adult health 1 Final review

jeopardy and kahoot: Fluid and Electrolytes, Acid Base Balance, COPD, TB, Heme GI, Cardiac Diagnosis, Cardiac Treatment, Heme Misc, ARDS, Asthma, Misc Respiratory

What is the normal value for serum potassium?

3.3-5 mEq/L

What are signs and symptoms of hyperkalemia?

TIGHT AND CONTRACTED-ST elevation and peaked T waves, arythmias of vfib and cardiac standstill, hypotension, bradycardia, diarrhea, hyperactive BS, paralysis, muscle weakness

What are signs and symptoms of hypokalemia?

LOW & SLOW; Flat T waves, ST depression, Promienent U waves, decreased DTR, muscle cramping, parlyzed limbs, decreased GI motility, hypoactive BS, constipation, abd distenstion, parlytic illeus

What is the normal value range of serum sodium?

135-145

What are signs and symptoms of hypernatremia?

Big & Bloated; skin is flushed, edema, low grade fever, polydipisia, late- swollen dry tongue, nausea and vomiting, increased muscle tone

What are signs and symptoms of hyponatremia?

DEPRESSED & DEFLATED; seizures and coma, tachycardia and weak thready pulses, respiratory arrest

What are normal ranges for serum calcium?

9.0-10.5 (Bones, blood, beats)

What are signs and symptoms of hypercalcemia?

CALM & QUIET; heart block, prolonged PR intervals, hypoflexia DTR, Depressed and swallow respiration, hypoactive BS

What are signs and symptoms of hypocalcemia?

BUCK WILD; ST depression, T wave inversion, sever- Vfib, Tachycardia; hyporeflexes- increased DTR, abnormal eye movements (nystagmus) diarrhea

What are nursing interventions for hyperkalemia?

increase fluids, use diuretics, hold K+, dialysis, monitor kidney function, monitor EKG and BS.

What are nursing interventions for hypokalemia?

increase foods high in K+ add K+ supplements, recognize s/sx of hypo

what are K+ rich foods?

bananas, dark green leafy vegs, raisins, salt substitutes, bran cereal, potatoes, dried beef

What are nursing interventions for hypernatremia?

Check I&O, weight, admin diuretics, manage sodium intake, increase hydration

What are nursing interventions for hyponatremia?

Check I&O, weights, monitor neuro signs and symptoms, check for edema, manage fluid intake, administer hypertonic saline (NS 0.9%)

what are signs and symptoms of Respiratory Acidosis?

bradycardia, hypotension, agitation, altered mental status, trouble staying awake, retaining CO2, confusion

what causes of Respiratory Acidosis?

Hypoventilation, Respiratory Depression, Asthma, COPD, Pneumonia,Pulmonary Edema

what are sign/Symptoms for Metabolic Acidosis?

Headache, lethargy, Kussmauls's respiration, Nausea, vomiting, confusion, coma

What are causes of Metabolic Acidosis?

Acid increase: Keto Acidosis, starvation, Lactic Acidosis: Shock hypoxemia

Decreased Bicarbonate: severe diarrhea, renal failure

what are signs and symptoms of Respiratory Alkalosis?

Tachycardia, anxiety, confusions, diaphoresis, dizziness, coma

what are causes of Respiratory Alkalosis?

Hyperventilation, Hypermetabolic states: Fever, anemia, septicemia, Anxiety, pain

What are signs/symptoms for Metabolic Alkalosis?

Weakness muscle cramps, hyperactive reflexes, tetany, confusion, slow shallow respirations to minimize co2 loss(Body needs this to counter alkalotic state), nausea, seizures

What are causes for Metabolic Alkalosis?

Antacids, Hyperaldosteronism; Cushing's disease, steroids, Acid loss by: vomiting, gastric suctioning, Diuretics-K+/NA+ loss

what is the normal value for pH?

7.35-7.45 acid blood level (normal is 7.40)

what is the normal value for PaCO2?

35-45 carbon dioxide (respiratory)

what is the normal value for HCO3?

22-26 base (metabolic)

what is the normal value for PaO2?

80-100 partial pressure of oxygen in bloood

What are the signs, symptoms and lab values for COPD?

- Chronic productive cough 3+ months over 2+ years

- Bronchial walls thicken d/t chronic inflammation, impedes airflow, cannot maintain oxygen levels

- Alveolar walls adjacent to bronchioles become thickened, fibrosed

- Impaired Ventilation: increased mucus, obstruction of small airways, chronic productive cough

- Viral, bacterial respiratory infections common (alveolar macrophages dysfunctional d/t damage)

- Low PaO2- Hypoxemia and High PaCo2-hypercapnic

What are signs and symptoms of Emphysema?

- PINK PUFFER- damage to alveloi results in loss of lung elasticity & loss of inflation of lung tissue

- results in loss of lung tissue recoil and air trapping

P: pink skin, pursed lip breathing

I: Increased chest- barrel chest

N: Minimal or NO chronic cough

K: Keep tripoding

What are signs and symptoms of Chronic Bronchitis?

- Inflammation of the bronchi and excessive mucus production resulting in a chronic hacking cough and recurrent infection

B- big and blue skin- cyanosis (hypoxia)

L- long term chronic cough and sputum

U- Unusual lung sounds- crackles and wheezes

E- Edema peripherally due to cor pulmonale

What are the nursing priorities and interventions for patient with COPD?

- Proper positioning- sit patient upright/high fowler's

- May need BiPAP- to decrease hypercapnea

- Avoid opioids & benzodiazepenes because the decrease breathing which may worsen oxygenation status/respiratory acidosis.

- Anxiety- COPD patients are frequently anxious due to the inability to breathe. Assist with relaxation techniques and pursed lip breathing to prevent air trapping and airway collapse during expiration

What are the important patient teaching for patients with COPD?

- Promote health eating- small frequent meals with rest periods, high calorie and high protien

- Avoid- high carbs, exercise 1 hour before/after meals to conserve energy. Avoid gassy foods

- Increase fluid intake (8 glasses or 2-3L daily) to thin mucous. Avoid drinking fluids with meals

- Report increase in sputum, fever or worsening dyspnea

- Prevention- pneumococcal every 5 years, flu vaccine every year

- Meds- good inhaler technique. Always have albuterol to lessen cough and wheezing

- Bronchitis- guaifensesin and cool mist humidifier to mobilize secretions

- Pursed lip breathing- inhale 2 seconds, exhale 4 seconds

- Hugg coughing technique- sit upright in chair, deep slow inhalation, hold breath for 2-3 seconds and then forcefully exhale

What is Tuberculosis (TB)?

What type of infection is TB and caused by what bacteria?

Bacterial infection caused by M. Tuberculosis.

how is TB spread?

Spread by airborne route. Inhaled in the lungs and spread to lymph and blood stream

What are the signs and symptoms of TB?

Night sweats, anorexia/ weight loss, cough and hemoptysis- blood tinged sputum, dyspnea and SOB, fever and chills

How is TB diagnoses?

Positive INTRADURMAL Mantoux testing over 15mm duration= positive TST AND Positive Chest x-ray

what are the 3 things that you must have to diagnose TB?

3 sterile positive sputum cultures in 3 consecutive days

What are the 4 TB meds

RIPE:
Rifampin, INH Isoniazid, Pyrazinamide, Ethambutol

what is the precautions with administration and monitoring of Rifampin?

RED-FAMPIN- normal to see red, orange in tears urine and sweat. Pts should not wear contacts due to discoloration of tears; oral contraceptives are NOT effective; use back up birth control, monitor for jaundice; heptotoxic!

what is the precautions with administration and monitoring of INH Isoniazid?

interferes with Vit B6 so monitor for peripheral neuropathy- new numbness, tiingling extremities, ataxia. Pts may be on Vit B6 25-50mg daily for supplementation. Hepatotoxic- report jaundice, dark urine, elevated liver enzymes (HOLD MEDS); NO ETOH

what is the precautions with administration and monitoring of Pyrazinamide?

3rd TB drug; hepatotoxic

what is the precautions with administration and monitoring of Ethambutol?

EYE; May cause blurred vision, color changes!

How long is TB medication treatment?

Medication treatment 6-12 months

What kind of mask do you wear when caring for TB?

You must weark N-95 mask with patient care at all times

When is a patient deemed no longer infected with TB? What test results need to happen with TB?

Pt is no longer infected if they have 3 negative cultures on 3 different days

What is characteristic of Vitamin B12 and folate deficiencies?

- Vitamin B12 and folate deficiencies are characterized by the production of abnormally large erythrocytes called megaloblasts

- Because these cells are abnormal, many are sequestered (trapped) while still in the bone marrow, and their rate of release is decreased

- Some of these cells actually die in the marrow before they can be released into the circulation

- This results in megaloblastic anemia

What are the characteristic signs and symptoms of iron deficiency and anemia?

Iron deficiency in the adult generally indicates blood loss (from bleeding in the GI tract or heavy menstrual flow). Bleeding in the GI tract can be preliminarily identified by testing stool for the presence of blood

Thrombocytopenia is related to what?

can result from a decreased platelet production, increased platelet destruction, or increased consumption of platelets

Impaired platelet communication, antibodies, and autoimmune processes are not typical pathologies

What is the first action a nurse should do when suspects a hemolytic blood transfusion reaction?

Stop the blood

The most common causes of acute hemolytic reaction are errors in blood component labeling and patient identification that result in the administration of an ABO-incompatible transfusion

Prophylactic antihistamines are not normally given, and would not prevent acute hemolytic reactions. Similarly, baseline vital signs and slow administration will not prevent this reaction.

What is DIC (Disseminated intravascular coagulation)?

may occur either as a cause or as a complication of shock

widespread clotting and bleeding occur simultaneously. Bruises (ecchymoses) and bleeding (petechiae) may appear in the skin. Coagulation times (e.g., prothrombin time [PT], activated partial thromboplastin time [aPTT]) are prolonged. Clotting factors and platelets are consumed and require replacement therapy to achieve hemostasis.

urinary output of 30 ml/hr is key assessment

how many ml/hr is normal urinary output?

30 ml/hr

What is the most common cause of peptic ulcer?

Most common cause of peptic ulcers is gram-negative bacteria (Helicobacter pylori)

What are some key aspect of duodenal ulcer?

- often awakens between 1 and 2 with pain

- ingestion of food brings relief but experience pain 2 to 3 hours after a meal

- cause hypersecretion of stomach acid

- Vomiting is uncommon

- Hemorrhage is less likely in the client with duodenal ulcer than in the client with gastric ulcer

- may experience weight gain

- black tarry stool (melena)

what is a peptic ulcer?

a sore on the lining of your stomach, small intestine or esophagus

esophageal ulcer occurs where?

occurs in the lower part of your esophagus

A duodenal ulcer is a peptic ulcer that develops in the what?

in the first part of the small intestine (duodenum)

A peptic ulcer in the stomach is called what?

Gastric Ulcer

what do patients with a Gastric ulcer experience?

- can vomit blood
- pain increased with food (30-60min)
- weight loss

Pt states they have sharp pain resolved with eating, what could this be a sign of?

Peptic Ulcer

why would a Pt with a Peptic Ulcer state they have sharp pain resolved with eating?

Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food

The stomach, which stores and mixes food with secretions, secretes a highly acidic fluid in response to the presence or anticipated ingestion of food

What are some nursing interventions for hiatus hernia?

Eating smaller meals to reduce stomach bulk

Avoiding stimulation of gastric secretions by vomitting, caffeine, and alcohol, which may intensify symptoms

Refraining from smoking, which stimulates gastric acid secretions

Avoiding fatty foods, which promote reflux and delay gastric emptying

What are the steps when finding someone down or just collapsed?

Gently shake and shout “Are you OK?”

Shout for help (“call a code”)

Check for a carotid pulse

Begin chest compressions

What is the normal range of a troponin level?

between 0 and 0.04 ng/ml

How do we interpret an elevated troponin level?

Very high levels of troponin are a sign that a heart attack has occurred

Most patients who have had a heart attack have increased troponin levels within 6 hours.
After 12 hours, almost everyone who has had a heart attack will have raised levels

Troponin levels may remain high for 1 to 2 weeks after a heart attack

What is information is important to gather when a patient complains of chest pain?

The nurse must gather information about the patient's symptoms and activities, especially those that precede and precipitate attacks of angina. Scale 0-10, did nitro resolve the pain.

What is cardiac output?

computed by multiplying the stroke volume by the heart rate

can be affected by changes in either stroke volume or heart rate, such as a heart rate being low or high.

What is pericarditis?

swelling and irritation of the thin, saclike tissue surrounding the heart

What are signs and symptoms of pericarditis?

Sharp, grating, pleuritic chest pain (inspiratory), pleuritic chest pain (inspiratory), and ­ increased WBC, dyspnea (splinting) are all assessment findings related to pericarditis

Why is an MI with ST elevation an emergency?

A heart attack with a completely blocked coronary artery is called a STEMI

STEMI stands for ST Elevation Myocardial Infarction.

What is percutaneous coronary intervention (PCI)?

PCI uses a balloon tipped catheter to open blocked coronary vessels

What are the signs and symptoms of hypovolemic shock?

a decrease in intravascular volume. Cardiac output is decreased, blood pressure decreases, and pulse is fast, but weak.

What is Neurogenic shock ?

Neurogenic shock can be caused by spinal cord injury.

What are the signs and symptoms of Neurogenic shock?

WARM DRY SKIN is KEY

low blood pressure; bradycardia; and warm, dry skin due to the loss of sympathetic muscle tone and increased parasympathetic stimulation

What is this rhythm?

V Tach

What medication is used for V Tach?

SVT Adenosine

What is this rhythm?

Ventricular fibrillation

What rhythm is this?

A Flutter

What is Sickle Cell disease?

one of a group of inherited disorders known as sickle cell disease. It affects the shape of red blood cells, which carry oxygen to all parts of the body.

some red blood cells are shaped like sickles or crescent moons. These sickle cells also become rigid and sticky, which can slow or block blood flow.

What are nursing interventions for patient care of Sickle Cell disease?

There's no cure for most people with sickle cell anemia. Treatments can relieve pain and help prevent complications associated with the disease.

Hydration is key

what is the normal hemoglobin value?

12-18

what is the normal HCt value?

36-54%

what is the normal platelet value?

140,000-400,000

what is the normal WBC value?

4500-11,000

What are key nursing interventions for neutropenia?

- Avoid all fresh fruits and vegetables, including all fresh garnishes

- Avoid raw or rare-cooked meat, fish, and eggs

- Avoid salad bars, fruit bars, and deli counters

- Avoid raw nuts

- Make sure all of the dairy products you eat are pasteurized

- Avoid yogurt and yogurt products with live and active cultures

- Monitor for temperatures. if fever then culture

When caring for postoperative patient's what are the key nursing assessments?

ABC:

Airway

Breathing

Circulation-hemorrhage

What places patient at risk for multiple organ dysfunction syndrome (MODS)?

The client with advanced age is at risk for developing MODS due to the lack of physiological reserve. The client with malnutrition metabolic compromise and the client with multiple comorbidities is at risk for developing MODS due to decreased organ function.

What happens in the body during Acute Respiratory Distress Syndrome (ARDS)?

Diffuse inflammatory damage to alveolar capillary membranes, inflammatory exudate builds up in alveoli and causes collapse.
- Shunting of blood
- decreased perfusion
- increased capillary pressure
- hypoxiema

What causes ARDS?

Imparied gas exchange leads to multisystem organ failure. It is a secondary disorder cause by something such as sepis, trauma or shock.

What is Acute Respiratory Failure (ARF)?

Hypoxemic failure (Low O2 and High Co2)

What is the medical management for ARDS?

Identify primary disorder. Agressive respiratory support including PEEP (improve alveoli function). increase FiO2 to keep PaO2>60 mm Hg; Spo2>90%

Balance fluid resuscitation. treat shock.

What is the priority complication of ARDS?

MORTALITY RATE- 35-60%

How is ARDS treated?

Balance fluid resuscitation. treat shock.

What are 4 priority assessments and s/s of ARDS?

- recognize early

- May mimic pulm edema

- First sign of hypoxemia- Agitation, restlessness, confusion

- Increasing anxiety, SOB, tachypnea, dyspnea

- Decreased breath sounds with crackles. Retractions

- Hypoxemia despite high FiO2. Hypotension, Tachycardia. shock. pulmonary hypertension.

What is 1 of the priority nursing diagnosis for ARDS?

Impaired Breathing Pattern- Impaired Respiratory Function, inflammatory response and pain

What are the nursing interventions for ARDS?

H-O-L-Y
High fowler's, oxygen and suctioning, listen to lung sounds, yell for help (notify HCP)

Monitor respiratory status. Positioning to optimize inhalation and chest expansion.

Freq turning to improve ventilation and perfusion

Promote comfort

Monitor for complications- pneumothorax, PE/blood clots

What is the proper positioning for a patient with ARDS?

Prone positioning may be utilized to max oxygenation

What are signs and symptoms of asthma?

A-S-T-H-M-A
A- accessory muscle use

S- shortness of breath and dyspnea

T- tight chest and tachypnea

H- high pitched wheezing

M- minimal diminished breath sounds

A- Absent breath sounds (silent chest) PRIORITY, acidosis, air trapping (prolonged expiration)

MAY LEAD TO RESPIRATORY FAILURE= High CO2, hypercapnic; Respiratory acidosis- PaO2< 80 Hypoxic

What is the first sign and symptom of an asthma exacerbation?

Night time non-prod cough

What are danger signs of an asthma exacerbation?

1st sign of hypoxia- mental status change

2. agitation

3. restlessness

4. drowsiness

*Status asthmaticus- may require endotracheal intubation

what is the first sign of hypoxia?

mental status change