Zachs study guide D444

priority intervention for ocular chemical burn

immediate irrigation to prevent permanent damage

nursing intervention for ocular scratches

evaluate for redness, tearing, photophobia, or foreign body sensation

Patient teaching for ocular scratches

apply a cold compress, lubricating eye drops, and oral analgesics. apply eye patch and avoid rubbing the eye

s/sx of corneal abrasion

severe pain, tearing, photophobia, and blurred vision

nursing intervention for corneal abrasion

Apply topical cycloplegic drops to help with pain, and use the prescribed topical antibiotic drops as prescribed.

patient teaching for corneal abrasion

avoid topical anesthetics at home because they can delay healing, and avoid contact lenses until healed

Nursing priorities with all eye injuries

Immediate protection of vision by irrigation, shielding, and preventing further trauma.

Pain management by using medications as prescribed and patient teaching with necessary follow-up.

Ensure medications are followed and eyewear is used to prevent recurrence.

Summary of eye injuries

chemical burns -> immediate copious irrigation, pH eye testing, eye shield. urgent referral

scratches -> lubrication, antibiotics, cold compress, no rubbing

corneal abrasions -> cycloplegics for pain, antibiotics, avoid anesthetics at home, recheck in 24 hrs.

pneumonia pathophysiology

microorganisms enter alveoli -> inflammatory response -> alveolar edema and consolidation -> impaired gas exchange -> hypoxemia

s/sx of pneumonia

fever, chills, productive cough, dyspnea, tachypnea, crackles, rhonchi, bronchial breath sounds

s/sx of pneumonia in geriatrics

confusion, hypothermia, poor appetite, and generalized weakness

how to diagnose pneumonia

chest x-ray, sputum culture/gram stain, CBC (leukocytes), ABG's, pulse oximetry

how is pneumonia treated

with antibiotics, antivirals, and antifungals

nursing interventions for pneumonia

assessing respiratory status and administering oxygen as ordered. encourage the patient to cough and deep breathing while in semi-fowlers or high-fowlers position.

patient teaching for pneumonia

complete the entire course of antibiotics, rest and increase fluids, avoid alcohol and smoking, and report worsening symptoms

lab value for liver

ALT

normal = 7-56

lab value for kidney

creatinine

normal = 0.6-1.3 mg/dL

lab value for heart

troponin I

normal is anything < 0.04

lab value for the lungs

PaO2

normal = 80-100 mmHg

lab value for pancrease

lipase

normal = 23-300 U/L

thyroid lab value

TSH (thyroid stimulating hormone)

normal = 0.4-4.0 mU/L

lab value for blood

hemoglobin

normal = men 14-18, women 12-16 g/dL

lab value for coagulation

INR

normal = 0.8-1.2

lab value for bones

calcium

normal = 8.5-10.5

lab value for neurologic system

sodium

normal = 135-145

lab value for nutrition

albumin

normal = 3.5-5.0

what is respiratory acidosis

when Co2 is retained due to inadequate ventilation which creates excess carbonic acid and decreases pH

what does respiratory acidosis cause

asthma, COPD, and pneumonia

what is respiratory alkalosis

where too much CO2 is exhaled, which results in less carbonic acid and increases pH.

what does respiratory alkalosis cause

hyperventilation, hypoxemia, and CNS stimulation

what is metabolic acidosis

occurs when the body loses bicarbonate or accumulates acid, resulting in decreased ph

what does metabolic acidosis cause

ketoacidosis, lactic acidosis, renal failure and diarrhea

what is metabolic alkalosis

a condition where the body accumulates too much bicarbonate or loses acid, which increases the pH

what does metabolic alkalosis cause

vomiting, diuretics, and excess antacids or bicarbonate administration

what does vomiting cause

metabolic alkalosis - loss of stomach acid reduces acid, and the body becomes alkaline

what does an NG tube cause

metabolic alkalosis, which is the same as vomiting, it removes gastric acid

what does diarrhea cause

metabolic acidosis - loss of bicarbonate from the intestines makes the body more acidic

what does hyperventilation cause

respiratory alkalosis - blowing off too much CO2 increases the pH

what does hypoventilation cause

respiratory acidosis - the body retains CO2 and decreases pH

HIV pathophysiology

it is a retrovirus that attacks the immune system. it targets the helper T cells. Over time, the loss of helper T cells weakens the immune system, leaving the body vulnerable to opportunistic infections and cancers.

how is HIV spread

through bodily fluids

blood, semen, vaginal fluids, rectal fluids, or breast milk

what are the normal CD4 levels

500-1,600 cells

aids = <200 cells

how is HIV treated

by ART therapy for life, monitor CD4 and viral load

nursing care for HIV

infection prevention, medication adherence, psychosocial support, and safe sex education

what is tinea pedis and what causes it

a fungal infection of the feet caused by dermatophytes

s/sx of tinea pedis

itching, burning, stinging between the toes, scaling, redness, peeling, fissures, etc.

interventions for tinea pedis

Keep the feet dry and wash daily with soap/water and dry thoroughly. remove shoes/socks when possible and wear breathable shoes

what drugs are used for tinea pedis

clotrimazole and terbinafine

nursing care for tinea pedis

watch for secondary bacterial infection especially in diabetic patients

what are the short acting beta 2 agonists?

albuterol and levalbuterol = they relax the airway smooth muscle which leads to rapid bronchodilation

what are the side affects of albuterol and levalbuterol

tachycardia, tremors, and nervousness

what drugs are the long acting beta 2 agonists

salmeterol and formoterol = these help with long term bronchodilation

*always used for maintenance never for attacks

what drugs are inhaled corticosteroids

fluticasone, beclomethasone = anti-inflammatory and decrease airway swelling and mucous

what are the side effects of inhaled corticosteroids

oral thrush and hoarseness

teach patient to rinse mouth to prevent oral thrush

what drugs are the oral/systemic corticosteroid

prednison, methylprednisone = used for short term burst for severe exacerbations

what are the side effects of oral corticosteroids

hyperglycemia, weight gain, mood changes, and infection risk

what are leukotriene modifiers

they block inflammatory mediators and are used for long term control especially for allergic asthma

what asthma drug can you never use on your own

a long acting beta2 agonist like salmeterol. always pair it with ICS (inhaled corticosteroid)

what is COPD

a progressive irreversible lung disease characterized by airflow limitation. It includes chronic bronchitis and emphysema

what are the nursing interventions for COPD

high fowlers position and administering oxygen as ordered. encourage pursed lip breathing and teach diaphragmatic breathing.

monitor for hypoxemia and hypercapnia. encourage nutrition and infection prevention

what drugs are use in COPD

Bronchodilators = SABA and LABA

anticholinergics = ipratropium and tiotropium

inhaled corticosteroids = for frequent exacerbations and systemic steroids for acute exacerbations

what drugs can become hepatotoxic

acetaminophen

statins

antitubercular

antifungals

anticonvulsants

what drugs are statins

atorvastatin, simvastatin

what do statins do

they reduce the production of cholesterol in the liver

what drugs are antitubercular

isoniazid, rifampin, pyrazinamide

what drugs are antifungal

ketoconazole, itraconazole, fluconazole

what drugs are anticonvulsants

valproic acid, phenytoin, carbamazepine

nursing interventions for hepatotoxic drugs

monitor ALT, AST and bilirubin

teach patients to avoid alcohol, report jaundice, dark urine, and abdominal pain

what drugs cant be given together

opiods and benzodiazepines

warfarin + NSAID's

ACE inhibitors + potassium sparing diuretics

Statins + macrolide antibiotics

SSRI's + MAOI's

what is celiac

an autoimmune disorder triggered by the ingestion of gluten that leads to inflammation and damage of the small intestines villi, causing mal absorption of nutrients

what foods do people with celiac avoid

wheat, barley, rye, triticale

nursing intervention with celiac disease

teach patients to always read the food label for hidden gluten and encourage a dietician consult for safe, balanced nutrition

what is chron's disease

chronic relapsing autoimmune inflammatory bowel disease that can affect any part of the GI tract

what drugs are taken for chron;s disease

anti-inflammatories, immunosuppressants, biologics, nutritional support.

nursing intervention with chron's disease

bowel rest, IV fluids/electrolytes, pain management (avoid opioids)

what are esophageal varices

dilated fragile veins in the lower esophagus caused by portal hypertension. the veins are at a high risk of rupture and massive hemorrhage

how do esophageal varices happen?

Liver disease causes scarring, which blocks normal blood flow through the liver. Liver disease causes scarring, which blocks normal blood flow through the liver. The blood backs up into the portal vein, which causes portal hypertension. pressure forces blood into smaller collateral veins, including those in the esophagus and the veins become enlarged and fragile, which causes them to rupture.

what does an esophageal varice put you at risk for

massive upper GI hemorrhage, hypovolemic shock, and a high risk of death if untreated.

what is multiple sclerosis

chronic progressive autoimmune disease of the CNS. the immune systm attacks the myelin sheath of neurons and causes demyelination and scarring.

nursing interventions for MS

disease modifying therapies that slow progression. for acute relapses use corticosteroids to reduce inflammation. for symptom management use muscle relaxants, anticholinergics, and antidepressants.

what is huntingtons disease

progressive neurodegenerative disorder caused by a mutation in the HTT gene. It leads to the breakdown of nerve cells in the brain

s/sx of huntingtons disease

involuntary jerky dance like movement, poor concentration, depression, anxiety, irritability, and aggression

nursing interventions for huntingtons disease

tetrabenazine for the involuntary movements, SSRI's for depression, haloperidol for aggression or psychosis

fall prevention, high calorie diet for energy loss, speech therapy, emotional support, and end of life planning

what is myasthenia gravis

chronic autoimmune neuromuscular disorder characterized by fluctuating weakness of voluntary skeletal muscles, often worse with activity and improves with rest.

caused by antibodies that attack acetylcholine receptors at the neuromuscular junction, leading to impaired nerve-to-muscle transmission.

s/sx of myasthenia gravis

drooping eyelids and double vision, dysphagia, dysarthria, risk of aspiration, muscle weakness, and increased weakness with increased activity

drugs for myasthenia gravis

anticholinersterase to improve strength, corticosteroids to suppress immune response.

nursing interventions for myasthenia gravis

monitor respiratory status, give medications before meals, implement aspiration precautions, and provide rest periods

what is glaucoma

a group of eye disorders characterized by increased intraocular pressure, optic nerve damage, and progressive, irreversible vision loss

what are cataracts

clouding of the eyes lens leading to decreased vision. lens proteins break down and clump, making the lens more cloudy

what is the pre-op care for cataract surgery

explaining the procedure to the patient and giving eye drops before surgery to dilate the pupil. antibiotic drops are used to reduce inflammation, NSAID drops are used to reduce inflammation, and the patient is ensured to have a ride home because it is an outpatient procedure

what are the post-op instructions for cataract surgery

aantibiotic drops and corticosteroid/NSAID drops are used to help with inflammation

eye shield at night or when sleeping and sunglasses to help with light sensitivity

avoid rubbing the eye and wash hands frequent;y

what is psoriasis

chronic autoimmune disorder caused by the rapid turnover of epidermal cells, which results in thick, scaly, and inflamed plaques on the skin

what is gerd?

gastroesophageal reflux disease

what medications are used with GERD

antacids, H2 blockers, and proton pump inhibitors for strong acid suppression

what do you do with GERD if medication fails?

surgical option of Nissen fundoplication which is the fundus of the stomach wrapped around the LES to strengthen it

what is a hiatal hernia

protrusion of part of the stomach into the thoracic cavity through the esophageal hiatus of the diaphragm

what is a sliding hiatal hernia

stomach + LES slide upward into the chest when supine, and lead to reflux symptoms

paraesophageal hernia

the stomach fundus rolls up beside the esophagus leading to less reflux but a rik of strangulation

what is H pylori

high yield GI infection

what medications are contraindicated with H pylori

NSAIDs: cause mucosal irritation and increase bleeding risk

Corticosteroids: prednisone also increases the risk of bleeding

Alcohol: worsens gastric mucosal injury

Anticoagulants: increase bleeding risk with ulcers