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186 Cards in this Set

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What are the 4 A's of schizophrenia?
- Affect
- Autism
- Ambivalence
- Associations-loose (LOA)
What is schizophrenia?
It's a brain disorder, a psychotic thought disorder. It's a group of disorders marked by severely impaired thinking, emotions, speech, and behaviors.
What's the etiology of schizophrenia?
It's not a single factor or etiology. It's a combination of biologic, psychoanalytical, developmental factors, psychosocial, and environmental factors.
What are some biological factors?
- Genetics
- Stress-Diathesis model
- Dopamine
- Neuroanatomic abnormalities
Genetics: genetic theory of risk
Vulnerability to schizophrenia is related to genetic factors.
What's the stress-diathesis model?
- Complications during pregnancy could possibly increase the risk for schizophrenia.
- More than 95% of persons who experience these factors do NOT develop the disorder:
1. Viral infection during the 20th to 30th weeks of pregnancy.
2. Incompatibility of the Rh factor
3. Anemia
4. Maternal preeclampsia
What is the function of dopamine?
- Regulates movement and coordination
- Affects emotions: mood, affect, thoughts, and motor behavior
- Influences voluntary decision making ability
- Necessary for smooth motor movements and clear thought processes
- Excess dopamine is believed to cause symptoms of psychosis disrupting cognition and thought
What neuroanatomic abnornalities are found in schizophrenics?
- Ventricles enlarged
- Decrease in cerebral and intracranial size
- Decreased brain activity
- Loss of gray matter as exhibited by decrease in frontal lobe size
Anatomical changes: significant loss of brain gray matter
- Individuals with schizophrenia , including those who have never been treated , have a reduced volume of gray matter in the brain, especially in the temporal and frontal lobes over a five year period.
- Pts with the worst brain tissue loss also had the worst symptoms, which included hallucinations, delusions, bizarre and psychotic thoughts, hearing voices, a depression.
What are the 4 phases of schizophrenia?
Phase 1: schizoid personality (premorbid phase)
Phase 2: Prodromal phase
Phase 3: Schizophrenia psychotic phase
Phase 4: Residual phase
Phase 1: Premorbid/schizoid
These are features prior to the disease:
- Indifferent to social relationships
- Limited range of emotional experience and expression
- Do not enjoy close relationships; prefer to be alone
- Appear to be cold/aloof
- About 2/3 of people with schizoid personality go on to develop symptoms in the active phase of the disorder.
Phase 2: Prodromal Phase
- Social withdrawal
- Impairment in role functioning
- Peculiar/eccentric behavior
- Neglect of personal hygiene or grooming
- Blunted/inappropriate affect
- Disturbance in communication
- Bizarre ideas
- Unusual perceptual experiences
- Lack of initiative, interests,or energy
- Length of phase variable; may last for years before deteriorating to the schizophrenic state
Phase 3: Schizophrenia psychotic phase
Psychotic symptoms are present. This is the active phase of the disorder. There are 3 stages: acute, recovery/maintenance, and stable.
Acute Stage
Florid positive and negative symptoms
Recovery/Maintenance Stage
Symptoms present but less severe. Need supervision to take care of self.
Stable stage
Symptoms in remission or in milder form. Live independently in the community.
Phase 4: Residual phase
- Follows an active phase of the illness.
- Symptoms similar to prodromal phase with flat affect and impairment in role functioning
- Schizophrenia characterized by periods of remission and exacerbation.
Diagnostic criteria for the active psychotic phase of schizophrenia
2 or more of the following during one month for a significant amount of time:
- Delusions
- Hallucinations
- Disorganized speech; loose associations (topic to topic without transition)
- Grossly disorganized behavior; catatonic; waxy flexibility, aggressive including sexual, depression, anxiety
- Negative symptoms
How do negative symptoms respond to treatment?
Poorly
What are some negative symptoms?
- Affective flattening
- Alogia
- Avolition/Apathy
- Anhedonia
- Ambivalence
- Social isolation
What is affective flattening?
Unchanging facial expression, poor eye contact, reduced body language, inappropriate affect, diminished emotional expression.
What is alogia?
(Poverty of speech) Brief empty responses, decreased fluency and content of speech
What is avolition/apathy?
Inability to initiate goal-directed activity, little interest in work or social activities, impaired grooming/hygiene.
What is anhedonia?
Absence of pleasure in social activities, diminished intimacy/sexual interest
What is ambivalence?
Indecisiveness; cannot make a decision. This can cause a severe increase in anxiety.
Define hallucination
A misinterpretation of reality in the abscense of any stimulus.
Define illusion
Misinterpretation of reality with the presence of a stimulus.
What is a delusion?
A false fixed belief
What symptoms of schizophrenia respond better to treatment?
The positive symptoms.
What are some positive signs of schizophrenia?
- Delusion
- Hallucinations
- Disorganized behavior
- Disorganized thinking/speech
Positive Signs: Delusion
- Persecution
- Grandeur
- Reference (Everyone/thing are talking to them; it's about them)
- Control (Someone has power over them; being controlled)
- Somatic (having to be about the body)
Positive Signs: Disorganized Behavior
- Bizarre dress and behavior
- Disheveled appearance
- Restless, agitated, sexual behavior
- Waxy flexibility
- Posturing
- Pacing and rocking
- Echopraxia (purposely imitates movements made by others
Positive Signs: Disorganized thinking/speech
- Loose associations
- Concrete thinking
- Circumstantiality (unable to get to the point)
- Clang associations
- Word salad
- Mutism
- Perseveration
- Echolalia
- Thought blocking
- Ego boundaries
- Tangentiality (never get to the point)
- Neologisms
What are the 5 major subtypes of schizophrenia?
- Paranoid
- Disorganized (formerly hebephrenic)
- Catatonic
- Undifferentiated
- Residual
Paranoid Schizophrenia
Pts have paranoid delusions, command hallucinations, and persecution. They function at a higher level than other subtypes but at risk for suicidal behavior and violent behaviors under the influence of their delusions.
Disorganized Schizophrenia
This is the most severe form. Key features are disorganized thinking, speech, and behavior. Flat or inappropriate affect. Act silly or withdraw socially to an extreme. Unable to dress self. Hallucinations/delusions more fragmented. Positive symptoms: word salad, neologisms, echolalia, echopraxia.
Catatonic Schizophrenia
n
Undifferentiated Schizophrenia
n
Residual Schizophrenia
m
What is COPD?
It's a broad term used to describe conditions characterized by a chronic obstruction to airflow. Pts have difficulty moving air in and out of the lungs.
What is chronic bronchitis? What are they called?
It's a clinical condition in which pts produce excessive mucus. They are called Blue Bloaters.
What is emphysema?
Permanently overextended air spaces that destroy alveolar walls and lung tissue. They are called Pink Puffers. They usually get a barrel chest.
What is asthma?
It's a chronic inflammatory disorder of the airways that is characterized by episodic exacerbations of acute inflammation.
What do asthma attacks cause in the body?
The physical changes lead to cough, edema, and constriction of airways.
In asthma the airways are in spasm. What does this cause?
Wheezing
When is a peak expiratory flow rate (PEFR) considered an emergency?
Less than 50-60% or red zone.
What should be done if an asthmatic's signs and symptoms don't reverse within 30 minutes?
Medical attention should be obtained at once.
What are the rescue drugs for asthma?
- Albuterol Sulfate (Ventalin, Proventil) nebulizer
- Metaproterenol Sulfate (Alupent)

Both drugs act within 10 minutes and last for 4-6 hours.
When is theophylline used with asthma?
It's considered a third line drug as it may cause cardiac arrythmias. It relaxes smooth muscle. Too rapid admin can cause severe hypotension, premature ventricular contractions, and cardiac arrest.

The level should be 10-20.
Nursing interventions for asthma?
Breathing exercises:
- diaphragmatic breathing
- inspiratory hold
- pursed lip breathing
incentive spirometry
Position: semi-fowler's to high, orthopneic position, monitor HR, ABGs, breath sounds
What's atelectasis?
The collapse of an alveoli or a lobule of lung tissue.
What are some common causes of atelectasis?
- immobility
- inhalation of anesthesia
What are the primary nursing interventions for atelectasis?
- Prevention
- good pulmonary regime (deep breathing, coughing, reposition
What is pulmonary edema? What is it considered?
It's the abnormal accumulation of fluid in the interstitial and alveolar spaces of lung tissue. It's a medical emergency.
What may result from or follow radiation therapy for breast or lung cancer?
Radiation pneumonitis
What are some risk factors for pneumonia?
* elderly
- decreased immune system
- underlying resp disease
- nutritional deficiences
- immune disorders
- ETOH abuse
* Neuro difficulties: no gag or swallow reflex. Aspiration is a major factor here.
* Pts who are NPO
What is a common cause of nosocomial pneumonia?
Pseudomonas
What are severe cases of fungal infections treated with?
Amphotericin B
What results in arterial hypoxemia?
The shunting of blood from the right to left side of the heart. This is because of consolidation.

Increased breath sounds are usually heard.
What are some clinical manifestations of pneumonia?
- An abrupt onset of fever and shaking chills, can rise to 101-105.
- Stabbing chest pain aggravated by breathing and coughing
- Tachypnea (RR 25-45)
What are some symptoms of pneumonia that present in the elderly?
Anorexia, weakness, lethargy, confusion, and a rapid resp rate.

Temp is not reliable in older persons.
Diagnostic eval for pneumonia
- History, recent URI
- chest x-ray
- blood culture
- sputum exam
What is the leading cause of cancer death in the US?
Lung cancer
What causes lung cancer 80% of the time?
Smoking
Risk factors for lung cancer
- smoking; determined by pack year history
- pollutants
- second hand smoke
- Env. pollutants
- Radon
- genetics
- diets low in fruits and veggies
What is radon?
A colorless, odorless gas formed in soil and rocks. Can seep into homes from ground rock.
How does lung cancer manifest in COPD patients?
As a change in the nature of the cough.
What symptoms are most prevalent with lung cancer?
- Cough 75% of the time
- Hemoptysis noted 50% of the time.
What is superior vena cava syndrome?
It occurs when a tumor presses on the superior vena cava impeding venous return from the head, neck, arm, and upper torso. It's a medical emergency.
What does a thoracentesis do? How much is removed?
It may relieve dyspnea. A liter or more of fluid may accumulate in the pleural space. Lab exam of fluid.
What must a person be placed on after a bronchoscopy?
- NPO until return of the gag reflex
- semi fowler's position
What is a mediastinoscopy?
It's an incision made into the mediastinum to determine the extent of lung cancer. Done under general anesthesia in OR.
What are some toxic effects of radiation therapy?
They include:
- esophagitis
- pneumonitis
- dysphagia
- anemia
Pulmonary (lung) function studies
Especially lung volume and vital capacity are done to determine whether the contemplated resection will leave sufficient lung tissue.
What does a thoracentesis do? How much is removed?
It may relieve dyspnea. A liter or more of fluid may accumulate in the pleural space. Lab exam of fluid.
What must a person be placed on after a bronchoscopy?
- NPO until return of the gag reflex
- semi fowler's position
What is a mediastinoscopy?
It's an incision made into the mediastinum to determine the extent of lung cancer. Done under general anesthesia in OR.
What are some toxic effects of radiation therpay?
They include:
- esophagitis
- pneumonitis
- dysphagia
- anemia
Pulmonary (lung) function studies
Especially lung volume and vital capacity are done to determine whether the contemplated resection will leave sufficient lung tissue.
How is TB transmitted?
By droplet or airborne
What is a pneumonectomy?
The removal of an entire lung.
What is involved in the care of a pt following a pneumonectomy?
- pt may lie on back or on operated side only.
- IV fluids are monitored carefully to prevent fluid volume overload.
Who are high risk people for TB?
- people who have been previously infected
- crowded living conditions
- low income
- substandard housing
- newly arrived immigrants
- homeless street people
- HIV infection
What are some specific signs of TB?
- Cough
- hemoptysis
- night sweats
- low grade fever in the late afternoon and evening
- loss of appetite
- wt loss
- fatigue/weakness
TB Infection
Means the bacilli has established itself in the body, and the organism can be detected by a positive skin test.
TB Disease
The bacilli can be isolated from secretions or lung tissue, and chest x-rays or the clinical pathology present supports the diagnosis.
What test screens people at risk for TBC?
A skin test with purified protein derivative (PPD)
Mantoux Test
Tubercle bacillus extract in the form of PPD is injected intradermally. The test is read 48-72 hours later.
What does a Mantoux test reaction indicate?
It indicates that a pt has been exposed to myobacterium tuberculosis recently or in the past. It does not mean that active disease is present in the body.
What is a significant result to the Mantoux test?
An area of 10mm or more is significant. Doubtful reactions measure 5-9mm. Less than 5mm is not significant.
What is the AFB test and how is it done?
Acid fast test stain can identify the acid fast bacillus. The culture can take up to 8 weeks. 3 early AM sputum cultures are obtained. 3 positive results indicate the need to treat the patient.
How is TB prevented?
- limit contact with the person
- isolate pts until 3 neg AFBs
- wear an N95 mask while caring for the pt.
- remind pt to cover face when coughing.
- secretions should be expectorated into tissues
- if pt leaves the room they must wear a mask
- report TB cases to public health dept
Drug therapy for TB
- Isoniazid (INH) with vitamin B6
- BCG Vaccine (Bacille Calmette-Guerin)
What does Isoniazid (INH) do and who receives this treatment?
It helps to prevent the development of the disease.

Recommended individuals are:
- recent converters are treated for 1 year (hepatitis can occur and limit ETOH intake)
- families and close friends
- young children with positive skin tests
- TB positive persons under 35 with abnormal x-rays
- TB positive hosts with lowered resistance to infection from steroids, cancer, DB, silicosa, gast
When is the BCG vaccine used?
It's used on individuals exposed to TB to prevent initial infection to the disease.
What is the dosage for INH? What adverse signs should be reported?
5-10mg/kg/day up to 300mg.

S/E are peripheral neuritis and hepatitis.

Teach pt to report signs of numbness and tingling:
- Admin B6 to prevent neuritis
- take on an empty stomach
- monitor liver enzymes
What's the doage and S/E to Streptomycin?
15-20 mg/kg

- damage to 8th cranial nerve
- renal toxic
- obtain baseline BUB, CR, and hearing tests prior to admin
- pt should report any dizziness, vertigo or tinnitus
What is the dosage for Rifampin? S/S of S/Es?
- Body fluid turns orange
- heptitis
- nephrotoxic, ototoxic
- admin before meals
- use with caution in hepatic pts
- do not use with protease inhibitors
What are the transmission-based isolation categories?
- contact precautions
- droplet precautions
- airborne precautions (N95 mask, neg. pressure room)
What does the disruption of the pleural space cause?
It causes loss of negative intrapleural pressure, allowing partial or total lung collapse.
What are the purposes of closed chest drainage post thoracotomy?
- allows the drainage of air and serosanguinous fluid from the pleural space and prevents their reflux.
- helps re-expand the remaining lung tissue by re-establishing normal neg. pressure in the pleural space.
- prevents a mediastinal shift and lung collapse by equalizing pressures on both sides of the thoracic cavity.
What items do all chest drainage systems use?
They all use a collection chamber and a water seal.
What is the purpose of the collection chamber?
It allows you to observe the amount and type of fluid draining.
What is the purpose of the water seal?
It stops air from entering the pleural space by way of the drainage tube when the pt inhales. It acts as a one-way valve.
When does the water seal bubble a lot?
With an air leak.
What is a symptom that should prompt smokers to seek medical attention?
A change in the nature and frequency of a cough.
Many pts with lung cancer do not see the doctor until they develop what symptom?
Hemoptysis
What is the primary purpose for conducting a variety of pulmonary function tests?
To evaluate the functioning pulmonary reserve.
What does a forced expiratory volume of 62% indicate?
The patient has obstructive pulmonary disease.
What type of ABGs reflect an obstructive disease?
Decreased PO2 and increased PCO2.
What does smoking damage usually lead to?
COPD
What is a normal initial response to a diagnosis of lung cancer?
denial
Post-bronchoscopy, what potential complications would the nurse be concerned with?
1. aspiration
2. tracheal/laryngeal edema (potential for airway obstruction)
In obstructive resp disease what kind of breath sounds would the nurse expect?
- rhonchi
- rales - CHF
With theophyline what concepts should the nurse be aware of?
- smokers as contrasted to nonsmokers generally require closer spacing of dosage.
- smoking increases the metabolism of the drug.
What side effect is significant with theophyline?
tachycardia
What is the therapeutic range for theophyline?
15-20 ug/dl
If the theophyline level of a patient is 15ug/dl and the pt doesn't complain of any side effects, what is the most appropriate action for the nurse to take?
Continue therapy as ordered.
Detection of an air leak related to the raw surface areas of the lung is best determined by what?
Noting the occurrence of intermittent bubbling in the underwater seal unit.
If air were unable to escape immediately post-op due to obstruction of the chest drainage system, either bottles or pleuravac, the patient would be most at risk for what?
A pneumothorax
An obstruction of chest tube drainage system would be reflected in what observation?
An absence of fluctuations in the underwater seal bottle or chest tube. It may also indicate complete re-expansion of the lung.
What is the degree of suction in a pleuravac determined by?
Suction control chamber level of water.
When is the most appropriate time for chest physiotherapy to help prevent atelectasis and post-op pneumonia?
Immediately post-op in the recovery room: gentle chest pt; observe pt for untoward effects such as increased HR or resp rate.
Patient has increased cough on top of smokers cough and increase sputum production. Patient noted some hemoptysis and an aching sensation over left chest wall. He has also noted some hoarseness and a 20lb weight loss. What could the hoarseness be secondary to?
Tumor compression of recurrent laryngeal nerve
What is the primary purpose of chest, bone, liver , and brain scans?
1. to provide information concerning the functional status of those organs.
2. detect evidence of metastatic disease.

Provides baseline prior to chemo.
What is the aim of weaning a pneumonectomy patient from a mechanical ventilator as soon as possible?
Effective positive pressure ventilation on ligated bronchial stump, with possible rupture. (Decreases pressure on the bronchal suture line)
If a chest tube is in place post-operatively, what will it most likely be? (pneumonectomy)
Connect to one bottle underwater seal drainage and clamped.
What is a pneumonectomy more prone to have happen?
1. A mediastinal shift to the operated side.
2. A mediastinal shift to the unoperated side.

May be either side.
Post operatively, how should a patient be placed? In what position?
Lateral with the operated side down.
Post operatively the patient becomes restless, anxious, dyspnic, and tachycardic. Neck veins are distended and a significant drop in b/p is noted. What would the nurse suspect?
A mediastinal shift.
What should the nurse do immediately if a mediastinal shift is suspected?
1. Unclamp the chest tube for several breaths.
2. Call the MD

Priority setting - unclamp first
Post-op fluid restriction is an important consideration for the pneumonectomy patient because of what?
Changes in pulmonary blood flow.
Arrhythmias may be seen in the post-op care of the pneumonectomy patient. What drugs may be used to treat these dysrhythmias?
- Digitalis
- Lidocaine
The aim of O2 therapy is to have the patient inhale the least O2 concentration necessary to maintain what?
Reasonable O2 sat and adequate PO2
What is the primary concern with the patient receiving chemo?
- Bone marrow suppression
- infection
What is radiation therapy aimed at?
- Cure
- Palliation
- Comfort

May be any pre or post-op to reduce the bulky tumor mass. Post-op to prevent spread to nodes.
What is flail chest caused by?
Fractures of 3 or more consecutive ribs.
What type of movement does flail chest cause?
Paradoxical chest movement
In a patient with pleural effusion you could expect which changes in breath sounds?
Diminished on the same side as the effusion.
What type of breath sounds does pleural inflammation cause?
Grating sounds heard on both inspiration and expiration.
What type of breath sounds are noted with fluid and consolidate?
Bronchial breath sounds
What is the desired effect of the positive pressure breathing with mechanical ventilation for the patient with flail chest?
It stabilizes the chest wall and improves ventilation and perfusion.
Why are chest tubes inserted?
1. To drain the pleural space
2. Facilitate intrapleural pressure
3. Re-expand the collapsed lung
Why is underwater seal drainage systems used with the chest tubes?
1. It permits drainage of air and fluid from the pleural space.
2. It prevents back flow of air and drainage.
Describe the fluctuation that is expected in the water seal bottle
The water seal chamber should rise with inspiration and fall with expiration. The water seal reflects the status of the pleural space. No movement indicates that the lung has re-expanded or a kink in the tubing.
In a 2 bottle water seal drainage system: What is the purpose of the vent?
It releases air to the atmosphere and decreases the pressure in the bottle.
The wall suction dial does not control the amount of suction applied to the patient. What is suction determined by?
The submerged depth of the rod in the suction bottle.
Air escaping from the pleural space (air leak from the patient) is manifested as what?
Intermittent bubbling in the water seal bottle.

Bubbling is related to the resp rate. Escape on inspiration.
Air entering the system from a loose connection is manifested as what?
Continuous bubbling in the water seal bottle.
The nurse is going to ambulate a patient who has underwater seal drainage with wall suction. It would be important for the nurse to do what first?
Disconnect the wall suction.
When getting the patient back to bed the water seal bottle is broken. What should be the first nursing action?
To submerge the tube in sterile water.

Two kelly clamps are usually placed at the bedside. The best action is to submerge the chest tube in water, next best is to clamp it. The complication with clamping is a tension pneumothorax.
Identify 8 nurging resp. when caring for a patient with chest tubes attached to underwater seal drainage with suction.
1. Check for patency (kinks)
2. Check for air leaks (tape the connections)
3. Maintain dependency of the tubes. Clamps and sterile water at bedside.
4. Check the amount of drainage. Measure every hour for fresh post-op.
5. Occlusive dressing - sterile technique, changed every day.
6. Check suction. Add sterile water PRN.
7. Ascultate breath sounds (priority)
8. Assess for subcutaneous emphysemaor swelling of tissue.
List the criteria that suggest tubes may be safely removed from patient.
1. Re-expansion of the lung by X-ray.
2. Absense of air leaks.
3. Drainage less than 100mL in 24 hours.
What are the 2 methods for calculating the HR?
#1 Count the number of small boxes between the 2 R waves, then divide that number into 1500 (good for regular rhythms).

#2 In a six second strip multiply the number of R waves by 10.
A-Fib
It occurs when the atria depolarize and in irregular uncontrolled manner. There is no concerted contraction of the atria. With A-Fib it's possible to get a clot because the blood never fully leaves the the atria. Usually give digitalis for this.
A-Flutter
These are called F waves. They are larger than normal P waves and they have a saw-toothed waveform. Not every atrial flutter wave results in a QRS complex. CO decreases because ventricles do not sufficiently fill.
PVCs
The beat originates in the ventricles. The beat occurs normally usually with a pause. There's no wave before the QRS. The T wave is inverted.
Catatonic Schizophrenia
Characterized by disturbances of measurement: Waxy flexibility, rigidity, stupor agitation, bizarre posturing. Repetitive imitations of novements or speech of others - echopraxia, echolalia, mutism, rigid posture.
Undifferentiated type of Schizophrenia
- Characteristics: + and - symptoms
2. Don't meet the criteria specified by other types.
-Flat affect and pooor eye contact are characteristic
Residual type of Schizophrenia
- Persons have had at least one acute schizo episode.
- Don't have strong + symptoms: withdrawal from others
- Have neg. symptoms; withdrawn from others; social isolation.
- May be the indication that the disorder has not resolved completely
Schizophreniform disorder
- Usually occurs during prodromal just prior to active phase
- Features are the same as schizophrenia, BUT the duration of symptoms at least one month, less than 6 months (becomes schizophrenia if persists beyond 6 moths)
- 2/3 go on to full disorder
Schizoaffective disorder
- Manifested by schizophrenic behaviors with strong symptoms of mood disorders: mania or depression
- Depressed with psychomotor retardation and suicide ideation

- exhibit bizarre delusions, hallucinations, incoherent speech, catatonic behavior, blunted affect, inappropriate affect
- Prognosis is better than for schizophrenia but worse than mood disorders
Psych assessment includes what 8 areas of functioning?
- Thought content
- Thought form
- Perception
- Affect
- Sense of self
- Volitions (inability to initiate goal-directed activity)
- Impaired interpersonal functioning
- Psychomotor behavior
What are the 4 Ss of schizophrenia?
1. Stimulation
2. Structure
3. Socialization
4. Support
What are the signs of lung cancer?
- A cough is noted 75% of the time
- Hemoptysis is noted 50% of the time
- A COPD patient might notice a change in the character of their cough
- Pain on inspiration
- Shoulder pain
- Fatigue, finger clubbing
What are some late signs of lung cancer?
Anorexia, weakness, wt loss, anemia
What's a thoracotomy?
A surgical opening into the thoracic cavity. Typically done with a pneumonectomy. Usually no chest tubes. The space fills with serosanguinous blood.
Pneumonectomy: Position, I&O, Tx
Position with incision down or on back.

IV fluids are monitored carefully to prevent fluid volume overload. Any increase of rales, pulse, b/p, and dyspnea could indicate this.

Treatment includes diuretics, digitalization, and d/c IV fluids.
What's the drug therapy for TB?
INH with vit B6 helps prevent the dev. of the disease.

BCG vaccine used on those exposed to TB to prevent initial infection of the disease.
INH dosage, side effects, labs to watch
5-10mg/kg/day up to 300mg. Side effects are peripheral neuritis and hepatitis. Report signs of numbness and tingling. Admin B6 to prevent neuritis. Take on empty stomach. Monitor liver enzymes.
Rifampin (for TB): doasge side effects, nsg indications
10-20mg/kg/day. Side effects include turning body fluids orange, hepatitis, nephrotoxic, ototoxic. Admin before meals, use with caution with hepatic patients, don't use with protease inhib.
Flu shot and the elderly
Nurse should advocate the use of inactivated influenza vaccination in all pts >50 years of age.
- Give in the fall
- Those that are allergic to eggs should receive it.
How do you assess an asthma patient?
The characteristic clinical manifestations of asthma are: wheezing, cough, dyspnea, and chest tightness after exposure to a precipitating factor or trigger.

Normally bronchioles constrict during expiration.

If patient presents with wheezing then it goes away, it could be a medical emergency.
How is bronchitis diagnosed?
Persistent cough followed by an acute upper airway infection.

Fever, headache, malaise, and SOB upon exertion.

Physical exam may reveal mildly elevated temp, pulse, and resp rate with either normal breath sounds or rhonchi and expiratory wheezing.

Chest x-rays can tell if pneumonia or bronchitis.
What is Inderal used for? What classification is it?
It's used with chronic stable angina. It's a beta blocker. Beta blockers decrease myocardial contractility, HR, SVR, and b/p, all of which reduce the myocardial O2 demand.
What is Lasix and what does it do?
Lasix is a loop diuretic. It decreases the intravascular volume. By decreasing venous return to the LV and reducing preload, the overfilled LV may contract more efficiently and improve CO.
What is Cor Pulmonale? What usually precedes it? What causes it? What is done for it?
It's the enlargement of the right venticle secondary to diseases of the lung, thorax, or pulmonary circulation.

HTN is usually a pre-existing condition.

The most common cause is COPD. Polycythemia is often present. Can be triggered by an acute resp tract infection.

Give: O2, correct acid/base balance, diuretics and a low sodium diet, digoxin or theophylline.
Alpha 1 - Antitrypsin (AAT) deficiency
It's the genetic risk factor that leads to COPD. It's an autosomal recessive disorder. It's produced by the liver and found in the lungs. Severe deficiencies leads to premature bullous emphysema.
How do the lungs change with age?
Some degree of emphysema is common in the lungs of older people. Aging changes the lung structure, thoracic cage, and the resp muscles.

There is a gradual loss of the elastic recoil of the lung. Lungs become more rounded and smaller. There's also a decrease in the number of functioning alveoli.
What meds are given for chronic stable angina?
- Short acting nitrates (nitro) are 1st-line therapy.
- Beta blockers are the preferred drugs for the management of chronic stable angina. Ex: Inderal (or meds ending in -olol)
What is pulmonary edema? What's the most common cause? What's the treatment?
It's an abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs. It's a medical emergency.

The most common cause is left-sided heart failure.

Treatment includes diuretics, O2 therapy, vasodilators, and possibly inotropic agents.
QRS interval
The QRS interval is measured from the beginning to the end of the QRS complex. It represents the time taken for depolarization of both ventricles.
A-Fib
Characterized by a total disorganization of atrial electrical activity due to multiple ectopic foci resuilting in loss of effective atrial contraction.

Calcium channel blockers (Diltiazem), Beta blockers (Metoprolol), and digoxin is given.
What are PVCs? What can they indicate? What's the treatment?
They are premature venticular contractions originating in an ectopic focus in the ventricles.

3 or more consecutive PVCs could indicate V-Tach.

Beta blockers and lidocaine are given.
What is V-fib? What's the treatment?
It's a severe derangement of the heart rhythm. The ventricle is simply "quivering" and no effective contractions are happening, and consequently no CO occurs.

Associated with acute MI and myocardial ischemia. HR is not measurable. If not treated the patient will die.

Treatment consists of immediate CPR with ACLS measures with the use of defibrillation.
Heart failure
Characterized by ventricular dysfunction, reduced exercise tolerance, diminished QOL, and shortened life expectancy.

Left versus right. Pulmonary edema occurs with left sided failure.

Symptoms include: fatigue dyspnea, tachycardia, edema, nocturia, skin changes, behavioral changes, chest pain, wt changes.