things i dont know 2

Constipating foods

cheese, lean meat, eggs, pasta

Foods with laxative effect

Frutis + vegetables, bran, chocolate, alcohol, coffee

Gas producing foods

Onions, cabbage, beans, cauliflower

How do opioids affect stool 

constipation

How do antacids affect stool

• decrease GI motility

• Antacids neutralizes stomach acids (HCl)

What are the effects of antibiotics, magnesium, and metformin on stool?

Diarrhea

What medications slow gastric motility and causes constipation?

• antacids

• anticholinergics and antipasmodics

• antiseizure

• ca2+ channel blockers

• diuretics

• iron supplements

• anti-parkinson’s disease meds

• narcotic pain meds

• antidepressants

What is ulcerative colitis

Ulcerations and inflammation of the colon

Chron’s disease

Inflammation of small intestine, but could affect any part of GI tract

What is in a colostomy diet

• low fiber first 6-8 week

• 2,5 quarts fluids

• avoid foods that cause blockages (nuts, corn, popcorn, coconuts)

• avoid foods that cause gas or produce odor

• add foods that thicken stool: bananas, cheese, pasta, rice, yogurt, applesauce, potatoes 

What medications affect the CNS?

opioids, sedatives

What medications decrease heart rate and cardiac output?

Beta adrenergic antagonists (beta blockers)

Medications that cause lung disease

Chemotherapeutic agents

How does stress affect respiratory

• excessive sighing

• hyperventilation → anxiety 

How does anxiety affect respirations

Bronchospasm, bronchial asthma

What are the early manifestations of hypoxia

1. tachypnea/tachycardia

2. restlessness, anxiety, confusion

3. pale skin, pale mucous membranes

4. elevated blood pressure

5. use of accessory muscles

What accessory muscles are used during hypoxia

Sternocleidomastoid muscles, scalene muscles, trapezius muscles, intercostal muscles, abdominal muscles 

What are the late manifestations of hypoxia

1. stupor

2. cyanotic (no longer pale) skin, nail beds, palms, mucous membranes

3. bradypnea

4. bradycardia

5. hypotension

6. cardiac dysrhythmias

When are oxygen devices / oxygen therapy used?

Early and late manifestations of hypoxia

• not intended to support ventilations (number of breaths)

What oxygen devices are low flow delivery

Nasal cannula (24 - 44% @ 1-6L/min

Simple face mask (35 - 50% @ 5-8L/min

Non-rebreather (80 - 95% @ 10-15L/min

What are some nursing interventions for oxygen therapy/oxygen device uses

1. humidification

2. pressure assessment

3. proper fit

4. switch to NC for mask wearers while eating

5. Inflated reservoir bag (non-rebreather)

6. Reassess oxygenation status

What are some high flow delivery devices?

High flow nasal cannula (23 - 100% @ 10-60L/min)

Venturi Mask (24 - 50% @ 4-12L/min)

Aerosol Mask (24 - 100%@ 10L/min)

CPAP, BiPAP

When are aerosol masks used?

For pediatrics or tracheostomy  

• tracheostomy: stoma created in front of neck that leads directly to trachea 

What are some oxygen complications?

1. Toxicity (extended exposure to high concentrations)

• cellular damage causes alveolar collapse

2. Hypoventilation (depression of respiratory center)

• COPD, sleep apnea, neuromuscular diseases

3. Combustion

• oxygen is high flammable and can explode 

What are the methods for airway clearance?

1. Cough - clearance + specimen collection 

2. Suctioning - clearance + specimen collection 

3. Chest physiotherapy 

4. Intubation (artificial airway_ 

5. Tracheostomy 

When should sputum specimens be obtained?

• prior to first meal or 2 hours after eating

• by cough or endotracheal suctioning

What are the three methods of suctioning

1. Oral

2. Nasal

3. Endotracheal

How to do oral suctioning?

1. oropharyngeal

2. yankauer suction catheter

3. medical asepsis (clean technique)

How to do nasal suctioning?

1. nasopharyngeal 

2. flexible catheter (lubricated)

3. surgical asepsis

How to do endotracheal suctioning?

1. suction catheter with small bore to prevent tracheal obstruction and hypoxia

2. hyper-oxygenate w/ bag-valve-mask

3. only 10-15 seconds each pass (max 5 minutes)

4. surgical asepsis (sterile)

Use when patient is unable to cough or clear own secretions 

What are the techniques for chest physiotherapy?

1. percussion

2. vibration

3. postural drainage

• to loosen and mobilize secretions for expectoration

• contraindicated in patients with pregnancy, trauma, neurologic diagnoses, post-surgical, pulmonary emboli

What is CPAP

Continuous positive airway pressure

• constant, steady stream of pressurized air throughout breathing cycle

• keeps airway open so it doesn’t collapse

What are CPAPs used for

1. Sleep apnea (OSA)

2. Heart failure o

3. Pulmonary edema

KEEP AIR WAY OPEN

What is BiPAP

Bilevel positive airway pressure

• Provides inspiratory and expiratory airway pressure

• IPAP: high pressure to assist inhalation

• EPAP: lower pressure to keep alveoli open during exhalation

What is BiPAP used for?

1. COPD

2. Neuromuscular disorders or weak respiratory 

3. Acute/Chronic hypercapnic respiratory failur

Helps to breath in and out

What is urinary calculi?

Kidney stones

What is gout

Uric acid crystals in joints (associated with renal problems)

What do diuretics do

prevent reabsorption of water and certain electrolytes in tubules → excrete more urine

What do cholinergic medications do in urine productin and elimination

Stimulate contraction of detrusor muscle, producing urination 

What do analgesics and tranquilizers do on urine production

suppress CNS, diminish neural reflex effectiveness

What do anticoagulants do to affect urine color

red urine

what do diuretics do to urine color

pale yellow

what does pyridium do to urine color

orange to orange-red urine

what does antidepressant amitriptyline or b complex vitamins do to color

green or blue-green urine

what does levodopa do to urine color

brown or black urine

What is stress incontinence

due to increased abdominal pressure under stress (weak pelvic floor muscles)

What is urge incontinence

involuntary contraction of bladder muscles

What is overflow incontinence 

blockage of urethra 

Neurogenic incontinence

disturbed function of nervous system

What causes edema

1. increased hydrostatic pressure

2. decreased plasma oncotic pressure

3. increased capillary permeability

how should a stoma look

• stabilize in 6-8 weeks

• protrude 1-3cm above skin

• color: dark pink to red, moist

• minimal bleeding, though small amount is normal

• periostomal skin intact

when should you chnage colostomy pouch

when half full or sooner to prevent detachment

what kind of colostomie has the highest risk for food blockage

ileosotomy

signs of ulcerative cholitis

bloody diarrhea, frequent bowel movement, pain

signs of chrons disease

chronic diarrhea, can have blood or mucus

tachycardia causes

decreased CO

bradycardia signs

dizziness or fatigue

What part of brain is is controlled by respiratory center

medulla oblongata

what is the respiratory center stimulated by

1. increased CO2 + H+ (acid), primary stimulus

2. decreased O2

3. Chemoreceptors in aortic arch and carotid bodies (where the carotid arteries diverge)

4. Proprioceptors / receptor in muscles and joints

all signals sent to medulla oblongata

what are chemoreceptors in aortic arch and carotid bodies sensitive to

ABGs

why do proprioceptors in muscles and joints affect respirations

muscle activity needs more oxygen to continue

what is ischemia 

blockage

what does ischemia lead to

infarct

what is infarct

tissue death (necrosis)

what two things cause thickening of alveolar - capillary membrane

Pneumonia

Pulmonary edema

Congential heart defects 

1. abnormal blood flow between heart chambers/vessels

2. affects perfusion

3. oxygenated and deoxygenated blood mix → poor systemic o2 delivery

Emphysema

1. Alveolar wall destruction

2. affects diffusion

3. reduced surface area limits gas exchange

Pneumonia

1. alveoli filled with fluid/pus

2. Affect diffusion (sometimes ventilation)

3. fluid blocks gas movement across membrane

Sleep apnea

1. repeated cessation of airflow during sleep

2. affects ventilation

3. air can’t move in or out, causing intermittent hypoxia

pulmonary edema

1. fluid accumulation in alveoli

2. affects diffusion

3. fluid barrier prevent gas exchange

hypotension/shock

1. inadequate circulation

2. affects perfusion

3. reduce blood flow and o2 delivery

Airway obstruction

1. blockage in upper or lower airway

2. ventilation

3. airflow into lungs blocked

what is orthopnea

SOB when flat

signs of hypoxia (early)

1. restless

2. headache

3. confusion

4. hyperventilation

5. tachycardia = use oxygen to beat heart

6. anxiety

7. accessory muscles

signs of severe/late hypoxia

1. bradycardia = electrical conduction of heart slows down as oxygen decreases

2. extreme restlessness

3. bradypnea

4. disrhythmmias

5. hypotension

6. cynosis

7. stupor (near consciousness) 

what, why, symptoms of angina

1. chest pain

2. is insufficient o2 rich blood to heart, caused by narrowed coronary arteries

3. chest pian, nausea, fatigue

what, why, symptoms of myocardial infarction

1. heart attack

2. BLOCKED blood flow through coronary arteries → necrosis

3. intense chest pain, radiating pain to other place near by, SOB, vomiting

what is heart failure

heart cannot pump adequately

what diagnostic methods are used to assess pulmonary function

1. spirometry, pulse ox

2. capnography

3. thoracentesis

4. ABGs, CBC

5. cytologic studies (sputum/tissue samples)

what is capnography

measures CO2 level on expiration

what is thoracentesis

removing excess fluid from pleural space

what is syncope 

LOC

what is diastolic heart failure

stiff and thick chambers (not enough space to fill heart)

what is systolic heart failure

chambers are thin and stretched out

heart muscle not strong enough to pump heart

what are diagnostic methods to assess cardiac function

1. EKG

2. CK, CKMB (creatinine kinase), troponin, BNP

3. Stress testing (exercise + nuclear)

4. echocardiogram (ultrasound)

Interventions to improve oxygenation

1. incentive spirometer

2. pursed lip breathing

3. coughing and deep breathing

4. suctioning

5. oxygen administration

what are the advantages of pursed lip breathing

prolongs expiration, decreases airway narrowing, prevents small air way collapse during exhalation, controls dyspnea

when do you use diaphragmatic breathing

COPD (shallow, rapid, exhausting pattern) a

partial rebreather 

8-11 L/min, resrvoir bag collects SOME exhaled air

when do you use hmidification

nasal cannula 4L+

what is FiO2 in room air

21%

high flow nasal canulla 

10-15 L/min

two-way valve prevents rebreathing of exhaled air. bag should not be fully collapsed 

what is the function of K+

1. nerve and cardiac (other cell) function

2. regulated electrical membrane potentials for cardiac, smooth, skeletal muscles

3. abnormal K+ = cardiac arrhythmias

How do you treat hypokalemia (< 3.5)

1. Supplemental oral or IV
   

2. never IV push

How do you treat hyperkalemia (>5)

1. Dialysis (remove waste, toxins from body when kidney can’t)

2. Medications

What is the function of sodium

1. nerve and muscle function

2. maintain blood pressure

3. fluid balance

4. acid-base balance though sodium bicarbonate

What are clinical manifestations when Na+ levels not in normal range

1. lethargy

2. confusion

3. dizziness

4. weakness

5. seizure 

What are the signs of hyponatremia (<135)

1. hypothermia

2. tachycardia

3. rapid, thready pulse

4. hypotension

5. orthostatic hypotension

What are the signs of hypernatremia (>145)

1. thirst

2. dry mucus membranes

What is the function of calcium

1. most abundant mineral/electrolyte

2. maintain bones

3. regulate muscle contraction

4. help nerves carry messages

5. helps blood vessels move blood