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105 Cards in this Set
- Front
- Back
what is the definition of Lupus Erythematosus (SLE)
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chronic, systemic, inflammatory connective tissue disease which involves multiple body systems. maybe autoimmune, with hormonal/genetic componets
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what is SLE characterized by
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remission and exacerbations
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what are the 3 forms of lupus erythematosus
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SLE, discoid, an drug induced
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what is the pathophysiology of LE
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widespread destruction of collage in body- can lead to organ destruction and death. estrogen inhibits suppressor t cell function leading to abnormal immune response
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what are the incidences of LE
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affects more women, african americans, latino, asian and native americans more than caucasians. 30-50 is most common age
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what are the signs and symptoms of LE
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arthritis, photosensitivity, flat or raised butterfly rash, discoid rash, sustained fatigue, alopecia, anemia/leukopenia, unexplained low grade fever, raynaud's phenomenon.
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what is the most common symptom in LE
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arthritis- arthralgia & myalgia 90% of people
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what is the most recognized symptom of LE
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butterfly rash, occurs in 50% of people
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where does discoid rash usually occur
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scalp neck ears head, raised disk shaped patches with scaling plaques
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what are the symptoms that indicate organ involvement in LE
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renal impairment (1/2 cases) - proteinuria, casts, & RBC in urine
40-50% suffer cardiac & pulmonary effects - pericarditis, pleurisy, pleural rubs CNS- seizures, cognitive changes, migraine |
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how is pt diagnosed with LE
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must have 4 of the 11 criteria established by American Rheumatism Assoc
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what are the 11 criteria for LE
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malar rash, discoid rash, photosensitivity, mucus membrane ulcers, arthritis, pleuritis/pericarditis, urine casts/protein, seizures, decreased RBC/WBC, abnormal immune tests, abnormal antinuclear antibody
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what drugs can cause lupus like symptoms
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pronestyl, dilantin, and isoniazid (INH)
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what are the medical interventions for LE
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anti-inflammatories, antimalaria (helps with arthritis, steroids, cytotoxic drugs
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what do the steroids do
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suppress tissue inflammation reducing damage to organs TAPER DRUG
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what to cytotoxic drugs do
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suppress hyperactive immune response
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what are the nursing interventions for LE
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psychosocial support.
pain management weekly skin inspections - sun screen prevent fatigue, joint pain (HEAT THERAPY), deterioration balanced diet aware of signs of exacerbation health maintenance/promotion |
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complications of LE
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peripheral vascular disease & loss of limbs
hypertension stroke renal failure congestive heart failure |
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what is death usually related to in LE
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renal failure or infections
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what is Scleroderma
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chronic disorder - excessive connective tissue causes hardening of skin (maybe organs too)
no know cause autoimmune |
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signs and symptoms of scleroderma
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changes in face and fingers
gradual hardening of skin and swelling of distal extremities joint involvement raynaud's dysphagia |
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what are the specific skin changes in Scleroderma
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edema, pallor, firm skin, slightly pigmented, fixed to underlying tissues.
face is taut shiny and masklike |
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classification of scleroderma
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systemic (involves organs)
localized (small patches on skin) |
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how is pt diagnosed with scleroderma
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no single diagnostic test - ANA is most sensitive, increased ESR, anemia
BEST TEST IS SKIN BIOPSY of LESION |
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complications of scleroderma
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heart and lung: pneumonia, R side heart fail, pericarditis, dysrythmias
ABD: diarrhea, constipation, cramping Renal: proteinuria, hematura, failure |
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what drugs are used to treat the s/s of scleroderma
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steriods, immunosuppressants, antacids & histamine receport antagonists (GI symptoms), salicylates and analgesics for joint pain
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how does physical therapy help with scleroderma
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helps with muscle contractures
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what is Fibromyalgia
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a rheumatic syndrom, causes musculoskeletal pain, spasms, stiffness, tenderness and sleep disturbances
90% women |
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what may cause Fibromyalgia
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sleep disorders, depression, infections, maybe complication of hypothyroidism, RA or sleep apnea
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what are s/s of Fibromyalgia
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similar to chronic fatigue syndrome but with chronic achy muscle pains.
pain can be localized or throughout |
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how is pt diagnosed with Fibromyalgia
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Hx and physical assessment, rule out other causes
must have pain that is present for at least 3 months and at 11 of the 18 tender points on palpation |
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what is used to treat Fibromyalgia
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NSAID, amitriptyline (antidepressant), muscle relaxants
healthy diet and lifestyle |
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what is a restrictive lung disease
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a limitation to full expansion of the lungs, lung volume diminishes as a result of decreased lung or thoracic compliance
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examples of restrictive lung disease
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cystic fibrosis and asthma
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what is obstructive airway disease
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airway obstruction that limits airflow on expiration. the lungs can't move air out
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what is COPD
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dead space increases in lungs, trapping carbon dioxide,
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what is the incidence of COPD
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more and 1 out of 10 suffers from asthma, chronic bronchitis, and emphysema
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what is the etiology of COPD
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cigarettes, pollution, allergens, and genetics.
cigarettes most common 80-90% |
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what type of disease is chronic bronchitis
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airway disease
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what type of disease is emphysema
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alveolar disease
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definition of bronchitis
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hypertrophy of bronchial mucous glands and production on mucoid sputum that is hard to cough up
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what is the hallmark symptom of chronic bronchitis
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daily productive cough lasting at least 3 months for 2 consecutive years
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what leads to airway obstruction & air trapping in chronic bronchitis
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excess mucus production, recurrent cough and inflammation
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why is infection susceptibility increased in chronic bronchitis
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the excess mucus production and impaired ciliary movement, inadequate clearing of secretions
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when does productive cough of chronic bronchitis usually occur
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on awakening.
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what are the assessment finds of chronic bronchitis
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coarse crackles, rhonchi and wheezing, SOB
venous congestion can produce hepatomegaly nail clubbing polycythemia |
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what does a pulmonary function test reveal in chronic bronchitis
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airflow limitation on expiration.
diminished vital capacity |
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what is emphysema characterized by
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destructive changes in alveolar walls and enlarged air spaces, lungs become distended due to loss of elastin. air is trapped into distal spaces
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signs and symptoms of emphysema
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dyspnea
little cough/sputum use of accessory muscles to breathe diminished breath sounds increased RR prolonged expiratory phase pursed lip breathing |
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why are most emphysema patients thin
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use calories to breath and their appetites are diminished bc they can't breathe
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what are the signs and symptoms of COPD
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barrel chest, hypoxemia, hypercapnia, difficulty breathing, LOC changes, N/V, flushed apperance, polycythemia, cyanosis, R ventricle failure
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what are signs of worsening COPD
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dyspnea on exertion, rales, rhonci
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what is usual ABG for COPD
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respiratory acidosis or comp resp acidosis
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how is COPD diagnosed
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chest xray, bronchoscopy
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what are the goals in COPD
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to improve ventilation, remove secretions, prevent complications and slow s/s
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what are home interventions for COPD
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quit smoking, breathing exercises, chest physiotherapy, nutritional support, increase fluids, oxygen therapy
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what medications are used for COPD
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bronchodialators, corticosteriods, expecorants
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what are the side effects for bronchodialators
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increased HR, irregular HR, anxiety, nervousness
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side effects for corticosteroids
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headache, hoarsness, depression, restlessness, cough, diarrhea, dry mouth, adrenal complications
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what is asthma
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chronic inflammatory disorder of airways where a stimulus causes airways to narrow. common in children
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what are common triggers for asthma
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exposure to allergens, exercise, cold, inhaled irritants, emotional stress
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signs and symptoms of asthma
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SOB, dyspnea, chest tightness, increased RR & HR, wheezing, coughing, anxiety, resp alkalosis, prolonged attack results in resp acidosis
lack of wheezing may mean worsening of disease |
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how is asthma diagnosed
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pulmonary function test, peak expiratory flow rate, ABG, and skin test
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what are the severity classifications of asthma
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intermittent - occasional flare ups
moderate persistent severe persistent |
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meds for intermittent asthma
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albuterol (SABA)
steroid inhalers |
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meds for moderate persistent asthma
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low to medium dose LABA - Formoterol
Corticosteriods Fluticasone/salmeterol Mast Cell stabilizers- cromoglicic acid leucotriene modifiers- montelukast |
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meds for severe persistent asthma
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high dose inhaled corticosteroids and LABA
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what is nursing care for asthma
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peak expiration flow rate
measure peak flow meter teach about zones on flow meter teach correct inhaler use teach importance of step wise approch to meds |
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what is used in asthma emergency
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SABA, steroids, epi, oxygen, IV, fluids
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preventative measures for asthma
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allergy testing
physical activity |
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what is the most common bacterial cause for pneumonia
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Streptococcus pneumonia
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what med is given to treat pneumonia bacteria
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Cephalosporin
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what are the symptoms of atypical pneumonia
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nonproductive cough, sore throat, headache, arthritis, myalgia, and Gi symptoms
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what is the mortality rate of hospital acquired pneumonia
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20-50% due to coexisting disease and high prevalence of gram negative bacteria resistant to antibiotics
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what bacterias are the most common cause of HAP
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Staph Aureus, Enterobacter, Klebsiella Pneumoniae and Escherichia Coli
Treated with broad spectrum antibiotics |
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S/S of pneumonia
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decrease breath sounds
craclkes rhonci tachypnea and dyspnea productive cough fever and increased WBC (look at neutrophils too) hypoxemia infiltrates on chest xray |
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what is the most common s/s in older adults
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confusion or irritability decreased LOC from hypoxia
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what are preventions for pneumonia
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1. Pneumococcal vaccine
2. teaching public |
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nursing interventions for pneumonia
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TC&DB Q2h
incentive spirometry early mobilization/ambulation possible bedrest to decrease cellular demand elevated head of bed and RT treatments oxygen increased fluid always collect sputum before meds |
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how is TB diagnosed
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Mantoux skin test
Chest x ray sterile sputum specimen |
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what are the predisposing/precipitation factors of TB
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overcrowded poorly ventilated dwellings
poor nutrition alcoholism inadequate treatment of previous TB preexisiting medical conditions that lower immunity |
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what is passive Tb
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virus is in body but person is not sick, the germ is inactive. person cannot spread TB but has 10% chance of developing it
medication is recommended |
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s/s of TB
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fatigue, malaise, anorexia, weight loss, low grade fever and night sweats, productive cough with productive mucopurulent, sputum, pleuritic chest pain, dyspnea and hemoptysis
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what are the first line medications for TB
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isoniazid with streptomycin for 6-12 months or more
B6 Pyridoxine Rifampin Pyrazinamide Ethambutol Streptomycin |
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side effects of isoniazid
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liver damage and GI troubles
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se of rifampin
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discolored urine, tears, sweat and sun sensitivity
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what are nursing interventions for TB
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teaching pts to cover mouth with coughing/sneezing
standard and airborne precautions nutritional support high protein and CHO nurse should wear fitted TB mask |
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home precautions for TB
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not contagious 2-3 consecutive weeks after meds but meds continued 6-12months
direct observation therapy anyone in contact needs to be tested active TB pt should wear mask cover mouth when coughing/sneezing |
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what is normal pH
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7.35-7.45
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normal PaCO2
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35-45 high is acidosis
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normal HCO3
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22-26 high is alkalosis
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normal SaO2
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95-100%
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what conditions increase O2 consumption
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fever, illness, heat, decreased Hgb, drugs, pneumonia, HF, lung trauma, increase HR
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how is acidosis or alkalosis compensated
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by lungs (very quick- hyper/hypoventilation)
by kidneys (slow) |
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what is resp acidosis
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lungs too much CO2, hypoventilation r/t drug od, chest trauma, pulmonary edema, airway obstruction, COPD, neuromuscular disease, asthma
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s/s of resp acidosis
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hypoventilation, restlessness, confusion, and tachycardia, decreased LOC
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what is resp alkalosis
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hyperventilation, not enough CO2 r/t anxiety, high altitude, pregnancy, fever, hypoxia, excessive tidal volume in ventilated patients and initial stages of many diseases
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s/s of resp alkalosis
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hyperventilation, light headedness, muscle cramps and spasms, paresthesia, and palpitations
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what is metabolic acidosis
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acid base imbalance occurring from problems outside lungs
pts kidneys can't remove excess H+ or they are losing HCO3- through GI track |
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what does K+ do in met acidosis
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serum potassium may increase to dangerous levels attempting to raise extracellular pH, body exchanges intracellular K+ for serum H+ increases K+ in bloodstream
increase serum K+ decrease serum H+ |
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what causes met acidosis
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diabetic ketoacidosis, severe diarrhea, renal fail, shock, sepsis, exercise and saliclate overdose
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s/s of met acidosis
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arrhythmias, hyperventilation, hypotension, lethargy, and coma
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what is metabolic alkalosis
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increased HCO3 or decrease in body acids without a change in PaCO2
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what causes met alkalosis
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loss of gastic secretions, prolonged vomiting, overuse of antacids, potassium wasting drugs
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s/s of met alkalosis
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arrhythmias, confusion, apathy, stupor, hypoventilation, attempting to decrease extracellular pH body exchanges intracellular H+ or serum K+
decrease serum K+ increase serum H+ |