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;
116 Cards in this Set
- Front
- Back
|
What are the nursing interventions after nasal surgery? |
* No aspirin containing substances or NSAIDS for 2 weeks before surgery * maintenance of the airway * assessment of respiratory status * pain management * observation of the site for bleeding, infection or edema * teaching (no nose blowing, swimming, exercise) |
|
|
What can cause epistaxis (nosebleeds)? |
* Low humidity * allergies * upper respiratory tract infections * sinusitis * trauma * foreign bodies * hypertension (HTN) * street drugs * over use of nasal sprays * nasal surgery * anatomic malformation * tumors |
|
|
Describe epistaxis. |
* 90% of nosebleeds occur in the anterior portion of the nasal cavity. * posterior bleeding occurs more commonly in the elderly secondary to other health problems. |
|
|
What are the manifestations of allergic rhinitis? |
* sneezing * itchy, watery eyes * nasal discharge * nasal congestion |
|
|
Describe the influenza virus. |
Influenza viruses are classified into three serotypes (A, B, and C), but only A and B cause significant illness in humans. C causes only mild illness. Influenza A is subtyped based on the presence of two surface proteins: hemagglutinin (H) and neuraminidase (N). B & C are not subtyped. |
|
|
How is the influenza virus spread, what is the incubation period and how long does it last? |
It is spread between animals and humans. It has an incubation period of 1 to 4 days with peak transmission risk starting approx. 1 day before symptoms and continuing for 5 to 7 days. |
|
|
What is the most common complication of the flu? |
pneumonia |
|
|
What are the primary nursing goals in influenza? |
* Relief of symptoms * Prevention of secondary infections |
|
|
What are the nursing goals in managing a deviated septum? |
It focuses on symptom control of nasal inflammation and congestion. |
|
|
What are the goals of nursing management of the nasal fracture? |
* maintain airway * reduce edema * reduce pain * provide emotional support |
|
|
When caring for a patient with a scheduled rhinoplasty, what is important to assess? |
The patient's expectations of the surgery. Alterations in body image can affect self-esteem and interactions with others. |
|
|
What are the first aid measures to control epistaxis? |
1. Keep the patient quiet 2. Place the patient in a sitting position, leaning slightly forward with head tilted forward 3. apply direct pressure by pinching the entire soft lower portion of the nose against the nasal septum for 10 to 15 minutes. 4. If bleeding does not stop with 15 to 20 minutes, seek medical assistance |
|
|
What is the medical management for epistaxis? |
Identifying the bleeding site and applying a vasoconstrictive agent, cauterization or anterior packing, which may consist of a pledget impregnated with an anesthetic or a vasoconstrictive agent such as epinephrine placed in the nasal cavity for 10-15 minutes. If bleeding doesn't stop, packing of compressed sponges or epistaxis balloons may be used. |
|
|
What are the nursing management considerations for epistaxis? |
Because nasal packing may impair respiratory status especially in the elderly, closely monitor respiratory rate, heart rate and rhythm, oxygen saturation and LOC. Observe for signs of aspiration. |
|
|
Describe sinusitis. |
* It develops when inflammation of hypertrophy of the mucosa blocks the openings in the sinuses through which mucus drains into the nose. It collects behind the blocked ostia which provides a rich medium for bacteria, viruses and fungi. * It typically follows an upper respiratory tract infection. |
|
|
What classifications are there of sinusitis? |
* Acute (begins 1 week after after URI and lasts less than 4 weeks) * Subacute (lasts 4 to 12 weeks) * Chronic (lasting longer than 12 weeks and usually associated with allergies and polyps) |
|
|
What is the treatment for sinusitis? |
Initial treatment focuses on symptom relief * decongestants * nasal corticosteroids to decrease inflammation * analgesics to relieve pain * saline nasal spray to relieve congestion |
|
|
What are the clinical manifestations of acute sinusitis? |
* pain over the affected sinus * nasal obstruction * congestion * fever * malaise.
|
|
|
What are nasal polyps? |
Soft, painless, benign growths that form slowly |
|
|
What are the clinical manifestations of larger polyps? |
* nasal obstruction * nasal discharge (usually clear mucus) * speech distortion |
|
|
What is the management for a deviated septum? |
* nasal allergy control * nasal septoplasty (surgery to straighten the septum) |
|
|
What do you assess with a nasal fracture? |
* Patient's ability to breathe through each nostril * Note any edema * Note any hematoma |
|
|
What is ecchymosis around the eyes called? |
"Raccoon Eyes" |
|
|
If a patient has clear drainage that won't stop after a nasal fracture, what do you test for and why? |
Test the drainage for glucose, which would indicate cerebrospinal fluid (CSF). |
|
|
What is rhinoplasty and what is the management for that? |
A "nose job". * Preoperatively, the patient's expectations need to be assessed (it takes time for the swelling to come down). * Postoperatively, nasal packing is applied to apply pressure and prevent bleeding or hematoma formation. It is removed by the surgeon the day after surgery. * An external splint is left one for a week. It protects and supports. * The head should be maintained in an elevated position to decrease swelling. |
|
|
What ages are common for epistaxis? |
Younger than 10 and older than 50. |
|
|
What can predispose a patient to epistaxis? |
* Prolonged bleeding time * altered platelet counts * Patient who takes aspirin or anticoagulants * HTN can make it difficult to stop the bleeding |
|
|
What's the difference between intermittent and persistent allergic rhinitis? |
* Intermittent is less than 4 days a week, less than 4 weeks a year * Persistent is more than 4 days a week, more than 4 weeks a year |
|
|
What are the manifestations of allergic rhinitis? |
* symptoms resemble a cold * nasal turbinates appear pale, boggy and swollen which can obstruct sinus drainage and cause sinusitis. |
|
|
What is the nursing management of allergic rhinitis? |
* Identify and avoid triggers * meds to reduce inflammation and reduce nasal symptoms (like antihistamines) * adequate fluid intake * intranasal corticosteroid sprays (flonase) |
|
|
What is immunotherapy? |
Weekly allergy shots of the known allergen in order to decrease sensitivity. |
|
|
What is the common cold caused by and how long can it live on inanimate objects? |
The rhinovirus can survive on inanimate objects for 3 days. It is the most prevalent infectious disease and is transmitted via airborne droplets. |
|
|
How long should nasal decongestant sprays be used for and why? |
They should never be used for more than 3 days because they will cause a rebound vasodilation and congestion. |
|
|
Mrs. G. is a 70 year old grandmother who comes to the hospital with exacerbation of COPD. What do you expect to find in your assessment? |
* Tripod position * barrel chest * Low O2 sat * cyanotic * tachypnea * nail clubbing * pursed lipped breathing * atelectasis * cor pulmonale * jugular vein distention * "pink puffer" or "blue bloater" |
|
|
If you need to give a COPD patient oxygen, how much do you give? |
Start slowly. Giving too much oxygen can deprive their body of the drive to breathe. Keep the patient's oxygen level at about 90%. |
|
|
Why is a COPD patient's blood oxygen saturation lower than a normal? |
The respiratory drive is normally driven by higher levels of Carbon dioxide. Patient's with COPD have lost this respiratory drive and so their drive to breathe comes from low oxygen levels. |
|
|
Your COPD patient needs help controlling her SOB and respiratory rate. How do you help her? |
Teach pursed lipped breathing |
|
|
What does pursed lipped breathing do for a COPD patient? |
Exhalation becomes 2 - 3 X longer than inspiration and facilitates maximal expiration getting rid of CO2 |
|
|
Who should get the pneumonia vaccine? |
* people over 65 years * people between 2 and 64 with long term health problems * people between 19 and 64 who smoke or have asthma * people between 2 and 64 who have a disease that lower's the body's resistance to infection * People 19 to 64 living in special environments (i.e. long term care facilities) * any of these who got one longer than 5 years previously (should get one every 5 years) |
|
|
What nursing interventions help prevent hospital acquired pneumonia? |
* High Fowler's position * Incentive spirometer * ambulating * postural drainage * good oral care |
|
|
What kind of oral care should a hospitalized person have, who is in danger of getting pneumonia? |
* every 12 hours with sodium bicarbonate impregnated suction toothbrush which contains anti-plaque solution * every 4 hours the mouth should be cleaned with an antiseptic oral rinse with the foam suction swab * a mouth moisturizer can be applied to mouth and lips every 2 to 4 hours (not vaseline - it's flammable) |
|
|
How do you teach a patient to use an incentive spirometer? |
* form a tight seal around the mouthpiece * Inhale slowly * keep the ball at a certain spot for as long as possible * rest between breaths * Do it 10 times an hour |
|
|
How can you determine if pneumonia is hospital acquired or community acquired? |
If the patient has developed the pneumonia after 48 hours in the hospital, then it is hospital acquired. |
|
|
To treat your patient's pneumonia, the doctor orders cough meds, sputum culture, antibiotics, pain meds and a bronchodilator. Which do you administer first and why? |
Sputum culture then meds. The meds can interfere with the sputum culture. |
|
|
How do we obtain a sputum culture? |
* first thing in the morning * rinse mouth to avoid contamination * breathe deeply to illicit a cough * cough into the sputum specimen container * don't spit * increase fluids to help with obtaining the specimen |
|
|
Once you get a sputum culture from your patient with hospital acquired pneumonia, what is the next order from the doctor that you perform and why? |
Give antibiotics. The sooner they are administered, the sooner it should clear up. Early initiation of antibiotic therapy has been demonstrated to reduce mortality. |
|
|
How would you know if antibiotics are working on your patient with pneumonia? |
* temp should go down * repeat culture * check WBC count |
|
|
48 hours after your patient with COPD and pneumonia has had antibiotics, she wants to go for a walk. When is the best time to take her for a walk? |
* After a nap or after she's rested. * Not after a meal * After using a bronchodilator * After assessing her O2 sat and making sure she has good oxygenation * consider monitoring the O2 sat during the walk |
|
|
Your patient with COPD and pneumonia is feeling much better and is ready to be discharged. What teaching is appropriate for discharge? |
* keep up with pneumonia vaccines * continue taking the antibiotics as prescribed until they are gone * good oral and hand hygiene are important * Keep up O2 therapy * teach milestones to be expected and to call if something seems wrong. * eat well, rest well, and get regular exercise * avoid cigarette smoke * continue with incentive spirometer * |
|
|
What is it called when 4 ribs are broken? |
Flail chest |
|
|
What is paradoxical chest movement? |
When placing your hands on the patient's back with thumbs together and the patient breathes, only one side moves. |
|
|
A 54 year old patient is in an automobile accident where his chest hit the steering wheel. He comes to the ER complaining of severe chest pain when trying to breathe. What should you assess for? |
* A possible pneumothorax. - shortness of breath - pain - absent lung sounds |
|
|
What exists with a tension pneumothorax? |
When the trachea is not midline. If it is off to one side, then a tension pneumothorax exists. |
|
|
What are the nursing interventions for a patient with a chest tube? |
* changing the patient's position frequently * coughing and deep breathing exercises * maintaining the collection chamber below the patient's waist * Adding water to the suction control chamber as it evaporates * taping the connections between the chest tube and the drainage system * keep all tubing loosely coiled * assess vital signs, lung sounds and pain * mark the time of measurement & color of drainage (usually red at beginning) * Need a physician's order to clamp (use portable suction for a trip) |
|
|
How much drainage is too much from a patients chest with a chest tube? |
Over 100 CCs an hour |
|
|
When a patient is getting ready to have the chest tube removed, how do you coach the patient to prepare? |
Exhale and bear down (the valsalva maneuver). |
|
|
What is cor pulmonale? |
Enlargement of the right ventricle secondary to diseases of the lung. Pulmonary hypertension is usually a pre-existing condition. It is caused by COPD. |
|
|
What are the symptoms of Cor pulmonale? |
* Dyspnea on exertion * lethargy * fatigue * peripheral edema * weight gain * distended neck veins * full, bounding pulse * enlarged liver |
|
|
What is induration? |
A hard lump created in reaction to a mantoux. Indicates a positive result from a TB test. |
|
|
What are the medications given to a person with a positive TB test? |
INH and rifampin, which are hepatotoxic. |
|
|
When caring for a patient with TB, what are two things that must happen? |
* the patient must have a private well-ventilated room * the nurses must wear high efficiency particulate masks when in the patient's room |
|
|
What are the manifestations of the flu (influenza)? |
* Cough * fever * myalgia (joint pain) * headache * sore throat |
|
|
When asked what assessment data is the most important to report to a physician, what is the response? |
The assessment data that is NOT expected in the patient. That is a complication of the medical diagnosis, such as dyspnea with the flu. That is not a normal manifestation of the flu. |
|
|
What is Fungal pharyngitis and what is it treated with? |
Thrush or candidiasis from prolonged use of antibiotics or inhaled corticosteroids. It is treated with anti-fungals (Nystatin swish and swallow). |
|
|
What is bacterial pharyngitis and how is it treated? |
Strep throat. It is treated with warm liquids and antibiotics. |
|
|
What is pharyngitis? |
An inflammation of the pharyngeal walls, the tonsils, palate and uvula. |
|
|
What is Dressler's syndrome? |
A secondary form of pericarditis. Caused by damage to the heart, such as an MI. Can happen 2 - 3 weeks after an MI. |
|
|
What are the manifestations of Dressler's syndrome? |
* fever * pleuritic pain * pericarditis and/or pericardial effusion |
|
|
What is Beck's Triad? |
* Low BP * Increased JVD * muffled heart sounds (and possibly a pericardial friction rub) |
|
|
What is TEE and what does it help to diagnose? |
Transesophageal Echocardiography, helps to diagnose endocarditis. |
|
|
What is aortic valve stenosis? |
A narrowing of the aortic valve opening. Restricts blood flow from the left ventricle to the aorta. The most serious of the heart valve issues. Commonly develops in aging as calcium and scarring damages the valve. |
|
|
What is tricuspid valve stenosis? |
A narrowing of the tricuspid valve causing a reduction of blood flow from the right atrium to the right ventricle, causing an enlargement of the right atrium and shrinkage of the right ventricle. Eventually less blood circulates through the lungs. Most often caused by rheumatic fever. |
|
|
What is pulmonary valve stenosis? |
A narrowing of the pulmonary valve, causing a reduction of blood flow from the right ventricle to the pulmonary arteries. Most often caused by a congenital heart defect. |
|
|
What is mitral valve stenosis? |
A narrowing of the mitral valve restricting blood flow from the left atrium to the left ventricle, causing an increase in the left atrium. Most often caused by rheumatic fever. Also called "fish mouth valve" from it's discerning look. |
|
|
How do you diagnose endocarditis? |
* TEE * Blood cultures |
|
|
What is systole? |
The phase of the heartbeat when the heart muscle contracts and pumps blood from the chambers into the arteries. |
|
|
What is diastole? |
The phase of the heartbeat when the heart muscle relaxes and allows the chambers to fill with blood. |
|
|
What is preload? |
Preload is the filling pressure of the heart at the end of diastole. The greater the preload, the greater will be the volume of blood in the heart at the end of diastole. |
|
|
What is afterload? |
Afterload is the tension or stress developed in the wall of the left ventricle during ejection. |
|
|
What is SVR? |
Systemic Vascular Resistance is |
|
|
What is stroke volume? |
Blood from the left ventricle in one beat. (multiplied by the heart rate equals CO) |
|
|
What is myocardial contractility and what med can make it stronger? |
It is the intrinsic ability of the heart to contract. Digoxin is often given to make the contraction more forceful. |
|
|
What is CO and how is it calculated? |
Cardiac Output is the stroke volume multiplied by the heart rate. SV x HR = CO |
|
|
What are the neurological-hormonal mechanisms in the body that regulate blood pressure and cardiac output? |
* Autonomic Nervous System (symp. & parasym) * Baroreceptors in the carotid bodies & aortic arch * Aldosterone- Renin-Angiotensin System of the Kidneys, Adrenals |
|
|
· What are the three major factors that contribute to cardiovascular disease and atherosclerosis?
|
* Hypertension * Hyperlipidemia * Hyperglycemia |
|
|
What is metabolic syndrome? |
* Hypertension * Hyperlipidemia * Hyperglycemia * Overweight with visceral adipose tissue |
|
|
What is CRP and what does it reveal? |
C-reactive protein that reveals inflammation when discovered in blood serum. |
|
|
What constitutes a healthy blood pressure? What is pre-hypertension? What is hypertension Stage 1, Stage 2? |
Healthy is S <120 D <80 PreHTN is S 120-139 D 80-89 Stage 1 is S 140-159 D 90-99 Stage 2 is ≥160 and D ≥100 |
|
|
What is pheochromocytoma? |
A tumor on the adrenal gland that produces excess hormones causing hypertension, headaches and other symptoms. |
|
|
What are some identifiable causes of hypertension? |
* sleep apnea * drug related * chronic kidney disease * primary aldosteronism * renovascular disease * Cushing's syndrome (or steroid therapy) * pheochromocytoma * coarctation (congenital narrowing) of aorta * thyroid/ parathyroid disease |
|
|
A patient states that anginal pain increases after activity. The nurse should realize that angina pectoris is a sign of; A. Mitral insufficiency B. Myocardial ischemia C. Myocardial infarction D. Coronary thrombosis |
B. Myocardial ischemia |
|
|
What is ACS? |
Acute Coronary Syndrome is any condition characterized by signs and symptoms of sudden cardiac ischemia - reflects disease progression (unstable angina, EKG changes -STEMI or NSTEMI) |
|
|
What is atherosclerosis? |
The abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen. |
|
|
What is the treatment for hypertension? |
Treat to get the BP below 140/90 or, if the patient has diabetes or chronic kidney disease, then below 130/80. The majority of patients will require two medications to reach goal. |
|
|
For a patient with HTN and a compelling indication of heart failure, what is the initial therapy? |
* Thiazide diuretics * BetaBlockers * ACE inhibitors * ARBs (angiotensin receptor blockers) * Aldosterone antagonists (diuretic) |
|
|
For a patient with HTN and a compelling indiction of post MI, what is the initial therapy? |
* BetaBlockers * ACE inhibitors * Aldosterone antagonists (diuretic) |
|
|
For a patient with HTN and a compelling indiction of high CVD risk, what is the initial therapy? |
* Thiazide diuretics * BetaBlockers * ACE Inhibitors * Calcium channel blockers |
|
|
For a patient with HTN and a compelling indication of diabetes, what is the initial therapy? |
* Thiazide diuretics * BetaBlockers * ACE Inhibitors * ARBs (Angiotensin Receptor Blockers) * Calcium Channel blockers |
|
|
For a patient with HTN and a compelling indication of chronic kidney disease, what is the initial therapy? |
* ACE Inhibitors * ARBs (Angiotensin Receptor Blockers) |
|
|
For a patient with HTN and a compelling indiction of recurrent stroke prevention, what is the initial therapy? |
* Thiazide diuretics * ACE Inhibitors |
|
|
What can a person do to prevent coronary artery disease (what are the modifiable risk factors)? |
* control cholesterol through diet or meds * smoking cessation * increase physical activity * decrease obesity * reduce stress * treatment interventions for HTN & DM |
|
|
What is MAP and how is it calculated? |
Mean Arterial Blood Pressure. (SBP + 2DBP) / 3 |
|
|
A person's blood pressure is 120/80. What is the MAP? |
93 mm Hg |
|
|
What is important to remember when treating an elderly person for HTN? |
* Go low and go slow * 1st line of drug is diuretic * avoid use of NSAIDS with ACE inhibitors - can cause renal failure or hyperkalemia * watch for orthostatic hypotension * preferred meds for elderly is thiazide diuretics, CCBs, and RAAS blockers * do not give vasoactive meds after meals |
|
|
What are the clinical manifestations of a hypertensive crisis? |
* Headache * Nausea * Vomiting * Seizures * Confusion * Stupor * Coma |
|
|
What causes a hypertensive crisis? |
•Exacerbation of chronic hypertension •Renovascular hypertension (narrowing of arteries that carry blood to the kidneys) •Preeclampsia, eclampsia- pregnancy induced hypertension •Pheochromocytoma (tumor) •Drugs (cocaine, amphetamines) •MAO inhibitors with tyramine foods •Rebound HTN from abrupt drug withdrawal •Necrotizing vasculitis (autoimmune inflam. Of vessels) •Head injury •Acute aortic dissection
|
|
|
What is the nursing management of a hypertensive crisis? |
•Take BP and P every 2-3 minutes during initial administration of IV drugs (by MD) •IV medications include: vasodilators, adrenergic inhibitors, and ACE inhibitors •Prevent hypotension – could cause stroke, MI or visual changes •EKG monitoring for arrhythmias •Monitor hourly urine output for renal perfusion
•Neuro checks |
|
|
What is the collaborative management of a hypertensive crisis? |
•Hospitalization and intensive care monitoring •Mean arterial pressure (MAP) is used * MAP = (SBP + 2 DBP) 3 * Initial treatment goal is to decrease MAP by no more than 25 % within minutes to 1 hour * If stable target goal for BP is 160/100-110 mmHg over 2 to 6 hours
* Excessive lowering of BP may decrease cerebral , coronary, or renal perfusion and could precipitate a stroke, acute MI or renal failure |
|
|
What are the organs that are most affected by hypertension? |
* Heart * blood vessels * kidneys * eyes |
|
|
What is the DASH diet? |
Dietary Approaches to Stop Hypertension. It is a diet low in fat and cholesterol, rich in fruits and vegetables and low fat dairy products. |
|
|
What are the cholesterol levels that we should know? |
* Triglycerides less than 150 is normal, 200-500 is high * Total Cholesterol below 180 is ideal * LDL is optimal between 100-129 mg/dL * HDL is optimal at 60 or higher |
|
|
What are the different types of angina? |
* stable - predictable, with activity * unstable - credscendo or pre-infarction * intractable/ refractory - severe pain * Prinzmetal's angina - pain @ rest, reversible ST * silent ischemia - no pain |
|
|
What is the management of acute coronary syndrome (ACS)? |
* Initial Assessment- PQRST * 02 therapy * Diagnostic Testing * Cardiac Monitoring * Nitrates (vasodilators – Nitro – decreases preload) * Opioids – decreases preload, drops BP
*Anti-platelets - aspirin |
|
|
What is MONA? |
A mnemonic to remember the four primary interventions given for an acute MI * Morphine * Oxygen * Nitrates * Aspirin |
|
|
What are the biomarkers measured to detect a heart attack? |
* Troponin * CPK * myoglobin |
|
|
What is the normal level of troponin? |
0.01 |
