Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
66 Cards in this Set
- Front
- Back
|
Blood Gass Levels |
pH : 7.35 - 7.45 PaCO2 : 35 - 45 HCO3: 22 - 26 |
|
|
Cultures Blood & Sputum When should they be done? |
early in the morning before any antibiotics |
|
|
Chest X-rays |
show any consolidation, or cavitation indicative of TB |
|
|
Pulse Ox, if low what should you do? |
deep breath and cough, ALWAYS FIRST INTERVENTION |
|
|
Bronchoscopy pre & post |
pre: NPO post: NPO until gag reflex returns |
|
|
Thoracentesis |
check lung sounds for perforation (no sound) sitting position with arms raised onto a table, removes fluid from pleural space |
|
|
Sputum for AFB |
For patients who suspect TB, done early in the morning and usually done three times. |
|
|
What can cause Hospital-Acquired Pneumonia |
- not ambulating after surgery - aspiration |
|
|
Manifestations of Pneumonia |
- fever, chill sweats - pleuritic chest pain - cough - SOB - Dyspnea - crackles; Ronchi - pleural friction rub - copious sputum production/ rusty, green, or bloody |
|
|
Elderly Patients and Pneumonia |
may not present with fever, tachycardia, or respiratory manifestations, but with altered mental status and dehydration |
|
|
Viral Pneumonia |
low grade fever non productive cough normal to low elevation of wbc minimal chest x ray change more common in children VS will be slightly changed |
|
|
Bacterial Pneumonia |
high fever productive cough elevated WBC chest xray reveals infiltrates treated with antibiotics VS will have extreme change |
|
|
Bronchodilators |
reduces airway resistance by relaxing smooth muscle in bronchi also inhibits release of histamine. increases HR, O2 sat should improve |
|
|
Bronchodilators interventions |
Apical pulse high, DO NOT GIVE Using sparingly with asthma VS pre and post |
|
|
Bronchodilators Medications |
Albuterol (provental) Isoprpterenol (Isuprel) Metaproterenol Sulfate (Alupent) In hospital it is given by respiratory but we educate |
|
|
Decongestants |
Produce decongestion by acting on sympathetic nerve endings to produce constriction of dilated arteries. Use only for 3 days or else rebound effect, and can get worse |
|
|
Decongestants Medication |
Phenylehrine (Neo-Synephrine) Pseudoephedrine (Sudafed) Oxymetazoline (Afrin) |
|
|
Inhaler use |
- should not be held in mouth but two fingerwidths away (1.5 inches) in front of mouth - breathe deeply once before activating and the continue breathing in for about 5 seconds - then hold breath for 10 - 15 seconds before breathing out slow - if second dose is needed wait 1 - 2 minutes before taking another |
|
|
Inhaler use of two different inhalers |
administer bronchodilator first to open airway and cortcosteroid next. wait 5 minutes following the bronchodilator to inhale the cortcosteroid |
|
|
Pneumovax |
once diagnosed with pneumonia must take vaccine every 5 years |
|
|
Core Measures for Pneumonia |
- antibiotics are administered within 4 hours of admission - blood cultures before antibiotics - screening/administration of flu & pneumococcal vaccine - counseling for smoking cessation |
|
|
Tuberculosis |
slow onset multi drug resistant TB can occur if noncompliance with meds Airborne transmission, must be put in negative pressure room or ultraviolet light |
|
|
TB Transmission after Medications |
after the infected individual has received meds for 2 - 3 weeks the risk of transmission is greatly reduced |
|
|
PPD Results + |
Immunocompromised 5mm low risk patients 10 mm |
|
|
PPD Rules |
read 48 - 72 hours later once the test result is positive it will be positive in future tests/ so xray needed afterwards to determine |
|
|
Sputum Cultures |
most clients have negative cultures after 3 months of compliance with medications |
|
|
Clinical Manifestations of TB |
- may be asymptomatic at first - fatigue - lethargy - Anorexia - Weight loss - Low grade fever - Chills - Night sweats - Persistent cough - purulent sputum - chest tightness - dull chest pain |
|
|
Treatment of TB |
Patients with active TB will be treated for 6 to 9 months, immunocompromised patients treated longer People exposed to active TB are treated with preventative INH for 9 - 12 months |
|
|
Isoniazid (INH) |
Laniazid, Nydrazid side effects: -hypersensitivity reactions - peripheral neuritis - Neurotoxicity (TAKE B6 TO PREVENT) - Hepatoxicity - dry mouth - dizziness |
|
|
INH Education |
- take on empty stomach with water 1 - 2 hours before or after meal - avoid antacids - avoid tyramine - containing foods can cause reaction example: aged cheese - contact doctor if any signs of hepatoxicity, neurotoxicity, hepatitis, or visual changes |
|
|
Rifampin (RIF) |
Rifadin - heartburn - hepatoxicity - blood dyscrasias - colitis - Assess for visual changes (need baseline) |
|
|
Rifampin Education |
- take on empty stomach with water 1 - 2 hours before or after meal - avoid antacids - urine, feces, sweat, tears, will be red-orange in color and contact lenses can become discolored also - notify doctor if jaundice or any signs of hepatoxicity |
|
|
Ethambutol |
Myambutol - mental confusion - optic neuritis - thrombocytopenia - peripheral neuritis - Nausea |
|
|
Ethambutol Education |
- take the dose at bedtime to prevent nausea - follow up visits and vision acuity tests important - notify physician immediately if vision problems or anything else |
|
|
BUN |
10 - 20 |
|
|
Creatinine |
0.6 - 1.2 |
|
|
Streptomycin |
Contraindicated in patients with hypersensitivity, myasthenia gravis, parkinsonism, or eighth cranial nerve damage Side Effects: - visual changes - peripheral neuritis - nephrotoxicity - ototoxicity |
|
|
Streptomycin Interventions |
- Baseline BUN & Creatnine and hearing test - make sure patient knows to notify physician if any hearing loss, vision change, or urinary problems occur |
|
|
Pyrazinamide |
Side Effects: - Arthralgia, myalgia - photosensitivity - hepatoxicity - thrombocytopenia |
|
|
Pyrazinamide Education |
take with food to reduce GI stress
avoid sunlight or ultraviolet light |
|
|
SARS Sever Acute Respiratory Syndrome |
- incubation of 2- 10 days - transmitted via respiratory droplets |
|
|
Anemia |
- Blood loss - inadequate RBC production - increase RBC destruction - deficiency |
|
|
Manifestations of Anemia |
- pallor
- angina - fatigue - DOE - Night cramps - bone pain - Headache - Dizziness - Dim vision (lack of Vitamin A) |
|
|
Diagnostic Testing - Anemia |
Coomb's test - looks at breakdown of blood cells schillings test - diagnosis B12 deficiency |
|
|
Bone Marrow Aspiration |
pre: consent, purpose, vs post: vs, dressing change of pressure dressing can be done at bedside |
|
|
Iron Deficiency Anemia |
- can occur at any age group - smooth sore tongue - brittle and ridged nails - angular cheilosis: cracking in corner of mouth - pica: eating strange things usually ice |
|
|
Diagnosis of Iron Deficiency Anemia |
- bone marrow aspiration most definative DX - MCV decreased - h&h and rbc decreased - low ferritin, iron |
|
|
Management of Iron Deficiency Anemia |
- stool specimen for guiac - Iron supplement |
|
|
Education for Iron Meds |
liquid preparation drink threw straw IM is ztrack method IV administer slow and watch for allergic reaction PO take on empty stomach and with vitamin C for help in absorption |
|
|
Aplastic Anemia |
decrease or damage to marrow stem cells Neutropenia and thrombocytopenia |
|
|
Neutropenia Definition and Interventions |
low WBC - isolation - no fresh flowers, fruit, no kids, no one with cough in the room |
|
|
Thrombocytopenia Definition and Interventions |
low platelets - Bleeding precautions assessment for bruises - brush teeth with soft bristles - stool softeners/ no straining - no shaving with razors - additional pressure for IM injections |
|
|
Assessment findings for Aplastic Anemia |
Infection Anemia Purpura Retinal hemorrhages Pancytopenia (low wbc, low rbc, low platelets) |
|
|
Management for Aplastic Anemia |
bone marrow transplant peripheral blood stem cell transplant transfusions |
|
|
Megalobastic Anemia |
Folic acid and Vitamin B12 deficiency erythrocytes abnormally large Bone marrow shows hyperplasia pancytopenia can develop |
|
|
Folate Deficiency |
Usually happens to alcoholics Referral to AA |
|
|
Vitamin B12 |
need life long injections monthly schillings test conforms it |
|
|
Blood transfusions |
- baseline VS 15 mins later do it again - first 15 mins must be with patient and are most critical - temperature most important always keep track - if you need to stop the infusion stop change tubing and infuse saline - shouldnt exceed four hours |
|
|
Blood transfusions : Hemoglobin and Hematocrit |
Must evaluate after transfusion/ 1 unit of blood = 1 gram hemoglobin increase and 3% Hematocrit increase |
|
|
Albumin |
Volume Expander |
|
|
Warfarin Coumadin |
Anticoagulant - for long term coagulation Antidote is vitamin K prolongs the PT INR below normal , warfarin should be increased INR above normal, warfarin should be reduced |
|
|
PT (Prothrombin time) |
clotting time usually 9.6 to 11.8 |
|
|
INR (International normalized ratio) |
normal is 1.3 - 2.0 |
|
|
Heparin |
- anticoagulant does not dissolve clots, but prevents new thrombus formation - maintain aPTT at 1.5 to 2.5 times normal - measure every 4 to 6 hours during initial therapy, then on daily basis - aPTT to long (>80 seconds) dosage should be lowered - aPTT to short (<60 seconds) dosage should be increased - antidote protamine sulfate |
|
|
aPTT (activated partial thromboplastin time) |
Normal time is 20 - 36 seconds |
|
|
normal clotting time |
8 - 15 minutes |
