
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formation of bones and teeth, contraction of muscles, and clotting
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What does Ca affect?
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action potential of nerve and muscle cells
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What regulates calcium?
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parathyroid hormone by increasing serum calcium levels
or by calciuim which decreases serum calcium levels |
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What has an inverse relationship with calcium?
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calcitonin
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What are some causes of hypocalcemia?
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reduced calcium intake, decreased intestinal absorption, increased calcium loss: diuretics, hypoparathyroidism, hyperphosphatemia, pancreatitis, massive blood transfusions
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What are some signs and symptoms of hypocalcemia?
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hyperactive reflexes, muscle cramps, tetany, convulsions, parethesia, ECG changes, positive Chevostek's and Trousseau's sign
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What are some treatments for hypocalcemia?
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administer calcium, vitamin D, initiate seizure precautions, move cautiously to prevent fractures, assess for fracture
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What are some causes of hypercalcemia?
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increased intake of calcium, hyperparathyroidism (leads to increase in intestinal absorption), increased release of calcium from bone, decreased urinary excretion/renal failure
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Signs and symptoms of hypercalcemia:
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lethargy, weakness, depression, confusion, paresthesia, stupor, nausea and vomiting, fractures, flank pain (renal stone formation), ECG alterations
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What are some adverse reactions from isoniazid?
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hepatic enzyme elevation, hepatitis, and drug interactions resulting in increased dilantin and antabuse levels
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What do you monitor with isoniazid?
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hepatic enzymes
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What do you give with INH?
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Pyridoxine (Vitamin B6) to prevent peripheral neuropathy and CNS effects
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What is an adverse reaction of rifampin?
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hepatitis
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what do you monitor with rifampin?
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CBC, platelets, and hepatic enzymes
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What are some drug interactions with rifampin?
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methadone, birth control (makes completely ineffective) and many others
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What does rifampin do to body fluids?
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turn them orange
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What turns your body fluids orange?
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rifampin or rifabutin
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what may permanently discolor soft contact lenses?
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rifampin or rifabutin
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What is an adverse reaction with rifabutin?
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hepatitis
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What do you monitor with rifabutin?
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CBC, platelets, and hepatic enzymes
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What does Rifabutin do to drugs?
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reduces their levels (such as PIs, NNTRIs, methadone, dapsone, ketoconazole, hormonal contraceptives, etc)
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What are some adverse reactions with pyrazinamide?
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hepatitis, rash, GI upset
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What are some things to monitor while on pyrazinamide?
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uric acid and hepatic enzymes
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What is an adverse reaction with ethambutol?
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optic neuritis
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What are some things to monitor with ethambutol?
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visual acuity and color vision (usually red/green)
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What are some adverse reactions with streptomycin?
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ototoxicity (hearing loss or vestibular dysfunction) and renal toxicity
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What do you monitor with streptomycin?
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hearing and renal function tests
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How do you give streptomycin?
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IM only
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