Med Surg Exam 4

What is Pneumonia?

inflammation of lung tissue

Pneumonia Pathophysiology

• _________ causes lung __________.

• blood, fluid, and inflammatory cells accumulate in the _______.

• ___________ _____________ is impaired leading to possible ___________

infection, inflammation, alveoli, oxygen exchange, hypoxemia

With Pneumonia, ______, _______, and ______________ _______ accumulate in the Alveoli.

fluid, blood, inflammatory cells

7 Classifications of Pneumonia

• _________: pneumonia is the initial illness

• _________: pneumonia develops as a complication of another illness

• _____: caused by a virus

• __________: caused by bacteria

• _________: caused by organisms like mycoplasma pneumoniae

• ____________: foreign material enters lungs

• _____: ventilator-associated pneumonia

primary, secondary, viral, bacterial, atypical, aspiration, VAP

Clinical Manifestations of Pneumonia

• fever greater than ____.___ degrees celsius and _______

• _____/__________ cough

• _______, _________, or _______ sputum

• ___________

• _______

• _____ _________

39.4, chills, dry, productive, white, yellow, green, tachypnea, ronchi, fine crackles

More Clinical Manifestations of Pneumonia

• decreased ________ ________

• _________ when percussed

• __________ and nasal flaring

• pallor/ _________

• chest pain

• Adb. pain

breath sounds, dullness, retractions, cyanosis

Children may demonstrate resp distress through _________, _____ __________, ____________, and poor ___________.

retractions, nasal flaring, irritability, feeding

What are 3 Complications of Pneumonia?

pneumothorax, pleural effusion, and empyema

Pneumothorax (as a complication of pneumonia)

• _____ enters _______ ________

• pressure ____. preventing lungs from fully _____________

• characterized by sudden ____. _______ and _____. ________ ________

air, pleural space, inc, expanding, resp distress, dec, breath sounds

Pleural Effusion (as a complication of pneumonia)

• excess _____ in _______ ______

• _________ _______ decrease

• pt may have ____________ _____________

fluid, pleural space, breath sounds, difficulty breathing

Empyema (as a complication of Pneumonia)

• Collection of _____ in the _________ space

• associated with __________

pus, pleural, infection

A Chest Tube may be inserted w/ ________ _____________ ___________ to remove _____/_____ from pleural space in the event of a pneumonia complication.

closed drainage system, air, fluid,

Priority Nursing Assessments for Pneumonia

• _____ and _______

• ____

• mental status

• signs of _____ ________

• _________ status

• ______ ________

• ______ color

• I and O’s

RR, pattern, O2, resp distress, hydration, lung sounds, skin,

If a child is tachypnic or experiencing resp distress ______ ___________ may be unsafe (keep _____ as indicated)

oral feeding, NPO

2 Prevention Vaccinations for Pneumonia

• PCV13: pneumococcal ___________

• PPSV23: pneumococcal _____________ _________

conjugate, polysaccharide vaccine

VAP Prevention Bundle

• ___-____ degree HOB

• _____ care with _____________

• _______ _______ and ____ prophylaxis

• spontaneous breathing and awakening trials

30, 45, oral, chlorhexidine, peptic ulcer, DUT

What is the most common cause of emergency abd. surgery in children?

appendicitis

What is the average age of diagnosis for appendicitis?

10 yrs old

Appendicitis usually begins with…

appendix obstruction

Appendicitis develops when appendix becomes obstructed from…

• __________ stool (Fecalith)

• __________

• _________ _________ tissue

hardened, parasites, swollen lymphoid

Appendicitis Development

• Appendix becomes obstructed

• mucous can’t be drained, so _______ builds

• Blood Vessels __________ leading to _______

• __________ lining becomes ____________

• _________ invades and infection develops

pressure, constrict, Ischemia, epithelial, ulcerated, bacteria

Clinical Manifestations of Appendicitis

• _____ pain

• __________ tenderness at __________’s point

• _____/_________ bowel sounds

• ___________

• fever

• anorexia

• inc. ______

• _______ abdomen

• C/N/V/D

• __________

RLQ, rebound, Mcburneys, dec, absent, tachycardia, WBCs, tachypnea

What are 5 Diagnostic Measures for Appendicitis?

CBC, urinalysis, preg test, ultrasound, and CT scan

Diagnostics for Appendicitis

• WBC ____

• urinalysis ( to rule out _____ )

• pregnancy test ( to rule out pregnancy )

• ultrasound ( first-line imaging in _______ )

• CT Scan ( additional imaging)

inc. UTI, children

What are 3 Complications of Appendicitis?

rupture, peritonitis, and ileus

Appendicitis Rupture

• infected contents spill into abd. cavity

• may feel ________ ________ of symptoms

• This is an _________

sudden relief, emergency

Appendicitis Peritonitis

• inflammation/infection of _________ cavity

• ______ abd.

• severe/diffuse abd. pain

• ______

• _________

• possible progression to ________

Peritoneal, rigid, fever, tachycardia, sepsis

Infant (birth-1yr)

• Erickson _______vs.________

trust, mistrust

Infant (birth-1yr) Hospitalization Stressors

• __________ anxiety

• anxiety around strangers

• disruption of _______ _______ and ___________

seperation, basic needs, attachment

Infant (birth-1yr) Hospitalization interventions

• encourage parent ______ and _____________ in care

• ________ care

• avoid ______________

• promote safe sleep, comfort measures, and appropriate play

visits, participation, bundle, overstimulation

Toddler (1-3)

• Erickson ____________vs._________ and _______

autonomy, shame, doubt

Toddler (1-3) Hospitalization Stressors

• ____________ anxiety

• loss of _______ and ____________

• fear of _______/_______

• __________ and disruption of routine

seperation, control, independence, pain, injury, regression

Toddler (1-3) Hospitalization Interventions

• encourage _________ presence and familiar ___________ ________

• offer _________

• maintain ________/________

• set limits and maintain safety

parent, security object, choices, ritual, routine

Preschooler (3-6)

• Erickson ___________vs._______

initiative, guilt

Preschooler (3-6) Hospitalization Stressors

• highest risk is ____________

• fear of ____________, the ______, and _______

• difficulty deciding _____ and ________

• limited understanding of why hospitalization is necessary

regression, abandonment, dark, injury, fact, fiction

Preschooler (3-6) Hospitalization Interventions

• Acknowledge _______

• orient child to ____________ and build ______

• provide ________ and ___________ activities

• explain procedures in simple/concrete language

fears, hospital, build trust, play, diversion

School Aged Child (6-13)

• Erickson ___________ vs. ___________

industry, inferiority

School Aged Child (6-13) Hospitalization Stressors

• loss of _______ and _______

• fear of ______, _______, and ______

• want to ___________ procedures

control, privacy, pain, injury, death, unerstand

School Aged Child (6-13) Hospitalization Interventions

• explain __________ for procedures and hospitalization

• include in __________ and _________ making

• encourage _____________ in care

• provide ___________ ____________

• maintain limits and protect privacy

reason, teching, decision, participation, positive feedback

Adolescent (13-18)

• Erickson ________vs _____ __________

identity, role confusion

Adolescent (13-18) Hospitalization/Stressors

• loss of ________ and ________

• altered ________ ________ and _____________

• peer _____________

• fear may be hidden behind confident appearance

control, privacy, body image, appearance, seperation

Adolescent (13-18) Hospitalization Interventions

• encourage ______________

• assess ________________

• include in _____________

• provide __________ during care

• encourage normal _____________ and ________ __________

questions, understanding, decisions, privacy, grooming street clothes

What are 3 Main Hospitalization Stressors?

separations, loss of control, fear of bodily injury

Parent/Caregiver Support

• recognize ______ and _____________

• maintain _______________

• __________ treatments

• provide regular _________

• prepare parents for ____________ and _______ _______

fear, helplessness, communication, explain, updates, discharge, home, care

Sibling Support

• explain __________

• encourage _______

• change in ________ and child treatment cause stress

illness, visits, routine

Special Needs/Critical Care Support

• provide physical motor ___________

• adapt to _________ ________

• Assist parents about helpful __________, ____________ needs, and __________.

• Give regular ________

equipment, tactile needs, strategies, communication, triggers, updates

Providing a Child for Hospitalization

• explain in appropriate language

• prepare for procedures

• use _________ ______

• involve a ______ ______ specialist

• encourage parent presence and participation

• use comfort ____________ and ___________ during procedures

• maintain familiar routines, toys, security objects

• perform painful procedures __________ ________

• provide play, ____________ activities, and playroom access

medical play, child life, positioning, distraction, outside room, expressive

Appendicitis Ileus

• intestines stop ______________ normally, preventing movement of intestinal __________

contracting, contents

Appendicitis Ileus Symptoms

• ______/________ bowel sounds

• ___. __________

• N/V

dec, absent, abd, distension

Ileus as a complication of appendicitis can occur with ____________ or _______ ____. __________.

inflammation, after abd, surgery

Pre-Op Nursing Care for Appendicitis

• pain control

• _____________

• _____ _______

• _____ _____________

• psychological support

• teaching about surgery

antibiotics, IV fluids, NG decmpression

What is the Pre-Op Appendicitis Goal?

• _________ child, manage ____________, prevent worsening ____________, and __________ for surgery

stabilize, symptoms, infection, prepare

Safety Considerations for Pre-Op Appendicitis

• keep ____

• do not apply _______

• do not give __________ or _________

• avoid unnecessary abd. _____________

• notify provider if sudden changes in ________/condition

NPO, heat, laxatives, enemas, palpation, pain

Why can’t a hot compress be given for appendicitis?

increases inflammation and inc. risk of rupture

Why can’t laxatives or enemas be given with Appendicitis?

risk of perforation

Laparoscopic Appendectomy (Lap Appy)

• minimally invasive

• uses _________ and _______ _________

• treats _______ ______________

cameria, small incisions, acute appendicitis

If the appendix ruptures we need…

• ____________ management

• _____ ___________

• _________ ___________

infection, IV antibiotics, abscess drainage

What is the 2nd most common bacterial infection in women?

UTI

_____ is the most common cause of urinary tract inflammation

UTI

Inflammation in the urethra is…

urethritis

Inflammation of the bladder wall is…

cystitis

Infection/Inflammation of the renal parenchyma/collecting system?

Pyelonephritis

UTI that spreads into systemic circulation?

urosepsis

Urosepsis (Medical Emergency)

• UTI spreads into bloodstream causing potential _______, ________ ________, and _________ ______________.

sepsis, septic shock, organ dysfunction

Symptoms of Urosepsis

• fever

• __________ and ___________

• ____________

• ____________

• altered mental staus

• _______ impairment

• dec. ________ _________

tachypnea, tachycardia, hypothermia, hypotension, renal, urine output

Causes/Risk Factors of UTIs

• poor _________

• _____________

• _________ / ___________ ________

• ______________ __________

• ________ impairment

• _____________

• _____________

hygiene, catheterization, tumors/kidney stones, neurogenic bladder, renal, menopause, urinalysis

2 Clinical Manifestations of Urethritis

dysuria, urethral irritation

3 Clinical Manifestations of Cystitis

dysuria, frequent urgency, and suprapubic pain

5 Clinical Manifestations of Pyelonephritis

fever, chills, flank pain, CVA tenderness, N/V

Older Adults with UTI’s present _________

atypically

Older Adult UTI Symptoms

• loss of __________

• altered mental status

• __________

• generalized ____________

• absence of _________

appetite, confusion, weakness, dysuria

Consider that older adults with new confusion need assessment for ______. ____________ ________, including __________.

mult, possible causes, infection

UTI Nursing Assessments (Subjective)

• past medical hx

• previous ___________

• health patterns

• urinary ____________

• ______

• ____________ w/urination

• urinary _____. and ________

• hx of ____________ UTIs

surgeries, symptoms, pain, burning, freq, urgency, recurrent

UTI Nursing Assessments (Objective)

• ________ and chills

• _________

• _________ status changes

• ___ and ___’s

• urine ______________

fever, dysuria, mental, I, O, appearance

Additional Nursing Assessments for UTI

• ________ pain

• ______ tenderness

• _____________ _____________

flank, CVA, suprapubic

5 Diagnostics for UTI

• ______________

• ________ _________

• ____________ ____________

• ______’s in urine

• _________

urinalysis, urine culture, antibiotic sensitivity, WBC, nitrites

Urinalysis identifies _____’s, _______, and other evidence of infection

WBC, nitrites

Urine Cultures identify specific __________

bacteria

Nitrites suggests

• ___________ capable of _____________ nitrates into __________

• commonly gram __________ organisms like ___. ______

bacteria, converting, nitrites, negative, E, coli

What is Acute Pyelonephritis?

acute inflammation of renal parenchyma and collecting system

Acute Pyelonephritis

• associated with ______ __________

• fever, chills, flank pain

• can cause systemic infection

active infection

Acute pyelonephritis is treated with…

appropriate antibiotics

Chronic Pyelonephritis involves…

long term kidney damage

Chronic Pyelonephritis

• _______ infections / _______ related _________

• may have fewer obvious _________ _____________

• kidneys become __________ and ___________

• can cause permanent ______ of __________ _____.

repeat, reflux, damage, initial symptoms, scarred, fibrotic, loss, kidney function

Vesicoureteral Reflux (VUR)

• urine flows _________ towards _________ and ________

backwards, ureters, kidneys

Vesicoureteral Reflux (VUR) can cause…

• _________ _____s and _______ _________

• __________ of kidneys

• ________ ___________

• reduced ______ ___________

repeated UTI, kidney infections, scarring, chronic pyelonephritis, renal function

What are 2 drugs used to treat VUR?

antibiotics and phenazopyridine

Antibiotics for treating VUR

• oral of IV depending on _________

• selection based on ____________ and culture ______________

severity, organism, sensitivity

Phenazopyridine (Pyridium) is classified as a…

urinary analgesic

Phenazopyridine (Pyridium) purpose

• _________ burning and discomfort by soothing ________ _______ _________

relieves, urinary tract mucosa

Nursing Considerations for Phenazopyridine

• used alongside ___________ when indicated

• turns urine _______-________ and _______ clothes

• treats __________

antibiotics, reddish, orange, stains, symptoms

Nursing Management of VUR pt.1

• encourage ______ and regular _________

• administer __________

• obtain _______ _________

• teach _________

fluids, voiding, antibiotics, urine culture, hygeine

Nursing Management of VUR pt.2

• monitor _____, ___ and ___s

• assess ________ ______

temp, I, O, mental status

Urinary Diversion means creating ____________ ways for ______ to leave the body.

alternative, urine

Nephrostomy Tube

• __________ inserted through the _____ into the ________

• drains urine directly from the __________

• often used when urine can’t flow normally through the ureter

surgically, skin, kidney, kidney

Intermittent Catheterization

• catheter inserted to ______ the bladder

• removed immediately after ___________ (doesn’t remain in place continuously)

• used for pt’s with urinary __________ and ____________ bladder.

drain, drainage, retention, neurogenic

A patient with urinary retention and neurogenic bladder would be a good candidate for…

intermittent catheterization

A patient with urine not flowing normally through the ureter is a good candidate for…

nephrostomy tube

Surgical Urinary diversions reroute urine when a normal pathway is no longer ____________ or needs to be ___________.

functional, bypassed

What are 3 surgical urinary diversion techniques?

ureteroileosigmoidostomy, ileal loop, and nephrostomy