Nursing 230 Final

Front 1

upper respiratory tract

Back 1

nose, the sinuses, pharynx, larynx

Front 2

lower respiratory tract

Back 2

trachea, two mainstem bronchi; lobar, segmental, and subsegmental bronchi, bronchioles, alveolar ducts and alevoli

Front 3

cranial nerve I

Back 3

olfactory (smell) located in upper areas of nose

Front 4

the opening between the true vocal cords

Back 4

glottis

Front 5

prevents food from entering into the trachea by closing the glottis during swallowing. opens during breathing and coughing

Back 5

epiglottis

Front 6

blue bloaters

Back 6

COPD, mucus thicker, barrel chest

Front 7

Pink Puffers

Back 7

emphysema, red full of carbon monoxide

Front 8

Normal AP diameter

Back 8

1:2 to 5:7

Front 9

Increased AP diameter

Back 9

indicates COPD

Front 10

other indications of resp. adequacy

Back 10

clubbing, weight loss, unevenly developed muscles, skin and mucous membrane changes, endurance

Front 11

a fatty protein that reduces tension in the alveoli

Back 11

surfactant

Front 12

alveolar collapse, gas exchange is reduced because alveolar surface area is reduced

Back 12

atelectasis

Front 13

cultural awareness

Back 13

black people and others with dark skin usually show a lower oxygen sat. (3-5%lower) results from deeper coloration of nail bed not a true oxygen sat.

Front 14

age related changes to the alveoli

Back 14

surface area decreases, diffusion capacity decreases, elastic recoil decreases, bronchioles and alveolar ducts dilate, ability to cough decreases, airways close early

Front 15

nursing interventions for age related changes to the alveoli

Back 15

encourage pt to cough, deep breathe, use incentive spirometer, and encourage upright position

Front 16

age related changes to the lungs

Back 16

residual volume increases, vital capacity decreases, efficiency of oxygen and carbon dioxide exchange decreases, elastic decreases

Front 17

age related changes to the pharynx and larynx

Back 17

muscles atrophy, vocal cords become slack, laryngeal muscles lose elasticity, and airways lose cartilage

Front 18

age related changes to chest wall

Back 18

AP diameter increases, thorax becomes shorter, progressive kyphoscoliosis occurs, chest wall compliance decreases, mobility may decrease

Front 19

normal measurement of arterial oxygenation

Back 19

95-100%

Front 20

what could give a false high oxygen saturation

Back 20

elevated levels of abnormal hemoglobin

Front 21

what could give a false low oxygen saturation

Back 21

presence of vascular dyes, poor tissue perfusion

Front 22

respiratory disease

Back 22

a major cause of illness and chronic disability in older adults

Front 23

is a sign of lung disease

Back 23

cough

Front 24

excessive pink frothy sputum is associated with

Back 24

pulmonary edema

Front 25

hemoptysis is often seen in patients with

Back 25

chronic bronchitis or lung cancer

Front 26

patients with TB, pulmonary infarction, bronchial adenoma, or lung abscess may have

Back 26

grossly bloody sputum

Front 27

pain that feels as if something is "rubbing inside"

Back 27

pulmonary pain

Front 28

Paroxysmal nocturnal dyspnea

Back 28

sudden onset of breathing difficulty that is severe enough t awake during night

Front 29

fine crackles, or fine rales

Back 29

are heard either early or late inspiration, popping sound like hair rolled between the fingers

Front 30

coarse crackles, low pitched crackles

Back 30

most common on expiration but can be heard on inspiration, low pitched rattling sound likely to change with coughing or suctioning

Front 31

wheezes

Back 31

audible during either inspiration or expiration, or both.

Front 32

rhonchi

Back 32

heard during both, usually during the end of inspiration, and beginning or expiration. loud rough grating sound, usually associated with pleurisy

Front 33

normal red blood cells

Back 33

Men: 4.7-6.1

Women: 4.2-5.4

Front 34

Hemoglobin

Back 34

Men: 14-18

Women: 12-16

Front 35

Hematocrit

Back 35

Men: 42-52%

Women: 37-47%

Front 36

WBC Count

Back 36

5,000-10,000

Front 37

PaO2

Back 37

80-100 older adults may be lower

Front 38

PaCO2

Back 38

34-45

Front 39

pH

Back 39

7.35-7.45

Front 40

HCO3

Back 40

21-28

Front 41

elevated RBC r/t

Back 41

excessive production of erythropoietin in response to hypoxic stimulus, from COPD

Front 42

decreased RBC r/t

Back 42

possible anemia, hemorrhage, or hemolysis

Front 43

increased WBC r/t

Back 43

infection, inflammation, pneumonia, meningitis, tonsillitis, or emphysema

Front 44

decreased WBC r/t

Back 44

overwhelming infection, an autoimmune disorder, or immunosuppressant therapy

Front 45

causes of decrease PaO2

Back 45

COPD, asthma, chronic bronchitis, cancer of the bronchi and lungs, cystic fibrosis, anemia's, respiratory distress syndrome, atelectasis

Front 46

causes of increased PaCO2

Back 46

COPD, asthma, pneumonia, anesthesia, or use of opioids

Front 47

causes of decreased PaCO2

Back 47

hyperventilation/respiratory alkalosis

Front 48

informed consent

Back 48

dr must have pt sign before procedure

Front 49

indication for pneumothorax s/p thoracentesis

Back 49

medialstinal shift, decreased or absent breath sounds, presence of crepitus, respiratory distress, also watch for sings of bleeding

Front 50

bronchoscopy

Back 50

monitor for return of gag reflex

Front 51

under normal physiologic conditions of tissue perfusion, what percent of oxygen disassociates from the hemoglobin molecule

Back 51

50%

Front 52

clinical manifestations of respiratory distress

Back 52

dyspnea, nasal flaring, sternal retractions, stridor, abnormal resp. rate, accessory muscle use, pursed liped breathing, pallor, cyanosis

Front 53

hypoxemia

Back 53

low levels of oxygen in the blood

Front 54

hypoxia

Back 54

decreased tissue oxygenation

Front 55

Oxygen induced hypoventilation

Back 55

hypercarbia: retention of CO2

CO2 nacrosis: loss of sensitivity to high levels of CO2

Front 56

oxygen toxicity

Back 56

50% O2 for more than 24-48hrs

Front 57

low flow o2 delivery

Back 57

nasal cannula (1-6L), facemask, simple and NRB

Front 58

high flow o2 delivery

Back 58

venture mask, aerosol mask, tracheostomy collar

Front 59

BiPAP

Back 59

increases CO2 & O2

Front 60

CPAP

Back 60

Positive end expiratory pressure, increases O2

Front 61

interventions of tracheostomy

Back 61

make sure replacement trach is present at the bedside

Front 62

nutrition with tracheostomy

Back 62

thicken liquids, elevated HOB atleast 30 mins after eating

Front 63

weaning from trach

Back 63

once trach is capped for 24hrs RN can apply a dry dressing to the stoma & tape securely

Front 64

what complication would the patient with a cuffed trach be at risk for developing

Back 64

tracheomalacia

Front 65

if vagal stimulation occurs during suctioning what should the nurse do

Back 65

oxygenate the patient with 100% o2

Front 66

post op care of rhinoplasty

Back 66

drink atleast 2500ml fluid a day

Front 67

epistaxis interventions

Back 67

if bleeding continues make sure packing is secured to the patients cheek

Front 68

when is epistaxis an emergency

Back 68

when it is posterior nasal bleeding

Front 69

inner maxillary fixation (jaw wired)

Back 69

always have wire cutters at bed side

Front 70

OSA

Back 70

muscles relax and tongue and neck structures are displaced obstructing the airway

Front 71

how is OSA diagnosed

Back 71

sleep study, 10sec of disrupted sleep at least 5x an hour

Front 72

s/s OSA

Back 72

excessive daytime sleepiness, inability to concentrate, irritability, headaches

Front 73

assessment & s/s of head and neck cancer

Back 73

color changes in mouth, oral lesions that do not heal within 2 weeks, persistent unilateral ear pain, SOB hoarseness, reoccurring sore throat

Front 74

trycyclic antidepressants

Back 74

for nerve pain

Front 75

an important nursing intervention to prevent airway obstruction in an older adult with dementia is

Back 75

performing daily oral hygiene and removing secretion build up

Front 76

Pulmonary function test

Back 76

how much air is inhaled and exhaled during respiration, no smoking 6hrs before test, do not use bronchodilators before or during the test

Front 77

controller drugs

Back 77

change airway responsiveness to prevent asthma attacks, used everyday regardless of symptoms

Front 78

rescue drugs/ short beta 2 agonists

Back 78

actually stop attack once it has started

Front 79

status asthmaticus

Back 79

severe, life threatening acute episode of airway obstruction

Front 80

status asthmaticus treatment

Back 80

IV fluids, potent systemic bronchodilator, steroids, epinephrine, oxygen

Front 81

which risk factor is responsible for the majority of deaths from lung cancer

Back 81

cigarette smoking

Front 82

a pt with a history of asthma is have sob and incentive spirometer is in red zone, what should nurse do next

Back 82

administer the rescue drugs

Front 83

what to monitor for tonsilitis

Back 83

deviation of uvula

Front 84

treatment of laryngitis

Back 84

voice rest, steam inhalation, increased fluid intake, throat lozenges

Front 85

aminoglycocides

Back 85

toxic antibiotics to kidneys

Front 86

which is the most common manifestation of pneumonia in the older adult

Back 86

confusion

Front 87

a pt with pneumonia has decreased lung sounds on the left side and decreased lung expansion, what should you have the patient do

Back 87

have the pt cough and deep breathe

Front 88

pt is experiencing fever, chills, night sweats and weight loss, and the PMI is displaced what does this indicate

Back 88

pulmonary empysema

Front 89

a older adult is admitted with respiratory symptoms, which symptoms requires immediate intervention

Back 89

confusion requires immediate intervention

Front 90

what consist of the left side of the heart

Back 90

left main coronary artery, left anterior descending branch, left circumflex

Front 91

hypertension

Back 91

140/90

Front 92

prehypertension

Back 92

120-139/80-89

Front 93

map

Back 93

how well your organs are perfused, must be a least 60,

Diastolic BP x 2 + systolic BP x 1 / 3 = MAP

Front 94

Stroke volume

Back 94

amount of blood pumped from the LV with each beat, affected by Preload, Afterload and contractility

Front 95

Starlings law

Back 95

the more the heart fills during diastole, the more forcefully it contracts

Front 96

Preload

Back 96

ventricular stretch impacted by blood volume (filling pressure)

Front 97

Afterload

Back 97

ventricular resistance to deliver the SV

Front 98

Contractility

Back 98

strength of muscle shortening (contracting) during systole

Front 99

Fluid over load

Back 99

will increase preload

Front 100

hemorrhage will

Back 100

decrease preload

Front 101

no preload

Back 101

decreased cardiac output

Front 102

bilateral edema indicates

Back 102

heart failure or venous insufficiency

Front 103

unilateral edema indicates

Back 103

thrombus or lymphatic blockage

Front 104

dependent edema

Back 104

swelling in ankles, scrotum, affected by gravity

Front 105

s/s of right sided heart failure

Back 105

JVD and bruits, dependent edema,

Front 106

what do bruits indicate

Back 106

atherosclerosis

Front 107

S1

Back 107

closure of the mitral/tricuspid valve

Front 108

S2

Back 108

closing of aortic/pulmonic valves

Front 109

murmurs

Back 109

produced by turbulent blood flow through the chambers of the heart

Front 110

murmur stenosis

Back 110

ineffective opening (calcification)

Front 111

murmur regurgitation

Back 111

ineffective closing

Front 112

causes of pericardial friction rub

Back 112

pericarditis, MI, cardiac tamponade, inflammation, infection, infiltration

Front 113

Total cholesterol

Back 113

<200 mg/dL

Front 114

Triglycerides

Back 114

<150 mg/dL

Front 115

HDL

Back 115

> 40 mg/dL

Front 116

LDL

Back 116

<70 for cardiac patients

Front 117

Troponin T

Back 117

<0.20

Front 118

Troponin I

Back 118

0.03

Front 119

CK-MB

Back 119

0% of the total CK

Front 120

normal EF

Back 120

> 60 %

Front 121

a woman who is having a MI may experience which s/s

Back 121

indigestion, feelings of chronic fatigue, and a choking sensation

Front 122

a pt is admitted with a weight loss of 2.3 kg over 36hrs, diarrhea, n/v the nurse should assess which cardiac parameter more closely

Back 122

assess preload

Front 123

what is the best indicator of fluid retention

Back 123

weight gain

Front 124

causes of left sided heart failure

Back 124

HTN, CAD, valvular disease

HTN can lead to back up of blood into the lungs

Left sided HF usually leads to right HF

Front 125

s/s left HF

Back 125

fatigue, pulmonary congestion, crackles in the lungs, DOE or PND, breathlessness

Front 126

causes of right HF

Back 126

LV failure, right ventricular MI, pulmonary hypertension

Front 127

decreased blood flow to kidneys

Back 127

triggers RAAS

Front 128

angiotension II

Back 128

vasoconstriction

Front 129

angiotension I

Back 129

is converted to angiotension II in lungs

Front 130

ACE inhibitors

Back 130

vasodilate, can cause a dry cough hold for SBP <90, increase SV/CO

Front 131

ARB (angiotensin receptor blockers)

Back 131

block the effect of angiotension II

Front 132

HBNP/synthetic BNP

Back 132

need a separate IV/ incompatible with other medications

Front 133

rheumatic carditis

Back 133

valve thickening

Front 134

pulmonary congestion and RHF lead to

Back 134

decreased preload and decreased CO

Front 135

those at high risk for infective endocarditis

Back 135

IV drug abusers, valve replacement recipients, those who had have systemic infections, people with structural cardiac defects

Front 136

acute cardiac tamponade care

Back 136

increase fluid volume, hemodynamic monitoring, pericardiocentesis, pericardial window, pericardiectomy

Front 137

blood components

Back 137

plasma, RBC, WBC, platelets

Front 138

liver

Back 138

produces clotting factors

Front 139

spleen

Back 139

immunity & blood cell destruction

Front 140

fibrinolysis

Back 140

limits the size of clots by dissolving fibrin clot edges with plasmin

Front 141

ant clotting proteins

Back 141

protein C, protein S, antithrombin III

Front 142

beefy red tongue indicates

Back 142

vitamin B12 deficiency

Front 143

vitamin b12 deficiency causes...

Back 143

neurologic degeneration

Front 144

ferritin

Back 144

free iron

Front 145

what to check after bone marrow biopsy

Back 145

active bleeding, or bruising every 2hrs for 24hrs, cover site with dressing after bleeding is controlled

Front 146

Coumadin education

Back 146

foods high in vita k, avoid NSAIDS, soft toothbrushes, use a safety razor, and when to have blood level checked

Front 147

anemia

Back 147

reduction in either the number of RBCs, hgb, or hct

Front 148

causes of anemia

Back 148

dietary problems, genetic disorders, bone marrow disease, excessive bleeding

Front 149

sickle cell anemia

Back 149

results from increased destruction of RBCs, genetic disorder, cells become sickle shaped causing them to stick

Front 150

sickle cell anemia causes the patient

Back 150

chronic anemia, pain, organ damage, increased risk of infection, early death

Front 151

managing pain with SCD

Back 151

PCA pump, droxia, IV hydration with hypotonic soln, D5W 200ml/hr

Front 152

normal iron level

Back 152

60-170

avoid increasing with SCD

Front 153

aplastic anemia

Back 153

failure of bone marrow to produce RBC, harder to treat approach like cancer

Front 154

leukemia

Back 154

bone marrow cancer causes increased production of immature WBCs (blast cells)

Front 155

leukemia interventions

Back 155

preventing infection, chemo, ATBs, antifungals, antivirals, no standing water (vases), no uncooked foods, sterile h2o

Front 156

stem cell transplant

Back 156

best if patient is in remission, must give chemo treatment before transplant

Front 157

hodgkins lymphoma

Back 157

cancer that begins in a chain of lymph nodes large painless and easy to treat

Front 158

nonhodgkins lymphoma

Back 158

includes all lymphnoid cancers that do not have reed Sternberg cell, combination chemotherapy

Front 159

multiple myeloma

Back 159

WBC cancer, non curable, prolong life

Front 160

autoimmune thrombocytopenia purpura

Back 160

body makes antibodies against own platelets, excessive ecchymosis and petechial rash, monitor for bleeding

Front 161

most common complication of HTN

Back 161

kidney failure

Front 162

beurgers disease

Back 162

black toes due to DVT, shattering clots

Front 163

Heparin Drip

Back 163

monitor PTT, stop drip immediately if 50% decrease in platelets

Front 164

INR level

Back 164

1.5-2 is normal, but 2-3 for patients with A fib

Front 165

dark bloody stool indicates

Back 165

upper GI bleed

Front 166

bright bloody stool indicates

Back 166

lower GI bleed

Front 167

in a older adult which risk factor is a better indicator for heart disease and stroke

Back 167

blood pressure of 152/60

Front 168

what food could the patient consume to help prevent hypokalemia

Back 168

baked potatoes

Front 169

unstable angina pectoris

Back 169

chest pain last longer than 15 min unrelieved with NTG,

Front 170

nonmodifiable risk factors of MI

Back 170

age, gender, family history, and ethnic background

Front 171

MONA steps to follow during MI

Back 171

apply oxygen, nitro, IV nitro, aspirin and then morphine

Front 172

unrelieved pain with nitro drip

Back 172

get into cath lab ASAP

Front 173

NTG

Back 173

SL every 5 mins x3, then start iv drip

Front 174

thrombolytic therapy

Back 174

give within 6hrs of symptoms, t-PA

Front 175

exclusion criteria for t-PA

Back 175

patients who have had stable clots from recent surgery, trauma, stroke, or postpartum

Front 176

PTCA

Back 176

give Plavix before and after procedure, IV heparin before and during procedure, IV nitro

Front 177

sympathetic nervous system

Back 177

stimulates fight or flight

Front 178

EEG

Back 178

pt must be sleep deprived before test, no caffeine, wash hair before the morning of test, do not wear hair pens, hold anticonvulsants