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247 Cards in this Set
- Front
- Back
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Resonance
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Loud hollow
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Hyperresonance
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low booming over emphysema tis lungs
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Flatness
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heard over bone or large muscle
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Dullness
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Heard over medium pitch liver area
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Tympany
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High pitched drum like heard over the stomach
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Bronchiole sounds are heard where?
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Over the trachea and they have longer expiration sounds
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Bronchovesicular
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Heard over the main stem bronchus on both side and are even sounds
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Vesicular
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the lower sounds and are heard over the base of the lungs and are heard more during inspiration
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Fine Crackles
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Sounds like cracking hair
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Coarse crackles
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heard more toward base of lungs, and sound like bubbling
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Wheezes
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Sound high pitched and have a hissing quality
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Ronchi
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Lower pitched snoring quality coming from the bottom of the lungs
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Nasal cannula
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1-6L
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Room air = ?% O2
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21%
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Face Mask
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Delivers 30-60% O2
6-10L/min Short term therapy <12 hrs Effective for mouth breathers |
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non-rebreather mask
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Get the most O2 concentration, do not rebreathing exhaled air
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Rebreather mask
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Delivers high concentrations
6-15L/min ENSURE BAG IS INFLATED |
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Venturi mask
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Most precise O2 delivery
high flow rates 2-14L/min |
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3 cardiac problems with Oxygenation
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check pump (effectiveness)
check pipe (valves) check volume |
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Functions of oxygenation
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transportation
gas exchange transport nutrients remove wastes maintain blood pH |
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non-rebreather mask
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Get the most O2 concentration, do not rebreathing exhaled air
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Rebreather mask
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Delivers high concentrations
6-15L/min ENSURE BAG IS INFLATED |
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Venturi mask
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Most precise O2 delivery
high flow rates 2-14L/min |
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3 cardiac problems with Oxygenation
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check pump (effectiveness)
check pipe (valves) check volume |
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Functions of oxygenation
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transportation
gas exchange transport nutrients remove wastes maintain blood pH |
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Wheezes
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Sound high pitched and have a hissing quality
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Ronchi
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Lower pitched snoring quality coming from the bottom of the lungs
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Nasal cannula
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1-6L
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Room air = ?% O2
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21%
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Face Mask
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Delivers 30-60% O2
6-10L/min Short term therapy <12 hrs Effective for mouth breathers |
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non-rebreather mask
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Get the most O2 concentration, do not rebreathing exhaled air
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Rebreather mask
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Delivers high concentrations
6-15L/min ENSURE BAG IS INFLATED |
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Venturi mask
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Most precise O2 delivery
high flow rates 2-14L/min |
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3 cardiac problems with Oxygenation
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check pump (effectiveness)
check pipe (valves) check volume |
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Functions of oxygenation
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transportation
gas exchange transport nutrients remove wastes maintain blood pH |
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Upper airway made up of?
Functions? |
nose, pharynx, larynx, epiglottis
filters air, warms and humidifies |
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Lower airway made up of?
Functions? |
trachea, lungs, bronchioles, alveoli
Gas exchange @ alveolis, conduction of the air |
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ventilation
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mechanical act of air in and out
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respiration
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gas exchange in alveoli (diffusion)
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perfusion
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O2 to tissues via capillaries
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What makes us breathe
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imbalance of O2 and CO2 in medulla. When CO2 is increased it drives us to take a breath.
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Hypoxia
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Air Hunger
low O2 in the lungs (tissues) causes a decrease in hemoglobin |
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SEVERE response to Hypoxia
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cyanosis
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PaCO2
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partial CO2
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ABG normal
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35-45%
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tachycardia, dyspnea, tachypnea, and increased PaCO2 cool clammy skin are all signs of...
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early hypoxia
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bradycardia, increasing dyspnea and tachypnea, increased PaCO2 and Cyanosis are all signs of
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late hypoxia
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pulse pressure is
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difference between Systolic and diastolic
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Early hypoxia on vital signs
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rising systolic, falling diastolic, rising and bounding pulse, widening pulse pressure, rapid respirations
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Late hypoxia on viral signs
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falling blood pressure, falling shallow pulse, widened and narrowed pulse pressure, and slowed respirations
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Hemoptysis
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blood in the sputum
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PFT
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pulmonary function test
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physical assessment
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inspect
palpate percussion auscultation |
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Dangers of Oz therapy
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fire and pulmonary Oz toxicity
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Major Surgery
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to preserve life, remove/repair body part, maintain health
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Diagnostic surgery
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Make or confirm a diagnosis (ie. breast biopsy)
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Ablative surgery
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Remove a diseased body part (ie. appendectomy)
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Palliative surgery
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Reduce intensity of an illness, is not curative (ex.colonostomy)
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Reconstructive Surgery
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To restore function ro traumatized or malfunctive tissue (ie. skin gaft, plastic surgery)
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Transplantation surgery
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to replace organs or structures that are diseased or malfunctioning
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Perioperative nursing involves
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preoperative
intraoperative postoperative |
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Minor surgery
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elective, correct deformaties
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Elective surgery
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Delay of surgery has no ill effects, schedule in advance
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Urgent surgery
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needed within 24-48 hours, there is urgency
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Emergency surgery
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Most be done stat
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Constructive Surgery
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To restore function in congenital anomalies (ex. cleft palate)
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Surgical risk factors
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Age
Nutrition Obesity Immunocompetence Fluid and Electrolytes Pregnancy |
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Paralytic ileus
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Temporary bowel paralysis after surgery
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Post op complications
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hemorrhage
shock thrombophlebitis DVT / Pulmonary embolism Pneumonia Atelectasis |
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What test to test for a DVT?
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D-Dimer (a blood draw)
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How to physically check for a DVT
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compare both legs, check for swelling and heat/warmth
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How long to keep pt in bed after started on a blood thinner?
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24 hrs
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PTT test used for what med?
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Heparins
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PT/INR test used for?
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Coumadin
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Virchow's Triad
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How at risk a pt is for a DVT
Venous stasis Vessel wall injury altered blood coagulation |
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Risk of DVT extends for __ months past joint replacement
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3 months
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Greatest risk time for a DVT
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2-5 days post op
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2nd Peak risk time for a DVT
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10 days post op
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How long are its usually on Heparin or Loxenox post op?
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5 days
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How long are its usually on Coumadin post op?
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3 months
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Medications to treat Blood Clots
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anticoagulants
aspirin thrombolytic agents |
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Diagnostic tests for DVTs
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Doppler ultrasound
ventilation perfusion MRI D-Dimer |
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DVT treatments for its who cannot have anticoagulant therapy
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surgical procedures (inferior vena cava filter insertion and thrombolectomy)
Also pain management |
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What is the major cause of a fat embolism?
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Fracture or surgery of a large bone
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TPN
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total parenteral nutrition
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FES
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fat embolism syndrome
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VTE
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venous thrombo embolism
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Constipating foods
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cheese, lead meat, eggs pasta
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Foods with laxative effect
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fruits and veggies, bran, chocolate, alcohol, coffee
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Gas- producing foods
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onions, cabbage, beans, cauliflower
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Effect of aspirin, anticoagulants on stool
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pink to red to black stool
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Effect of iron salts on stool
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black stool
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Effect of antacids on stool
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white discoloration or speckling in stool
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Effect of antibiotics on stool
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green-grey color
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Ahysical assessment order of the abdomen
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inspection
auscultation percussion palpation |
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What is the major concern with diarrhea?
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Dehydration
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4 methods for emptying the colon
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enemas
rectal suppositories oral intestinal lavage digital removal of stool |
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Too much use of laxatives leads to the muscles ____. Also, too much loos of H2O leads to _____.
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tiring
constipation |
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Feces in the sigmoid colon would have what characteristics?
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hard and dry formed stool
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Feces in the descending colon would have what characteristics?
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soft but formed stool
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Feces in the ascending colon would have what characteristics?
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diarrhea/ semi liquid stool
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Feces in the transverse colon would have what characteristics?
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liquid stool
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5 types of colostomies
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sigmoid colostomy
Descending colostomy Transverse colostomy Ascending colostomy Iliostomy |
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Seepage of stool from the anus is indicative of...
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fecal impaction
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What are the differences between NGT and GT?
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NGT is a a temporary non surgical procedure (that goes from the nose to the stomach)
GT is a semi permanent surgical procedure that goes from the outside abdomen wall into the stomach. |
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The most important risk of NGT insertion is
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Aspiration/ tube entering the trachea
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Why is NGT needed? (3 reasons)
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1. for feedings and to give meds
2. decompress and remove unwanted air and fluid from the stomach 3. to treat an intestinal obstruction |
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How to measure a NGT before insertion?
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tip of nose, tip of ear, down to xiphoid process, mark with a pen
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What to document after NGT inserted? (4 things)
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1. size
2. Doctor ordered/reason 3. patient reaction/teaching results 4. Xray results |
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What are nursing interventions for patients with GT or NGT feeding?
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Check residual q4hr, Head of bed at least 30 degree, X ray before feeding, Use skin barrier, Admin oral hygene, Maintain a patent NG tube line
Check NGT placement q shift and PRN |
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What is normal O2 sat in healthy adult patients?
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92% or more
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Can you admin O2 without a Dr's order?
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No, unless in emergency situation as per protocols. Varies by hospital.
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List at least 2 places in the body that you can monitor O2 sat
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finger, toe
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What is melena?
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dark blood in stool
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What color of a stoma is considered normal and healthy?
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red, moist
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List at least 1 intervention if your patient has fecal incontinence/ Why?
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Provide a bedside commode and assistive devices or assistance in reaching the commode or toilet. This is so that the patient will limit the chance of accidents in the bed.
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Diffusion in the lungs is influenced by?
a. High Altituds b. thickening og alveolar-capillary membrane c. removal of a lung d. presence of disease e. all of the above |
e. all of the above
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Hemoglobin is used to transport both oxyhemoglobin and carboxyhemoglobin. True or false?
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True
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What is the definition of internal respiration?
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Exchange of O2 and CO2 between the circulating blood and the tissue cells
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During pulmonary ventilation, describe the events that occur (in order)
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the diaphragm contracts and descends, external intercostal muscles contract lifting the ribs upward and outward; thereafter, the diaphragm relaxes and ribs move down and sternum drops back
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What factors may affect respiration? Choose all that apply
a. the ability for retraction from muscles of the abdomen, neck, and back b. emphysema c. edema in the respiratory tract d. dyspnea |
a, b, c
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A nurse is providing education to a patient on the use of an IS, how would she describe the use of the IS?
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The IS assists the patient to breathe slowly and deeply to sustain maximum inspiration.
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Pursed-lip breathing had been encouraged by the physician. What is the best description of the benefits for the patient?
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It results in improved gas exchange and decreased dyspnea.
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Which O2 delivery device would the nurse expect to use to provide the highest concentration of O2 to a patient who is breathing spontaneously?
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nonrebreather mask
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A patient had a history of kidney disease. What is the nurse expecting his BUN, creat, aHemoglobin lab findings to be?
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increased BUN, serum creatinine, and decreased hemoglobin (because kidneys help in bone production of erythropoeitin which makes hemoglobin)
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A patient has been admitted with liver cirrhosis. What is the nurse expecting the lab findings to be?
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elevated serum INDIRECT and unconjugated bilirubin
(this is specific for liver cirrhosis) |
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What is the purpose of the Harris Flush?
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to release gas (done by lowering the bag)
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Do you need a Dr's order to suction stomach or give a tube feeding?
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YES
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How often do we chance the TED hose?
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q shift
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Do you need a Dr's order for TED hose?
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Yes
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Contraindications for NGT
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broken nose, allergies, swelling
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Is insertion of an NGT a sterile procedure?
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No
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When inserting the NGT what should you ask the patient to do so that tube does not go back into their mouth?
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Ask the patient to swallow
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Yanker
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a device that is connected to the wall suction... used for oral suctioning/cleaning
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O2 should always be at a minimum of ___L
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2
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Salem Pump
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airport used only for air, nothing else. airport pinned to gown higher than gastric level. cannot use for feeding, only suction.
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Nonrebreather mask must be ____ before it is put on patient... why?
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inflated
because if not inflated could lead to CO2 poisoning. |
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What is the first thing you want to see on a patients table after surgery?
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An IS
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For postmortem care what do you do if there is to be an autopsy?
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Leave all lines and tubes in place
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Where are the 3 labels placed on the body during postmortem care?
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Toe, bag, belongings.
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Nurse should wear ____, ____, and ____ during postmortem care
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mask, gown, gloves
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During post mortom care the patient's _____ will be tied together with a strap
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jaw
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What org does the nurse call to report a patients death?
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One Legacy
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Who can pronounce a patients death?
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only a certified person
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Nurses responsibilities when a patient dies (5 things)
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1. caring for the patient's body
2. caring for the family 3. discharging specific legal responsibilities, ensuring a death sertificate is issued and signed 4. Labeling the body, cleaning the body 5. reviewing organ donation arrangements if any |
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constipation is defined as..
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not having a bowel movement for 3 + days
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paralytic ileus
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Obstruction of the intestine due to paralysis of the intestinal muscles.
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fecal impaction
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is a large lump of dry, hard stool that remains stuck in the rectum.
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bowel incontinence
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Bowel incontinence is the loss of bowel control, leading to an involuntary passage of stool.
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Hemorrhoid
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A swollen vein or group of veins in the region of the anus
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flatulence
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the state of having excessive stomach or intestinal gas
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The Valsalva Maneuver cnsiderations
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The increased pressure in the thoracic cavity reduces the amount of blood flowing into the thoracic cavity, especially in the veins leading to the right atrium of the heart. The maneuver can also cause cause blood clots to detach, bleeding, irregular heart rhythms and cardiac arrest.
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ostomy
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a surgically created opening connecting an internal organ to the surface of the body
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stoma
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is an opening, either natural or surgically created, which connects a portion of the body cavity to the outside environment
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colostomy
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a surgical procedure that brings one end of the large intestine out through the abdominal wall.
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ileostomy
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is a surgical opening constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin.
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hypotonic enema
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large volume enema, plain water
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hypertonic enema
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small volume enema type of solution in fleets enema
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isotonic enema
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standard saline solution, large volume enema
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Soap suds enema
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The soapsuds enema uses a mixture of a mild soap and warm water injected into the colon in order to stimulate a bowel movement.
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oil retention enema
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an enema containing about 200 to 250 mL of an oil-based solution given to soften a fecal mass. The patient is asked to retain the solution for 30 minutes to several hours.
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NGT Purposes
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The most common purpose for inserting a nasogastric tube is to deliver tube feedings.Another purpose for inserting a nasogastric tube is to remove substances from the stomach.
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Measures to prevent a DVT
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early movement
compression stockings CPM (continuous pressure machines) lifestyle changes SCDs risk assessment |
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risk factors for DVTs
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geriatric, immobility, injuries, paralysis, surgery, clotting disorders, pregnancy and childbirth, oral contraceptives, cancer, smoking, obesity, infections, circulation or heart problems
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Prevention of FES
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bed rest, immobilize fracture, oxygen, hydration, gentle handling,
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3 normal breath sounds
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vesicular
bronchial bronchovesicular |
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3 adventitious breath sounds
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crackles, wheezes, pleural friction rub
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3 pulmonary diagnostic tests
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PFT (pulmonary function test)
Pule oximetry thoracentesis |
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Goal for O2 administration
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to improve tissue oxygenation delivered via an oxygen delivery device
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What is CAM
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complimentary alternative medicine
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Name the 5 different domains of CAM therapies
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1. systems of health care
2. mind-body therapies 3. manipulative & body based therapies 4. biologically based therapies 5. energy therapies |
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What are complimentary therapies?
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therapies used together with additional traditional treatment
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What are alternative therapies?
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therapies used in place of traditional treatment
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What is complementary and alternative medicine (CAM)?
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a diverse group of practices, products, and systems
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What is integrative medicine?
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a combination of therapies from traditional western medicine and CAN
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homeopathic
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small doses of specifically prepared plant extracts and minerals to promote healing (under systems of health care CAM domain)
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naturopathic
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employment of herbs and nutrition into health care practice
(under systems of health care CAM domain) |
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Acupressure and Acupuncture is a ___ ____ ____ (___) technique
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Traditional Chinese Medicine (TCM)
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Acupressure
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uses finger pressure at certain points on the body to stimulate the body’s self-healing.(under systems of health care CAM domain)
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Acupuncture
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uses needles at specific locations on the body, or acupoints, to address illness or pain.(under systems of health care CAM domain)
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Prayer, Journaling
Imagery, Meditation Music, Animal-assisted therapy Are all what kinds of therapy? |
Mind-Body Therapies
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Most commonly used mind-body therapy by health care professionals and patients
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Prayer
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__________ involves using various strokes & pressure to manipulate soft tissues to produce relaxation & can help reduce pain.
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massage, and is a Manipulative and Body-Based Therapy
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____ _____ is a mind-body exercise to promote blood flow of energy throughout the body.
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tai chi, and is a Manipulative and Body-Based Therapy
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___________is the use of essential oils to promote relaxation & sleep.
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aromatherapy, and is a Biologically-Based Therapy
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Taking garlic pills to lower cholesterol is an example of ______ _____________.
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herbal preparation, and is a Biologically-Based Therapy
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The most well-known energy therapy is _______ _______.
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therapeutic touch, and is a Biologically-Based Therapy
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Ginkgo biloba
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Used to promote better memory
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Echinacea
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immune system boost
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Garlic
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blood thinner
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St. John’s wort
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helps with depression
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Ginseng
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to help with aging/ vitality
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Pain as a physiological mechanism can be a warning sign of _____ _______
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tissue damage
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Negative effects of HCP prejudices regarding pain
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incomplete care and inadequate control of pain
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What is The Join Commission pain standard?
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Pain is what the patient says it is
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What is?
Bradykinin Prostaglandins Substance P |
Chemical neurotransmitters that control pain in the body.
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“Gate Control Theory of Pain”
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Dorsal horn cells act as a gate, closing to prevent nociceptive impulses from reaching the brain or opening to allow impulses to be transmitted to the brain.
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3 ways the "Gate" opens and closes:
1. The amount of activity in the ____ _____ 2. The amount of activity in other _____ ________ 3. Messages that descend from the ___ |
1. pain fibers
2. body parts (peripheral fibers) 3. brain |
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The 3 elements of pain
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physical, emotional, and mental
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How to close the "gate."
1. Physical: __________ 2. Emotion: __________ 3. Mental: ___________ |
1. pain meds, exercise, CAM
2. + feedback, relaxation, rest 3. distraction |
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5 steps to the pain process:
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Transduction
Conduction Transmission Perception Modulation |
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Transduction
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nocioceptors- sensory neurons transduct electric currents/impulses
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Conduction
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electric currents travel along neurons
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Transmission
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electric currents transmit into chemical messages
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Perception
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pain is perceived in the brain
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Modulation
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when sensation is sent back to the site
|
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4 types of pain
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Cutaneous
Somatic Visceral Neuropathic |
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Cutaneous pain
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surface level
ex: burn or cut |
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Somatic pain
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muscle/tendon damage
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Visceral pain
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organs
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Neuropathic pain
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nerve impaired pain, phantom pain, no tissue damage
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3 behavioral responses to pain
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Anticipation- occurs before pain is felt
Sensation- occurs when the pain is felt Aftermath- occurs when the pain is reduced or stopped |
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Acute and chronic pain three major categories
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Acute
Chronic Cancer (malignant) Chronic non-cancer |
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The most common reason that patients seek health care
|
Acute and chronic pain
|
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Time frame to define acute and chronic pain?
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acute < 3 mos
chronic > 3 mos |
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When pain should be assessed and documented?
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On admission
Within one hour after pain medication is administered With all vital signs At 24-hours after admission When nurses make round |
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Analgesics consist of 3 subcategories
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Nonopioid
Opioid Adjuvants |
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PCA
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Allows patient to self-medicate specific doses
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Local anesthetics
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Loss of sensation to a specific body part
|
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Topical local
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Absorbed through the skin
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Epidural
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Administered into spinal epidural space
Short- or long-term therapy |
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Transdermal
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Patches are worn 48 to 72 hours
|
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What are age-related changes that affect comfort in older adult?
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changes in metabolism (meds in particular)
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What are nursing strategies to address physiologic changes affecting comfort?
|
give lowest dose to begin with
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Nutrients that supply energy
|
Carbohydrates
Protein Lipids |
|
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Nutrients that regulate body processes
|
Vitamins
Minerals Water |
|
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KEY FACTORS FOR NUTRITION
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Physical,
Physiologic, Psychosocial |
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Anorexia nervosa
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body wt less than 85% of ideal fear of being fat, feeling fat, no menses for at least 3 consecutive months
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Bulimia
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a cycle of binge eating followed by perging(vomiting, using diuretics/laxatives, fasting, ect.)
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Obesity
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BMI of 30 or greater
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How to calculate BMI
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wt (kg)
------------------------ ht (m) x ht (m) |
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normal BMI
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18.5-24.9
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Are teeth important to take into account when assessing the dietary history?
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YES
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___ and ____ are userd to calculate BMI
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weight and height
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What patients I&O should be monitored?
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pts on Lasix
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Why do patients need to be weighted daily?
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kidney disease, tube feeding, edema, CHF, etc.
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When feeding pt on tube feedings what head of the bed should be at ___ degrees to prevent _____
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90 degrees
aspiration |
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If a patient is on an ensure supplement when should the ensure be given?
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In between meals as a snack
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Mechanical soft diet
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for pts that cannot chew well or at all. Everything is mashed/mushy.
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Soft/low-residue diet
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low fiber diet (ie. after bowel surgery)
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Dysphagia (thick nectar) diet
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like kerns nectar (ie. for pts with increased risk for aspiration)
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Why would a patient be on TPN?
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Fluid, electrolyte, and acid-base imbalances
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Red meat is an incomplete protein. True or False?
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False
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What is the name for the product that occurs when manufacturers partially hydrogenate liquid oils?
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Trans fat
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Which vitamin affects visual acuity in dim light, formation and maintenance of skin and mucous membranes, and the immune function?
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Vitamin A
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Food is more vital to life than water because it provides the medium necessary for all chemical reactions and it is not stored in the body. True or False?
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False
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What are possible complications of TPN? Mark all that apply:
A. Metabolic alterations B. Fluid, electrolyte, and acid–base imbalances C. Phlebitis D. Hypolipidemia E. Hypertension |
A. Metabolic alterations
B. Fluid, electrolyte, and acid–base imbalances C. Phlebitis |
