med surg

leptin

\-suppressess appetite

\-inc fat metabolism

ghrelin

regulates appetite thru inhibition of leptin

upper resp problems

allergies, colds, sinus problems, triggers (smoke pollen)

lower resp problems

copd, tb, asthma

early symptoms of hypoxia

Restlesness

Anxiety

Tachycardia/tachypnea

late symptoms of hypoxia

Bradycardia

Extreme restlessness

Dyspnea (severe)

symptoms of hypoxia in peds

Feeding difficulty

Inspiratory stridor

Nares flare

Expiratory grunting

Sternal retractions6

6 p’s of dyspnea

Pulmonary bronchial constriction

Possible foreign body

Pulmonary embolus

Pneumonia

Pump failure

Pneumothorax

kussmals

fruity acetone breath

cheyne stokes

near death breathing pattern

biots

irregular

crackles

\-high pitched

\-during inspiration

\-not cleared by cough

rhonchi

\-rumbling

\-course sounds (snore)

\-inspiration or expiration

\-may clear w/ coughing or sunctioning

wheezing

\-musical noise

\-inspiration or expiration (usually louder)

hemoglobin

\-available for O2

\
\-M 13.2-17.3 g/dL

\-F 11.7-16 g/dL

hematocrit

\-ratio of RBCs to plasma

\-inc in chronic hypoxemia

\
\-M 39%-47%

\-F 35%-47%

cat scan

check bone, soft tissues, vessels, injuries

mri

magnetic field no radiation to check organs + soft tissues

VQ scan

ventilation (airflow in lungs) and perfusion (where blood flows in lungs)

pulmonary angiogram

dye w/ radioactive tracers injected

pet scan

radioactive drug tracers to check for cancer

diagnostics for oxygenation

\-oximetry

\-end tidal CO2 37-50 mmHg

\-sputum studies

\-endoscopy (light down throat)

\-lung biopsy

\-thoracentesis (fluid from pleural space, need xray after to check pneumothorax)

\-pulmonary function test (spirometer)

\-PEFR

\-exercise test

pH levels

7\.35-7.45

PO2

80-100 mmHg

arterial oxygen saturation

95-100%

pCO2

35-35 mmH

HCO3

22-26

base excess

\-2-+2

alkalosis

\-pH greater than 7.45

acidosis

\-pH less than 7.45

metabolic acidosis causes

\-too much acid/base loss

\-DKA; kussmals

\-renal insufficiency (kidneys FAIL, acid PREVAIL)

\-diarrhea (base leaves your ASS)

respiratory acidosis causes

\-low + slow rr

\-hyperkalemia

\-CO2 in body, carbon diacidIN!

respiratory alkalosis

\-fast rr

\-hyperventilation/panic attack

\-CO2 out/carbon diacid out=more base

metabolic alkalosis

\-too much base/acid loss

\-ALK, ALK, ALK vomiting

pleural friction rub

\-inflammation in pleural space (space between chest wall + lungs)

\-sticky substance

\-drier than rhonchi + more symmetrical

\-louder over chest wall

* ”walking on creaky wooden floor”

pneumonia symptoms

cough, fever, chills, dyspnea, tachypnea, chest pain, tachycardia, muscle aches, dry cough, abdominal pain, cold in head or throat, chest pain, nausea/vomiting

\
bacterial- leukocytosis

\
viral- influenza but worsens after 12-36 hrs

pneumonia patho

consolidation + mucus airway obstruction lead to dec gas exchange

pneumonia diagnostics

chest x-ray, sputum culture + gram stain (green, yellow, rust), blood cultures (serious only), WBC, ABG for hypoxia

pneumonia in aging pts

confusion, hypothermia, anorexia, fatigue, headache (vague s/s)

pneumonia physical exam

crackles, consolifation, inc fremitus, dullness w/ percussion

fremitus

vibration of chest wall when they vocalize

pneumonia interventions

inc hob, coughing/breathing, splint chest, fluids, positioning, no smoking, relaxation, meds, oxygen, incentive spirometer (straw to open airway)

tb patho

mycobacterium tuberculosis typically found in base of lungs but can spread to brain, kidneys, bones

tb risk factors

Tight living quarters

Below poverty risk

\
Refugee immigrant

Immune system (HIV)

Substance abuse

Kids

\
(prolonged exposure)

tb precautions

airborne precautions w negative pressure room (N95 mask)

tb symptoms

productive coughing up blood, night sweats, temp elevation, weight loss, chest pain, abnormal lung sounds

tb assessment

history of tb, chronic illness, immunosuppressive meds

tb diagnostics

sputum specimen for AFB smear, TB skin test, chest x ray, lymph nodes

\
(3-4 times before diagnosis)

tb education

everything in room contaminated, proper disposal of used tissues, covering when coughing, no visitors/crowds, no traveling until smears neg, high protein + CHO diet, no alcohol on meds, LIVER FUNCTION SHOULD BE MONITORED

active tb

active bacteria in body with symptoms

latent tb

bacteria in body but not active + no symptoms

initial tb treatment

8 weeks

continuation tb treatment

18 weeks

tb meds

isoniazid (INH)

rifampin

pyrazinamide

ethambutol

tb DOT

directly observed therapy for noncompliant pts

\

latent tb meds

\-isoniazid for 6-9 (hiv) months

\
OR

\
\-3 month regiment of isoniazid + rifapentine OR 4 months of rifampin

COPD components

\-bronchitis

\-emphysema

\-asthma

\-progressive, not reversible

asthma patho

\-sudden trigger

\-30-60 min after exposure of allergen

\-s+s can reoccur 4-6 hrs (late response) after early response

asthma risk factors

genetics, immune response, allergens, exercise, air pollutants/occupational, URI , food + drug sensitivity/reflux, OTC meds, NSAIDs, flavorings in drinks, hypoxemia

asthma clinical manifestations

wheezing, cough, dyspnea, chest tightness, prolonged expiration (1:3), tachycardia w tachypnea, anxiety, retractions/use of accessory muscles (peds), sob, inc. mucus, inc. CO2 retention

asthma complications

mild/moderate, severe, life threatening

asthma diagnostic tests

\-history + resp assessment

\-spirometry

\-peak expiratory flow rate (PEFR)

\-chest x ray

\-oximetry

\-allergy skin testing

\-blood levels of eosinphils + IgE

asthma interventions

\-high fowlers position

\-admin oxygen + meds

\-nebulizer treatments w humidification

\-hydration

\-stay w client, provide reassurance

\-calm environ

\-breathing techniques

\-monitor PEFRs

\-correct admin of inhalers

\-client/family education

\
\
dec. chronic inflammation of asthma, asthma action plans, med education, improve quality of life

asthma quick relief

\
-short acting albuterol (B2 adrenergic agonists)

\
-inhaled Atrovent (anticholinergics)

\

asthma long term

-long acting-inhaled salmetrol, oral-albuterol (B2 adrenergic agonists)

\
\-theophylline (methylanthines)

\
\-inhaled fluticasone (Flovent), oral prednisone, Leukotriene modifiers- montelukast (singulair), Anti-IgE- Omalizumab

(corticosteroids)

management of asthma

Adrenergics (albuterol)

Steroids

Theophylline

Hydration (IV)

Mask O2

Anticholinergics

asthma prevention

preventing dust, stay out of cold air, avoid triggers, asthma diary, peak rates, masks, no nsaids, treat early URI

COPD patho

\-preventable + treatable disease w/ persistent, progressive airflow limitation

\-chronic bronchitis + emphysema destruction of alveoli

\-dec oxygen = drive to breathe

COPD risk factors

occ exposure, air pollution, infection, genetics, aging, asthma, smoking

chronic bronchitis (blue bloater)

\-dusky to cyanotic

\-recurrent cough + inc sputum production

\-hypoxia

\-hypercapnia (inc pCO2)

\-resp acidosis

\-inc hgb

\-inc resp rate

\-exertional dyspnea

\-inc incidence in heavy cig smokers

\-digital clubbing

\-cardiac enlargement

\-use of accessory muscles to breathe

\-leads to right HF

copd s/s

fatigue, uris, accessory muscle use, orthopneic, cor pulmonale (late in disease), thin in appearance, wheezing, pursed lip breathing, chronic cough, barrel chest, dyspnea, prolonged expiratory time, digital clubbing,

pulmonary emphysema (pink puffer)

\-inc CO2 retention (pink)

\-no cyanosis

\-purse lip breathing

\-dyspnea

\-ineffective cough

\-hyperresonance on chest percussion

\-orthopneic

\-barrel chest

\-exertional dyspnea

\-prolonged expiratory time

\-speaks in short, jerky sentences

\-anxious

\-accessory muscle use

\-thin appearance

\-leads to right HF

copd diagnostics

\-spirometry (confirms presence of airflow obstruction + determines severity)

\-history + physical

\-chest xray (flat diaphragm from hyperinflated lungs)

\-6 min walk test w spo2

\-ABG for acidosis

\-serum 1-antitrypsin levels

\-COPD assessment test: symptom review

copd complications

\-CO2 narcosis

\-acute exacerbations

\-pneumonia

\-resp failure

\-GERD/ulcers (can cause cough)

\-depression

\-cor pulmonale (right HF)

cor pulmonale

\-late manifestation of copd

\-constriction of pulmonary vessels in reponse to alveolar hypoxia

cor pulmonale symptoms

dyspnea, lung sounds normal/crackles in bases, distended neck veins, hepatomegaly, peripheral edema, weight gain

copd interventions

\-monitor lung sounds, sputum prod, O2 sats, effort of breathing

\
-administer oxygen, high protein, small frequent meals. drink 2-3 L/day (unless restricted), avoid sick people + irritants, stay inside w temp changes

\
\-purse lip breathing, diaphragmatic breathing, coughing techniques

\
\-acapella (blow out into device to change pressure, flutter mucus, vests, back percussion, high fowlers/orthopneic, cluster care, fans, relaxation, meds, smoking cessation

copd interprofessional care

\-limit exposure to irritants

\-smoking cessation

\-bronchodilators, corticosteroids

\-airway clearance

\-immunizations

\-pulmonary rehab

\-nutrition for low bmi

\-treatment for exacerbations

\-surgical therapy (lung transplant)

suppressed immune response

state of immunodeficiency (primary or secondary)

exaggerated immune response

\-overreaction

\-body loses ability to differentiate between self

\-allergic rxs, cytotoxic rxs, target cells destroyed in type 2 rxs, autoimmune rxs

exaggerated immune symptoms

\-allergic symptoms

\-pain

\-fatigue

\-fever

exaggerated immune clinical findings

allergic response

• mild

• severe

autoimmune disorders

• vague findings-findings associated w organ failure

suppressed immune symptoms

\-report of frequent infections

\-report of poor wound healing

\-fatigue

\-malaise

\-weight loss

suppressed immune clinical findings

\-appear poorly nourished/have wasting syndrome

\-chronic wounds

\-enlarged lymph nodes

\-opportunistic infection

primary testing for immunity

\-red blood cell count + white blood cell count w differential

\-fluorescent antinuclear antibody

\-c reactive protein

\-erythrocyte sed rate (ESR)

red blood cell count + white blood cell count w differential

check hemoglobin and monitor for infection

fluorescent antinuclear antibody (ANA test)

detects antinuclear antibodies in the blood to check for autoimmune disease

c reactive protein

measures inflammation in body

erythrocyte sedimentation rate (ESR)

blood test that measures how quickly rbc settle at bottom of test tube w blood sample

\
(faster rate=inflammation rate)

other diagnostic tests for immunity

\-allergy testing/genetic testing

\-immunoglobulin levels

\-rheumatoid factors

\-western blot test

\-ELISA

\-TORCH antibody panel

allergy testing/genetic testing

testing for triggers

immunoglobulin levels

inc. levels indicate allergies or chronic conditions

rheumatoid factors (RFs)

RF in blood= autoimmune disease

western blot test

positive=HIV (NOT USED)

ELISA

used for many diseases

\
HIV

TORCH antibody panel

group of infectious disease that cause illness in preg women + cause birth defects (group of blood test that detect presence of antibodies in response to immune system)

\
toxoplasmosis (cat poop, goat milk, dirty meat), rubella, cytomegalovirus, herpes

\
others like syphilis, hep b, enterovirus, epstein-barr, varicella, parvovirus

\

exaggerated immune response interventions

\-remove exposure

\-airway support

\-pharmacology (antihistamine, sympathomimetic, mast cell stabilizer, immunosuppressive therapy, anti-inflammatory agents, symptomatic relief)

suppressed immune response interventions

\-monitor immune function

\-nutrition + vitamin supplements

\-hydration + electrolyte balance

\-prevent/treat opportunistic infections

\-drug therapy

HIV symptoms

\-fever for month

\-diarrhea for month

\-unexplainable weight loss of \`10%+

\-protracted pneumonia

\-constant cough

\-protracted + relapsing virus, bacterial + parasitic diseases

\-sepsis

\-lymph nodes swollen for month

\-sub acute encephalitis

normal t cell count

800-1200