Adult Health Exam 3

what are the clinical presentations of aspiration

tachycardia, dyspnea, central cyanosis, hypertension, hypotension, potential death

risk factors for aspiration

seizures, brain injury, decreased LOC, supine body position, stroke, swallowing disorders

what are some interventions to prevent aspiration

keeping the HOB elevated greater than 30 degrees, use few sedatives as possible, confirm tube placement before enteral feedings, avoid stimulating the gag reflex, thickened liquids

what are the swallow evaluation tests that a nurse can do bedside

bedside swallow screen

what is pnemonia

inflammation of the lung caused by bacteria, fungi, or virus

what is a community acquired pnemonia

it is diagnosed in the community or less than 48 hrs in the hospital

what is healthcare associated pneumonia caused by

by multidrug resistant pathogens

when does hospital acquired pneumonia occur

48hrs or more after hospital admission

how does a patient acquired a VAP

when the patient has been intubated for more than 48 hrs

what are some preventions for pneumonia

pneumococcal vaccination; this is recommended for all 65 and older patients, and patients 19 and over with conditions affecting the immune system

clinical manifestations of pneumonia

fever, lung pain, tachypnea, headache, orthopnea, crackles in lungs, increased tactile fremitus, productive cough

how do you diagnose pneumonia

chest x-ray, ct scan (most effective), sputum culture, labs, arterial blood gas, bronchoscopy (may be used for acute severe infection)

medical management for pneumonia

giving the appropriate antibiotics as determined by the cultures done

what are some supportive treatments of pneumonia

fluids, oxygen for hypoxia, antipyretics, antitussives, decongestants

how should we assess a patient with pneumonia

look at vitals (tachypnea, febrile, tachycardia), the color/amount/odor of the secretions, assess the cough, inspect and auscultate the chest, look for changes in mental status, fatigues, edema, dehydration

some interventions for pneumonia patients

mobility, position changes, incentive spirometry, nutrition, hydration, rest, turn cough and deep breathe, airway maintenance

what are the S/S of atelectasis

dyspnea, cough, sputum production, tachycardia, tachypnea, pleural pain, central cyanosis (if a large area is affected)

who is HIGH risk for atelectasis

post-op patients

what is the most affective way to diagnose atelectasis

chest x-ray

what are some assessment findings associated with atelectasis

decreased breath sounds and crackles over the affected area, a pulse ox of less than 90%

what is the goal of management for atelectasis

improve ventilation and remove secretion

what does ICOUGH stand for

I: incentive spirometry

C: coughing and deep breathing

O: oral care

U: understanding education

G: getting out of bed

H: head of bed elevated

other management options for atelectasis

PEEP, CPAP, endotracheal intubation and mechanical ventilation (watch for VAP), thoracentesis to relieve compression (fluid)

interventions for atelectasis

frequent turning, early mobilization, strategies to expand lungs, incentive spirometry, voluntary deep breathing, secretion management

what are the 3 primary symptoms of any COPD

chronic cough, sputum production, dyspnea

what are some other clinical manifestations for COPD

weight loss due to dyspnea, increased work of breathing and SOB, accessory muscle use, tripod position (pursed lips, skin color changes), barrel chest (1:1 ratio), anxiety, oxygen saturation under 90, crackles or wheezing in the lungs

how do you diagnose COPD

past health history, physical assessment, arterial blood gas (respiratory alkalosis), chest x-ray, spirometry

what is chronic bronchitis

productive cough and sputum for at least 3 months in each of 2 consecutive years

what happens in chronic bronchitis

ciliary function is reduced, the bronchial walls are thickened, the airway is narrowed, and a mucus plug may appear in the airway

what happens to the alveoli in chronic bronchitis

they become damaged, fibrous, and the macrophage function diminishes

what is happening during emphysema

an abnormal distention of air spaces beyond the terminal bronchioles with destruction of the wall of alveoli which results in hypoxemia

what happens to the surface area of the alveoli in emphysema

decreases and increases in “dead space” impairing oxygen diffusion

what is a complication of emphysema

increased pulmonary artery pressure may cause right sided heart failure

what are some other complications that comes with COPD

respiratory insufficiency and failure, pneumonia, chronic atelectasis, pneumothorax, right sided heart failure

what is the medical management for COPD

promote stop smoking, reducing risk factors, managing exacerbations, providing supplemental oxygen, pneumococcal vaccine, flu vaccine, pulmonary rehab

name some surgical management for COPD

bullectomy, lung volume reduction, and lung transplant

what is a bullectomy

removing the space bullies

medication for COPD

bronchodilators including beta adrenergic and anticholinergics, corticosteroids, antibiotics, mucolytics, and antitussives

what are some ways to achieve airway clearance

directed coughing and increasing fluid intake

what are some ways to improve breathing patterns

pursed lip breathing and diaphragmatic breathing

what is asthma

chronic inflammatory disease of the airway that causes hyperresponsiveness, mucosal edema, and mucous production

what is the biggest predisposing factor for asthma

allergy

3 hallmark signs of asthma

cough, dyspnea, and wheezing

what are the exacerbation manifestations

cough that is either productive or dry, generalized wheezing, chest tightness, diaphoresis, tachycardia, hypoxemia and cyanosis, tachypnea

diagnosis for asthma

history, pulmonary function test, chest x-ray, pulse ox, arterial blood gas

what is the major complication with asthma

statis asthmaticus

what is status asthmaticus

bronchospasms, inflammation and increase mucous production that is unresponsive to typical rescue treatment with bronchodilators

what are the S/S of status asthmaticus

chest tightness, wheezing, dry cough, SOB, severe respiratory distress

how should we asses status asthmaticus

vitals, loss of consciousness, breath sounds, arterial blood gas, oxygen saturation, ability to speak full sentences, accessory muscle use, cough, positions, dyspnea, and previous intubation

what is the short acting relief for asthma

beta 2 adrenergic agonists, anticholinergics

what are the long acting medications for asthma

corticosteroids, long acting beta 2 adrenergic agonists, leukotriene modifiers

what is hyperlipidemia

abnormal amount of lipids in the blood; a disorder of lipoprotein metabolism including overproduction of lipoprotein of deficiency

what is hyperlipidemia associated with in developed countries

dietary and lifestyle choices

what should the range of total cholesterol be

less than 200 mg/dL

what should the range of low density lipoprotein (LDL) be

less than 100 mg/dL

what should the range of high density lipoprotein (HDL) be

greater than 60mg/dL

what should the range of triglycerides be

less than 150mg/dL

what are some non-pharmacological treatment for hyperlipidemia

stop smoking, reducing alcohol intake, obesity reduction; the use of primary prevention strategies (diet and exercise)

what is a “good fat”

unsaturated fat

what “bad fat”

saturated and transfat

what drug is the choice drug for hyperlipidemia

statins; they inhibit the biosynthesis of cholesterol

what do fibrates do

reduce triglyceride rich lipoproteins from the plasma

what do bile acid binding agents do

depletes the hepatic pool of cholesterol available

what do cholesterol absorption inhibitors do

prevent absorption and reabsorption of cholesterol within the GI tract

what is the nursing management for hyperlipidemia

review and educate patients on modifiable risk factors, encourage increased intake of soluble fiber which can aid in lowering lipid levels, encourage a diet low in cholesterol and fats, suggest fish oil (OMEGA 3s)

what factors affect BP

blood volume and cardiac output

how does the body regulate blood pressure

changing cardiac output and systemic vascular resistance

how is hypertension diagnosed and what is it defined as

a systolic BP of 130mmHg or higher or a diastolic BP of 80mmHg or higher; two or more accurate blood pressure measurements taken 1-4 weeks apart by HCP

what is primary hypertension

effects 95% of people and has an unidentifiable cause

what is secondary hypertension

only effects 5% of patients and is renal disease, sleep apnea, and pregnancy related

what are some risk factors for hypertension

smoking, obesity, physical activity, hyperlipidemia, diabetes mellitus, GFR less than 60 mL/min, older age, and family history

what are some symptoms of hypertension

headache, epitasis, tinnitus

what are the late and serious signs of hypertension (related to organ damage)

retinal and other eye changes, renal damage, myocardial infarction, cardiac hypertrophy, and strokes

what symptoms should you asses for potential target organ damag

angina, SOB, altered speech, altered vision, nosebleeds, headaches, dizziness, balance problems

what lab tests should be run

BUN and creatinine (kidney filtration), blood chemistry (electrolytes), and urinalysis (protein)

what should we look for in an ECG when assessing for hypertension

signs of ventricular hypertrophy

what are complications of hypertension

left ventricular hypertrophy, MI, heart failure, TIA, cerebrovascular disease, renal insufficiency and chronic kidney disease, retinal hemorrhage

what is the goal of treatment of hypertension

maintain blood pressure less than 120/80 for all

what are some lifestyle modifications associated with hypertension treatment

weight reduction, regular physical activity, reduce alcohol consumption, low sodium diet or DASH, stop smoking

what is the goal of pharmacologic therapy

decrease peripheral resistance, blood volume, and decrease strength and rate of myocardial contraction

what are some considerations with older adults with hypertension

medication regimen can be hard to remember, expense can be challenge, monotherapy, make sure the clients know the regimen, include family and caregivers in education

what is a hypertensive emergency

blood pressure is greater than 180/120 and must be lowered immediately to prevent damage

how should we reduce blood pressure in the first hour during a hypertensive emergency

reduce by 20-25%

what should the BP be reduced to over 6hrs in an emergency

160/100 or less

what class of medication will be administered for an emergency

IV vasodilators (nitroprusside, nicardipine, nitroglycerin

what is a hypertensive urgency

blood pressure is very elevated but no evidence of immediate or progressive target organ damage

what are the fast acting oral agents that can be used in an hypertensive urgency

beta adrenergic blocker (labetalol) and ACE inhibitor (captopril)

how do you calculate MAP

systolic +(2\*diastolic) divided by 3

what is diabetes

a group of disorders characterized by elevated blood sugar levels and results from defects in insulin production, insulin action or both

when is diabetes type 1 most commonly diagnosed

before the age of 30

risk factors for type 1 diabetes

family history and environmental factors

what is the patho behind type 1 diabetes

triggered by an autoimmune response, insulin producing beta cells of the pancreas are destroyed; absolute lack of insulin

what are the 3 Ps of manifestations of type 1 diabetes

polyuria, polydipsia, polyphagia

what test should be done in order to test for type 1 diabetes

hemoglobin A1c, fasting blood glucose, and a two hour postprandial glucose test

fasting blood glucose for DM type 1

greater than or equal 126 mg/dL

2 hour postprandial glucose for DM type 1

greater than or equal 200 mg/dL

the range for hemoglobin A1c DM type 1

greater than or equal 6.5%

medical management for DM type 1

pharm interventions, nutrition management, patient education and self management, detection and prevention of complications

what is the number one drug for DM type 1

insulin

how can insulin be administered

through a insulin syringe or a pen, or an insulin pump