adult health

tracheostomy dislodgement

keep emergency equipment at the bedside, including obturator, trach insertion tray, spare trach tube, suction equipment, and BVM, if it occurs call RRT, cover the stoma, and provide BVM over the nose and mouth

tracheostomy suctioning

hyperoxygenate, insert sterile catheter without applying suction, STOP if resistance is met, withdraw catheter in a circular motion while suctioning, repeat PRN and hyperoxygenate after each pass

laryngectomy

surgical removal of the larynx (voice box), commonly to treat lung cancer, total=permanent trach, partial= temporary trach

aplastic anemia

bone marrow failure (caused by radiation, autoimmune disease), decreases RBC, WBC, and platelets (pancytopenia), petechiae and bleeding

hemolytic anemia

RBC destruction caused by autoimmune reaction (blood transfusions or meds), jaundice

b12 deficiency anemia

diet low in animal protein, low b12 absorption (pernicious= gastric bypass), numbness in hands/feet, glossitis

appendicitis

experience RLQ (McBurney) pain and rebound tenderness, never apply heat or give laxatives or enemas (increase the risk for rupture)

peritonitis

life threatening inflammation of the peritoneum, often occurs from bowel perforation, allowing bacteria to flood the normally sterile abdominal space leading to sepsis

peritonitis assessment findings

rigid board like abdomen, severe pain, abdominal guarding, rebound tenderness, fever, shock (increased HR and decreased BP)

diverticulitis

inflammation or infection of diverticula, stool can become trapped inside diverticula causing bacterial overgrowth, inflammation, pain, and risk for complications like perforation or abscess

how should patients prevent diverticulitis?

eating high fiber diet

diverticulitis assessment

LLQ abdominal pain, fever, chills, increased WBC, constipation, abdominal tenderness/bloating

diverticulitis treatment

antibiotics, rest bowel (NPO), NO laxative or enemas (bowel perforation risk)

peritonitis treatment

administer antibiotics and position knees flexed to decreased abdominal discomfort

bowel obstruction and treatment

abdominal distention and no flatus, keep client NPO and insert an NG tube to decompress the abdomen

osteoarthritis cause, pain pattern, morning stiffness, joints affected, and any systemic findings?

joint degeneration from repetitive stress, WORSE with activity better with rest, morning stiffness lasts less than 30mins, weight bearing joints affected (knees and hips), NO systemic findings

rheumatoid arthritis cause, pain pattern, morning stiffness, joints affected, and any systemic findings?

autoimmune disease that attacks joints and causes systemic inflammation, BETTER with activity, worse with rest, morning stiffness lasts more than 1hr, small joints affected (fingers and wrists), lots of systemic effects

RA systemic effects

fatigue, anorexia, weight loss, and increased inflammatory markers (ESR/CRP)

gout what foods to avoid?

foods high in purine, shellfish (shrimp), red meat, organ meat (liver), and alcohol

tumor lysis syndrome

monitor electrolytes to detect (hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia) if it occurs, correct imbalances with IV fluids, diuretics, and administer allopurinol to decrease uric acid

superior vena cava syndrome (SVC)

tumor in the neck obstructs the SVC, upper body edema, facial swelling, preorbital edema, distended neck and chest veins

cholecystitis sxs

RUQ pain radiates to right shoulder, pain with high fat, indigestion, nausea, vomiting, murphy sign (pain with palpation of RUQ during inhalation), steatorrhea, fever, WBC increase

what antispasmodic is given for cholecystitis?

anticholinergics dicyclomine

pancreatitis

acute or chronic inflammation of the pancreas and enzymes destroy pancreatic tissue, place in fetal position to relieve pressure on the abdomen

pancreatitis sxs

LUQ or epigastric pain that radiates to the back, N/V, abdominal bruising (cullen sign), discoloration of flank (grey turner sign), elevated pancreatic enzymes (amylase, lipase)

pancreatitis complications

hyperglycemia, ARDS, peritonitis/shock, hypocalcemia

infective endocarditis

Infection of the endocardium from bacteria, fungi, or viruses entering the bloodstream which prevents heart valves from fully closing, backward blood flow

endocarditis findings “FROM JANE”

Fever/chills/malaise, Roth spots (retinal hemorrhages), Osler’s nodes, Murmur, Janeway lesions (not painful spots on palms and soles, Anorexia, Nail bed splinter hemorrhages, Emboli to other organs (stroke, pulmonary emboli, petechiae)

pericarditis sxs

inflammation of pericardium, sharp, pleuritic chest pain that is worsened by lying flat and relieved by leaning forward

pericarditis meds

pericarditis meds

NSAIDs ibuprofen, colchicine (anti inflammatory), or corticosteroids, antibiotics caused by bacterial infection

pericarditis complications

signs of cardiac tamponade, beck triad (hypotension, JVD, muffled heart sounds) and pulsus paradoxus (drop in SBP >10 mmHg during inspiration)

cardiac tamponade

life-threatening condition where fluid rapidly builds up in the pericardial sac, compressing the heart and impairing its function, prepare for pericardiocentesis

crohn’s disease

non curable patchy inflammation that can affect ANY part of the GI tract from mouth to anus, fatty stools rarely bloody (steatorrhea), complications include malnutrition, fistulas, strictures, peritoneal abscess

ulcerative colitis

curable with colectomy, continuous inflammation LIMITED to the rectum and colon, bloody mucus filled stools, complications include hemorrhage and toxic megacolon (risk for bowel perforation)

myasthenia gravis (MG) cause and key findings

destruction of acetylcholine receptors, muscle weakness (repetitive movement muscles), worsens with activity

Guillain Barre- Syndrome cause and key findings

attack on peripheral nerves, often triggered by infection, ascending paralysis, areflexia (absence of muscle reflexes)

Multiple sclerosis causes and key findings

myelin destruction in CNS, episodic weakness, numbness, vision changes

interventions for Myasthenia Gravis

edrophonium test (tensilon) to diagnose, keep atropine bedside in case of bradycardia, admin pyridostigmine to improve symptoms

high pressure alarm causes?

obstruction, coughing, bronchospasm, secretions, client biting, ET tube kinked

low pressure alarm caused by?

disconnection or leak, tubing disconnected, ET tube cuff leak

collection chamber

collects air/blood/fluid, report >100ml/hr of bloody drainage

water seal chamber

prevents air from entering pleural space, monitor bubbling intermittent= normal, continuous=air leak, tidaling good

suction control chamber

applies controlled suction (wet suction), monitor bubbling gentle=normal, absence=not enough suction