Term
| there are three types of urinary incontinence, what are they? |
|
Definition
1. stress incontinence
2. urge incontinence
3. overflow incontinence |
|
|
Term
|
Definition
| -caused by any increase in stress such as laughing, coughing, or sneezing |
|
|
Term
|
Definition
| there is an urgency to go with a rapid onset, where is the bathroom! |
|
|
Term
|
Definition
| the bladder fills up to the max and the person does not have good muscle contraction and the urine overflows like a fountain. is urinary retention that turns into urinary incontinence |
|
|
Term
| what the primary therapy for urinary incontinence? |
|
Definition
|
|
Term
| what is the nursing management of urinary incontinence? |
|
Definition
1. behavioral therapy involving time scheduled trips to the bathroom
2. Kegel exercises which help strengthen the pelvic floor muscle
3. diet- avoid bladder stimulants: coffee, chocolate, beer, and caffeine |
|
|
Term
| what diet and fluid intake would you recommend to an incontinent patient? |
|
Definition
diet: avoid bladder stimulants: coffee, chocolate, beer, and caffeine
fluid: do not restrict fluids since this can lead to hypovolemia and dehydration. instead limit fluid intake 1.5-2 hours before bedtime |
|
|
Term
| what is the pharmacological management of incontinence? |
|
Definition
1. anticholinergics: ditropan, detrol, bentyl
-relax smooth muscle
-inhibit detrussor muscle contractions
-best outcome with behavioral therapy (scheduled bathroom visits)
2. estrogen cream (HRT) hormone replacement therapy- local application of the cream to decrease urethral irritation and increase defense against UTI and infection |
|
|
Term
| what are some surgical managements for urinary incontinence? |
|
Definition
***last resort***
1. anterior vaginal repair- tightening of the muscles
2. artificial urethral sphincter insertion- gives patient control over urination |
|
|
Term
| when dealing with an artificial urethral sphincter, what must be done to allow the patient to urinate? how often? |
|
Definition
| let the control pump down to allow to inflatable cuff to loosen and allow the person to urinate; should be doing this every 2-3 hours to avoid urinary retention |
|
|
Term
| what are some causes for urolithiasis (stones)? |
|
Definition
1. genetic predisposition
2. metabolic conditions: such as increased Ca levels
a. gout
b. hyperparathyroidism
3. sedentary lifestyle
4. cystitis
5. urinary stasis
6. dehydration/ diet
a. high in Ca/tea/fruit juices |
|
|
Term
| urolithiasis is a medical term for a |
|
Definition
|
|
Term
| what are some clinical manifestations in urolithiasis ? |
|
Definition
1. n/v
2. pain (w/ obstruction)
a. unilateral flank pain
b. restless, anxious, 10/10
c. abd or suprapubic pain
d. urethral irritation
3. hematuria
4. restlessness |
|
|
Term
| explain the pathophysiology of an obstruction |
|
Definition
1. urinary obstruction leads to
2. dilation of structure behind (distal to) obstruction
3. backflow of urine
4. dilation of kidney pelvis (hydronephrosis)
5. this causes the stasis of urine
6. causing infection and or stone formation
7. leading to tubular damage
8. also will have pressure on kidney structure
9. causing dilation of kidney tubules
10. causing pressure on the renal arteries
11. leading to ischemia
12. causing tubular damage |
|
|
Term
|
Definition
| can be seen on an ultrasound, is the dilation of the kidney pelvis due to the backflow or urine due to an obstruction |
|
|
Term
| about what % of kidney stones pass spontaneously? |
|
Definition
|
|
Term
| what can be used to help a stone pass spontaneously? |
|
Definition
1. push fluids: IV and PO
2. ABXs
3. pain management:
toradol, morphine, dilaudid
4. control n/v with antiemetics:
phernergan, zofran, compazine |
|
|
Term
|
Definition
| used for pain management, especially in urolithiasis, is an NSAID, can be given IV and IM |
|
|
Term
| what should you be aware of when using phenergan? |
|
Definition
is very sedating so be cautious when using with older patients; start with the smallest dose in the ordered range
monitor sedation level, RR, and LOC |
|
|
Term
| nursing management for urolithiasis |
|
Definition
1. VS and I and O (urine output 30 ml/hr)
2. pain and n/v management
3. monitor for hematuria/ infection/ strain urine for stone to assess composition |
|
|
Term
| what are some more aggressive treatments for urolithiasis? |
|
Definition
1. ureter dilation with a urethral catheter to crush and remove stone via cystoscopy
2. lithrotripsy- ultrasonic waves under water to break up stone so patient can pass it
3. surgical removal |
|
|
Term
| cystitis is another name for |
|
Definition
| a urinary tract infection (UTI) |
|
|
Term
| what are some risk factors for developing a UTI? |
|
Definition
1. short urethra- females
2. pregnancy from increased pressure and having to empty your bladder
3. inserting foreign objects such as diaphragm use
4. strictures
5. tumors/obstruction
6. prostatic hypertrophy (BPH)
7. repetitive sexual intercourse
8. not urinating after intercourse
9. indwelling catheter
10. dehydration
11. calculi |
|
|
Term
| what are some clinical manifestations of a UTI? |
|
Definition
1. frequency/urgency
2. burning/dysuria
3. cloudy, hazy, foul smelling urine
4. hematuria
5. suprapubic pain |
|
|
Term
|
Definition
|
|
Term
| what is the most common bacteria that causes a UTI? |
|
Definition
|
|
Term
| in a UC, what does an R mean? an S? |
|
Definition
R- means the bacteria is resistant to antibiotic and will not work
S- sensitive to the antibiotic |
|
|
Term
| what are some complications of a UTI? |
|
Definition
1. ascending infection (pyelonephritis)
a. can lead to urosepsis
2. permanent kidney damage from chronic cystitis |
|
|
Term
|
Definition
1. fluid intake 3-4 L/day
2. cranberry juice/Vitamin C
3. wiping from front to back
4. hygiene
5. abx and analgesics |
|
|
Term
|
Definition
| class of antibiotics used to treat UTIs and they all in in floxacin |
|
|
Term
| pharmacological management of a UTI |
|
Definition
1. abx
a. fluoroquinolones:
1. ciprofloxacin (cipro)
b. bactrim (has sulfa so patients allergic to sulfur can Not have this)
2. analgesics
a. pyridium- turns urine orange and is for short term use for no longer than 3 days and if for the management of pain and does not replace the abx, can be OTC |
|
|
Term
| what precaution should be taken when administering the antibiotic bactrim? |
|
Definition
| has sulfa in it so it should not be used in patients with a sulfur allergy |
|
|
Term
| pyelonephritis most common cause |
|
Definition
|
|
Term
|
Definition
| inflammation of renal parenchyma/ collecting system |
|
|
Term
| some causes of pyelonephritis |
|
Definition
1. cystitis
2. pregnancy
3. obstruction
4. instrumentation
5. trauma |
|
|
Term
| chronic infections of the kidney over time can lead to |
|
Definition
| destruction of the kidney tissue and renal failure |
|
|
Term
| what are some clinical manifestations of pyelonephritis? |
|
Definition
fever
chills
sepsis
pain in the flank and CVA
leukocytosis
WBC, blood, and bacteria in urine |
|
|
Term
T or F:
a patient with cystitis would be much sicker than a patient with pyelonephritis? |
|
Definition
|
|
Term
chronic infections can lead to permanent kidney damage including an:
increased:
decreased:
and all of these things can lead to what in the patient? |
|
Definition
chronic infections can lead to permanent kidney damage including an:
increased: BUN/creatinine
decreased: GFR and creatinine clearance
all of these things can lead to secondary HTN in patient |
|
|
Term
| pharmacological treatment of pyelonephritis is similar to? and includes? |
|
Definition
similiar to the treatment of a cystitis
includes
1. abx
a. sulfonamides: bactrim (has sulfa so beware of patients with allergies to sulfates)
2. fluoroquinolones "floxacins"
a. cipro (ciprofloxacin)
b. avelox (moxifloxacin)
c. levaquin (levofloxacin) |
|
|
Term
|
Definition
| polycystic kidney disease |
|
|
Term
| a common disorder among those that are genetically predisposed |
|
Definition
| polycystic kidney disease |
|
|
Term
| what is the onset of PKD? |
|
Definition
|
|
Term
|
Definition
| the bilateral kidney medulla and cortex fill with multiple cysts that enlarge overtime and destroy whatever tissues is adjacent next to them due to compression |
|
|
Term
| clinical manifestations of PKD |
|
Definition
1. abdominal flank pain
2. palpable kidneys or even see it!
3. hematuria
4. cystitis
5. HTN
6. results in ESRD |
|
|
Term
| should a normal kidney be palpable? |
|
Definition
|
|
Term
|
Definition
1. keep them hydrated EARLY on to prevent infections such as cystitis and pyelonephritis
2. if it progresses to ESRD
a. HTN management
b. fluid restriction
c. low protein diet to make metabolism easier
d. nephrectomy to remove worse kidney
e. genetic counseling |
|
|
Term
| when dealing with PKD, at what stages is hydration acceptable, when is it not? |
|
Definition
early on hydration is acceptable
if they develop ESRD then hydration should be restricted |
|
|
Term
| what types of trauma can occur to the kidneys? |
|
Definition
1. mainly blunt force trauma
2. common in men < 30 yo due to adrenaline rushes |
|
|
Term
| clinical manifestations of kidney trauma |
|
Definition
1. hematuria
2. flank pain
3. R or LUQ abd pain |
|
|
Term
| management of kidney trauma |
|
Definition
1. takes time there is no "magi pill"
2. pain control
3. monitor
a. I and O at least 30 ml/hr output
b. hematuria
c. BUN/creatinine/ GFR
d. H and H to make sure they are not bleeding |
|
|
Term
| renal cell carcinoma is also known as |
|
Definition
|
|
Term
| renal cell carcinoma is commonly caused by |
|
Definition
|
|
Term
| what are some risk factors for adenocarcinoma? |
|
Definition
1. cigarette smoking
2. greater in men by 2:1 |
|
|
Term
| clinical manifestations of renal cell carcinoma |
|
Definition
1. early s/s are very vague: weakness, weight loss, anemia
2. late signs:
a. gross hematuria
b. flank pain
c. palpable mass |
|
|
Term
| diagnosis of renal cell carcinoma |
|
Definition
| biopsy and pathology would reflect cancer or malignancy in the cells |
|
|
Term
| management of renal cell carcinoma |
|
Definition
1. nephrectomy either partial or radical:
a. partial: only that part of the kidney is removed
b. radical: remove kidney, adrenal gland, proximal ureter, renal artery and vein. if the other kidney still works they may be able to urinate. may require an ostomy.
2. radiation and chemotherapy to disintegrate cancer and prevent its return |
|
|
Term
| bladder carcinoma is usually caused by |
|
Definition
| transitional cell carcinoma |
|
|
Term
| who is more likely to develop bladder cancer? men or women? |
|
Definition
|
|
Term
| risk factors for bladder carcinoma |
|
Definition
1. working in textile industry such as with aniline dyes
2. smoking
3. chronic bladder infection
4. renal calculi
5. metastasis from cervical/ prostate cancer |
|
|
Term
| clinical manifestations of bladder carcinoma |
|
Definition
1. painless and intermittent hematuria that comes and goes
2. urgency/dysuria
3. pain due to obstruction of urethra or ureters |
|
|
Term
if your patient has hematuria that is
painful: think?
painless: think? |
|
Definition
painful hematuria: think kidney stones or UTI
painless hematuria: think bladder carcinoma |
|
|
Term
| once bladder carcinoma is diagnosed it does require |
|
Definition
|
|
Term
| what are the types of surgical management for bladder carcinoma |
|
Definition
segmental resection
a. partial- removes just the part involved. post op will hold only 60 ml and will expand 200-400 ml. have a patient Foley post op to prevent bladder distention
b. cystectomy- removes entire bladder and requires urinary diversion |
|
|
Term
| why is nutrition imperative in oncology patients? |
|
Definition
| because they have a higher metabolism and need for calories, protein and carbs. they me not feel like eating but they must have an improved nutritional intake |
|
|
Term
| nutrition management in patients with bladder carcinoma (cancer) |
|
Definition
1. anorexia and nausea are common
2. increase in calories to prevent wasting
3. increase in fluid intake at least 2L/day
4. avoid bladder irritants: caffeine, alcohol, spices, smoking |
|
|
Term
| why does the right kidney sit a little lower than the left? |
|
Definition
| because of the liver and gallbladder |
|
|
Term
| what is the main blood supply to the kidneys? |
|
Definition
|
|
Term
T or F:
both kidneys have a renal artery and vein? |
|
Definition
|
|
Term
|
Definition
| the left and right ureters |
|
|
Term
| what serves as a reservoir for urine? |
|
Definition
|
|
Term
| what drains the urinary bladder? |
|
Definition
|
|
Term
| what are the main functions of the kidneys? |
|
Definition
1. regulate the volume and composition of ECF
2. excrete waste products and toxins
3. blood pressure control: renin-angiotension-aldosterone
4. erythropoietin production
5. vitamin D activation
6. help maintain acid-base balance |
|
|
Term
|
Definition
|
|
Term
| without the regular function of the kidneys what would occur to wastes? |
|
Definition
| the wastes and toxins would buildup in the body which is NOT compatible with life |
|
|
Term
| patients with kidney function problems typically do not produce enough erythropoietin which causes |
|
Definition
| anemia secondary to renal failure |
|
|
Term
| how can we replace erythropoietin in patients with renal insufficiency to prevent anemia? |
|
Definition
| erythropoietin injections |
|
|
Term
| explain vitamin D activation |
|
Definition
1. first activated in the cholesterol in the skin
2. activated in kidneys
helps increase absorption of Ca |
|
|
Term
| why is it typical to have renal insufficient patients with hypocalcemia/hyperphosphatemia? |
|
Definition
| because the kidneys help with vitamin D activation and vitamin D increases the absorption of Ca |
|
|
Term
| what is the normal pH range to be maintained in the blood? |
|
Definition
|
|
Term
| if the kidneys do not receive sufficient blood flow, what will happen? |
|
Definition
| they will release renin and begin the renin-angiotensin-aldosterone cycle |
|
|
Term
| describe the renin-angiotensin-aldosterone cycle |
|
Definition
1. if there is hypovolemia, hypotension, or deficient blood flow to the kidneys, the kidneys will release renin
2. renin converts angiotensinogen from the liver into angiotensin I
3. the lungs use angiotensin converting enzyme (ACE) to convert angiotensin I into angiotensin II
4. this causes the secretion of aldosterone which causes vasoconstriction and sodium and water retention
5. this causes in increase in circulating blood volume and increase in BP |
|
|
Term
| stressors to kidney function |
|
Definition
1. aging
2. malnutrition/dehydration
3. comorbidities:
1. cancer
2. HTN
3. vascular disease
4. DM
4. poor perfusion
5. medications that are filtered through kidneys because they can hold on to and accumulate
6. urinary patterns (like holding on to it can cause urinary stasis)
7. surgical anesthesia
8. radiation and chemotherapy
9. trauma, blunt forces, accident
10. obstruction: stone, mass, stricture |
|
|
Term
| what percentage of the blood output from the heart do the kidneys want? |
|
Definition
|
|
Term
|
Definition
| cause damage to the nephrons, the functional units of the kidney and can contribute to renal failure |
|
|
Term
| aging changes in kidneys: |
|
Definition
1. decrease in:
a. kidney size
b. # of nephrons
c. GFR
d. creatinine clearance
e. renal blood supply
f. Na conservation
g. ability to dilute/ conc urine
h. acid load excretion
i. muscle tone of the detrussor muscle, causing increase in residual volume left over in the urinary bladder |
|
|
Term
| gender specific changes to the renal functioning: |
|
Definition
women:
1. decreased estrogen levels
a. urethral irritation and dryness
b. bladder infections
men:
1. benign prostatic hypertrophy (BPH)
a. not cancerous but is just a benign enlargement
b. causes frequency, hesitancy, urgency, and dribbling, straining and retention
2. these can be relived by medications that shrink the prostate |
|
|
Term
| if the kidneys are NOT working correctly, what may you assess in a patient? |
|
Definition
1. weight gain due to not clearing urine
2. lethargy/confusion/LOC can't clear toxins
3. skin changes
a. pallor from decreased eryhthropoietin and anemia
b. turgor and texture changes
c. renal frost- grayish color from decreased eryhtropoietin production
4. abdominopelivic- check for any masses and the flanks and abdomen
5. mouth- check for stomatitis (inflammation of the mouth). also check break for a sweet ammonia breath odor which is from pH imbalance
6. auscultation of kidneys: should NOT hear anything! if you do hear a "bruit" there is a stricture or compression that is abnormal |
|
|
Term
| how should you palpate the kidney? |
|
Definition
1. place a hand on the stomach
2. place other hand on back
3. push up to elevate kidney
4. shouldn't be able to feel it, if you do they may be enlarged due to polycystic disease |
|
|
Term
| what is the landmark of the location of the kidney? |
|
Definition
| the CVA: the costal vertebral angle at the 12th rib |
|
|
Term
| what assessment would you do using the CVA? |
|
Definition
| you would percuss the costal vertebral angle at the12th rib to check for any irritation of the kidneys |
|
|
Term
| a bladder is palpable only when you have |
|
Definition
|
|
Term
| if your patient has not voided in 8hours and states that they feel uncomfortable, you palpate their bladder and should assess: |
|
Definition
-firmness
-distension
-facial grimace |
|
|
Term
|
Definition
a side fist to the CVA to check for kidney irritation or pain.
normal person: no effect
person with kidney problem: Chandelier sign PAIN! |
|
|
Term
|
Definition
|
|
Term
|
Definition
| comprehensive metabolic panel |
|
|
Term
| what are the lab tests for kidney functioning |
|
Definition
|
|
Term
BUN
1. what it means
2. normal values
3. indicates:
4. elevation |
|
Definition
BUN
1. what it means:
blood urea nitrogen
2. normal values:
10-30
3. indicates:
the excretion of nitrogen waste
4. an increase can indicate that the kidneys are not excreting properly or:
1. high protein diet
2. GI bleed
3. dehydration
4. catabolic state/ hypermetabolic state
5. hemolysis |
|
|
Term
| since a change in the BUN could be due to multiple factors, what key principle should be followed when looking at the BUN values? |
|
Definition
| look at the creatinine values as well |
|
|
Term
creatinine:
1. what it means
2. normal values
3. indicates:
4. elevation |
|
Definition
creatinine:
1. measures renal function, best assessment of renal function
2. 0.5-1.5, at 2 and above thats when there is a problem
3. indicates GFR and is a serum indicator |
|
|
Term
|
Definition
| glomerular filtration rate: how much blood is filtered through the kidney in a minute |
|
|
Term
| how is creatinine measured? |
|
Definition
| its a serum indicator, so its measured through the blood |
|
|
Term
| what is creatinine the end product of? |
|
Definition
| muscle and protein metabolism |
|
|
Term
| you would expect a high creatinine in patients with |
|
Definition
| renal insufficiency or renal failure |
|
|
Term
| you expect the elderly, malnourished and patients with muscle wasting to have what type of creatinine? |
|
Definition
|
|
Term
| BUN-creatinine ratio that is normal |
|
Definition
|
|
Term
| is a urinaylsis dipstick test sterile? |
|
Definition
|
|
Term
what is a normal value for urine
color |
|
Definition
|
|
Term
what is a normal value for urine
clarity? |
|
Definition
|
|
Term
what is a normal value for urine
pH |
|
Definition
|
|
Term
what is a normal value for urine
specific gravity? |
|
Definition
|
|
Term
what is a normal value for urine
glucose? |
|
Definition
|
|
Term
what is a normal value for urine
ketones? |
|
Definition
|
|
Term
what is a normal value for urine
bilirubin? |
|
Definition
|
|
Term
| a patient whose urine is 1.3.....what's going on? |
|
Definition
| their urine is very concentrated and they are dehydrated |
|
|
Term
| a patient with a urine specific gravity of 1.000...what's going on? |
|
Definition
| their urine is very diluted and they are overhydrated |
|
|
Term
what is a normal value for urine
WBCs?
abnormal value? what would this indicate? |
|
Definition
what is a normal value for urine
WBCs?
normal: 0-5
abnormal value? >5
what would this indicate: INFECTION |
|
|
Term
what is a normal value for urine
RBCs?
abnormal? indications? |
|
Definition
what is a normal value for urine
RBCs? 0-4
abnormal? >4
indications? bleeding or maybe menses |
|
|
Term
what is a normal value for urine
bacteria? |
|
Definition
|
|
Term
what is a normal value for urine
leukocyte esterase? |
|
Definition
|
|
Term
|
Definition
| break down of bacteria; indicates infection |
|
|
Term
| urine culture is this aseptic? |
|
Definition
| no, it is supposed to be sterile |
|
|
Term
| urine culture is used for |
|
Definition
|
|
Term
| composite urine collection |
|
Definition
| a timed collection of urine and measuring of creatinine clearance over 24 hours |
|
|
Term
| when performing a composite urine collection, it is important to |
|
Definition
| discard the first collection and then start the clock. also to keep the urine samples on ice |
|
|
Term
|
Definition
| amount of urine that is left in the bladder after the patient voids |
|
|
Term
| what is a normal residual urine volume? |
|
Definition
| less than 50 mL, anymore is abnormal |
|
|
Term
| an excessive amount of residual urine in the bladder (>50mL) can indicate |
|
Definition
-weakened detrussor muscle
-neurogenic bladder |
|
|
Term
|
Definition
kidney ureter bladder
is an x-ray radiographic study that outlines the anatomical structure and shape and size of the kidney, ureter and bladder. is a flat one view
can view stones and mass or tumors and can see small intestine and colon |
|
|
Term
|
Definition
-non-invasive
-uses ultrasonic waves to take pictures
- not painful
-put gel on the outside and you scan
-can show stones, tumors, masses, strictures |
|
|
Term
|
Definition
-more specific
-can see thin slices
-can see tumors or masses |
|
|
Term
|
Definition
-if patient has metal they cannot have an MRI
-questionnaire for magnets in patients body
-not invasive with no surgical consent required |
|
|
Term
| if your patient has kidney problems and needs a diagnostic test performed but has a metal implant in his body what are his other options? |
|
Definition
| x-ray, CT-scan or ultrasound, etc |
|
|
Term
|
Definition
| insert catheter into bladder and inject dye into it into ureter and kidneys to see flow of urine, structure, masses, and tumor |
|
|
Term
|
Definition
intravenous pyelogram
-involves putting an IV in patient
-inject dye into IV and watch systemically through blood stream and into kidneys to observe kidney perfusion |
|
|
Term
|
Definition
involves going through an artery such as the femoral and injects dye into catheter in the artery and watch perfusion to kidneys
post procedure: maintain pressure on artery and check for bleeding |
|
|
Term
| retorgrade pyelogram, IVP, and renal arteriogram are all |
|
Definition
| invasive and require surgical consents |
|
|
Term
|
Definition
looking at bladder with a scope
-look at tumors, masses
-evaluate bladder and infection
-remove smaller stones
-invasive requires consent
-minimal discomfort
-should have MILD pain and a red tinge in urine is normal
-should NOT be intense pain or bleeding or require morphine or dilaudid |
|
|
Term
| after a cystoscopy a nurse should |
|
Definition
1. monitor VS and urine output (30ml/hr or more)
2. encourage hydration
3. manage pain
4. monitor for complications |
|
|
Term
|
Definition
measures pressure in bladder against the bladder wall
how well can the bladder stretch and compress
how well in the detrussor muscle function, how is the bladder tone?
is there detrussor muscle stability and sensation of bladder filling |
|
|
Term
| post op after a cystometrogram |
|
Definition
| you should monitor for infection and discomfort there should be no gross bleeding |
|
|
Term
|
Definition
1. need a consent and type and cross done for possible transfusion
2. hold anticoagulants: heparin, lovenox, arixtra
3. check labs: H and H, platelets, PT and INR |
|
|
Term
|
Definition
1. lay prone or on side for 30-60 min to help tissue to seal itself to avoid bleeding
2. bed rest for 24 hours to limit bleeding
3. monitor site and pressure dressing
4. frequent VS (q5-10min first hour)
5. monitor for complications
6. pain management especially flank pain |
|
|
Term
|
Definition
| retaining more than 50 mL of urine in the bladder after voiding |
|
|
Term
assessment of a patient with urinary retention:
complication |
|
Definition
- no urine output or less than 30 ml/hr
- suprapubic fullness/pain on palpation
- frequent small voiding and dribbling due to incomplete detrussor muscle contraction
complications:
-chronic infections:
a. calculi
b. cystitis to pyelonephritis to urosepsis
(without treatment)
-kidney damage secondary to reflux or urine r/t increased pressure |
|
|
Term
| nursing management of urinary retention |
|
Definition
1. I and O
2. monitor suprapubic and bladder area to make sure there is no bladder distension
- should be nice and soft with no discomfort
3. encourage privacy
4. patient positioning
5. sitz bath
6. water running
7. warm wash clot to perineum
8. catheter is last resort |
|
|
Term
|
Definition
is a type of bladder retention where a neural alteration is affecting bladder control
causes:
1. spinal cord lesions or trauma
2. herniated vertebral disk
3. multiple sclerosis
4. congenital anamolies
5. infection
6. DM |
|
|
Term
| what are the different types of neurogenic bladder? |
|
Definition
1. reflexic
2. areflexic
3. sensory |
|
|
Term
| reflexic (spastic) neurogenic bladder |
|
Definition
-multiple contractions
-results: incomplete emptying due to poor detrussor muscle contraction |
|
|
Term
| areflexic (flaccid) neurogenic bladder |
|
Definition
-flaccid detrussor muscles
-incomplete emptying |
|
|
Term
| sensory neurogenic bladder |
|
Definition
cannot sense the need to go
urine retention |
|
|
Term
| complications from neurogenic bladder |
|
Definition
1. infection: cystitis-pyelonephritis-urosepsis
2. renal calculo (stones)
3. autonomic dysreflexia: immediate nursing attention that can be fatal, autonomic response to noxious stimuli |
|
|
Term
autonomic dysreflexia
treatment |
|
Definition
requires immediate nursing attention. is an ANS response to the stretching of the bladder being perceived as noxious stimuli causing HTN, bradycardia, HA, flushing, and diaphoresis.
treatment: prevention, and correction by removing urine from bladder and treating symptoms |
|
|
Term
| what is the max time limit to kink a foley? |
|
Definition
| 15 minutes then unkink it |
|
|
Term
| the most common urinary diversion |
|
Definition
|
|
Term
| what type of procedure is Foley catheter insertion? |
|
Definition
|
|
Term
| during insertion of a Foley, you break sterile field, what should you do? |
|
Definition
| start all over with a NEW sterile kit using sterile procedure to prevent the risk of a UTI |
|
|
Term
| perineal care for a patient with a Foley should be done how often and in what way? |
|
Definition
how often: 2-3 x a day
how: start from proximal part of catheter and wiping down and away from patient |
|
|
Term
| explain the process of collecting a specimen for a UA or CS? |
|
Definition
1. go to most proximal and clean it with alcohol
2. aspirate with a syringe
3. place urine in appropriate container |
|
|
Term
| is it favorable to have a catheter in for a long time? |
|
Definition
| no the goal is to remove them as quickly as possible to reduce the chances of infection |
|
|
Term
| how often should an indwelling catheter be changed? |
|
Definition
|
|
Term
|
Definition
-inserted cutaneously and sutured in place.
- temporary or long term
- tolerable
- may have to role patient side to side to get complete emptying of the bladder |
|
|
Term
| with a suprapubic catheter, what must be done to ensure that there is complete emptying of the bladder? |
|
Definition
| roll the patient side to side |
|
|
Term
| nursing management of a suprapubic catheter |
|
Definition
1. patency
2. monitor I and O at least 3) ml UO/hr
3. maintain skin integrity
4. monitor for signs of infection/erythema |
|
|
Term
| how would you collect a urine sample from a suprapubic catheter? |
|
Definition
the same way you would with an indwelling or Foley catheter:
1. swab the most proximal port
2. aspirate and then place urine in specimen collection container |
|
|
Term
ureterostomy
purpose
requires |
|
Definition
bringing one ureter through the skin, making a stoma (entry to the skin) and an external apparels would collect urine
purpose: simplest and to reroute or bypass a tumor
requires: an exterior urinary device to collect urine from stoma |
|
|
Term
| what are the three types of surgical urinary diversions? |
|
Definition
1. ureterostomy
2. illeal conduit
3. Koch continent illeal urinary reservoir device |
|
|
Term
|
Definition
-more complex than a ureterostomy
-more extensive
- R and L ureter are attached to a small piece of ilium and that piece is brought out to the skin and leads to a stoma
- BM is normal
- requires external device to collect and drain urine |
|
|
Term
| which of the 3 surgical urinary diversions is the simplest? |
|
Definition
|
|
Term
| koch continent illeal urinary reservoir device |
|
Definition
- most invasive
- involves forming a bladder from a piece of bowel and connecting the ureters with a valve and a stoma with a valve is created as well.
- does not require an external device
-patient gets to catheterize themselves so they must learn sterile technique |
|
|
Term
| of the 3 types of surgical urinary diversion, which of the three is the most invasive? |
|
Definition
| koch continent illeal urinary reservoir device |
|
|
Term
| which surgical urinary diversions require an external draining and collecting device? |
|
Definition
| ureterostomy and the illeal conduit |
|
|
Term
| which surgical urinary diversion does NOT require an external urine drainage and collecting device? |
|
Definition
| koch continent illeal urinary reservoir device |
|
|
Term
| pt educations required for a koch continent illeal urinary reservoir device |
|
Definition
-sterile processes
-how to self catheterize and the need to drain every 2-3 hours to prevent urinary stasis |
|
|
Term
| what are the advantages to the surgical urinary diversion: koch continent urinary reservoir device? |
|
Definition
| -more patient control & tolderance |
|
|
Term
| what are the downsides to a koch continent illeal urinary reservoir device? |
|
Definition
| more extensive, invasive, and complex |
|
|
Term
| complications of surgical urinary diversions |
|
Definition
1. anastomosis- break down of stoma site
2. leaking or urine
3. necrosis/infection at stoma site
4. skin breakdown
5. parlytic ileus due to use of bowel during surgery and peristalsis does not return, so listen for BS
6. obstruction of ureters or strictures |
|
|
Term
|
Definition
| when peristalsis does not return to the bowels |
|
|
Term
| what measures can be taken to monitor for a paralytic ileus? |
|
Definition
|
|
Term
| pre-operative nursing management |
|
Definition
1. patient education on the producre and education
a. stoma management
b. external devices
c. catheterizations
2. pain management education
3. incentive spirometer use
4. bowel preparations
a. clear liquid supper
b. enemas till clear |
|
|
Term
| post operative nursing management for surgical urinary diversion |
|
Definition
1. maintain tube patency
2. monitor I and O
3. hydration
4. prevent bladder distension
5. care of stoma site and skin intergrity
6. monitor for bleeding/pallor/infection
7. a stoma should have a nice pink color to it
8. monitor labs and electrolytes
9. manage pain
10. manage external device catheterization
11. monitor placement and output of NG tube to low intermittent suction. |
|
|
Term
| if before surgery your patient has any questions about the risks, benefits, alternatives, and complications of the surgery you should |
|
Definition
|
|
Term
| what is the purpose of an NG after a surgical urinary diversion? |
|
Definition
| to keep the stomach decompressed especially if any part of the bowel was used until peristalsis returns. do not want any increased pressure to cause dehiscense |
|
|
Term
| at what settings should you keep your patient's NG tube post op from a surgical urinary diversion? |
|
Definition
|
|
Term
|
Definition
| low intermittent suction on an NG tube |
|
|
Term
pharmacological management for:
urinary incontinency |
|
Definition
1. anticholinergics: ditropan, detrol, bentyl
-commercial, gotta go gotta go right now!
- relax smooth muscle
-inhibit detrussor muscle contractions
-aim to prevent urinary incontinence episodes
-used best with behavioral therapy
2. estrogen cream (HRT)
-applied locally to vaginal and urethral area
-decreases urethral irritation, dryness and increases defense against UTI |
|
|
Term
pharmacological management for:
urolithiasis |
|
Definition
1. pain management:
toradol, morphine, dilaudid
2. control n/v:
phernergan, compazine, and zofran |
|
|
Term
| before giving toradol you must check.... and know... |
|
Definition
| that renal function is ok, check for an elevated BUN or creatinine since this means decreased renal function and places patient at ris for peptic and gastric ulcers as the other NSAIDs do as well |
|
|
Term
|
Definition
| 4-8 mg IV and is usually well tolerated |
|
|
Term
| when choosing between phernergan or zofran it would be better to chose |
|
Definition
| zofran since it is less sedating and more well tolerated |
|
|
Term
pharmacological management for:
cystitis/UTI |
|
Definition
1. abx- fluoroquinolones (floxacins)
a. ciprofloxacin (cipro)
2. abx sulfas
a. bactrim
b. BEWARE OF ALLERGIES TO SULFER
3. urinary analgesic- pyridium
a. not an abx
b. turns urine orange
c. only for short term use, less than 3 days, no more |
|
|
Term
pharmacological management for:
pyelonephritis |
|
Definition
1. abx:
a. fluoroquinolones (floxacins)
a. avelox (moxifloxacin)
b. levaquin (levofloxacin)
b. sulfonamides
a. bactrim |
|
|
Term
diuretics:
-lasix or (_________)
-what type of diuretic is it?
-indications for use
-precautions for use
-interactions
-monitor
-routes
-adverse reactions |
|
Definition
diuretics:
-lasix or FUROSEMIDE
-what type of diuretic is it?
lood diuretic
-indications for use
hypertension, hypervolemia or volume overload
-precautions for use
renal/hepatic impairment, sulfa allergy, hypokalemia, DM
-interactions
digoxin and lithium
-monitor
VS, BP, K and Mg, BUN/ creatinine, I and O and weigh
-routes
IV and PO
-adverse reactions
hypokalemia, hypotension, orthostatic hypotension, muscle cramps, hyperglycemia (from loss of fluids), rash (from sulfa allergy), photosensitivity, tinnitus (ringing in the ears) |
|
|
Term
| should patients with a sulfur allergy be on lasix? |
|
Definition
| no because lasix has a sulfur component |
|
|
Term
| if your patient is on lasix and is having a new onset of tinnitus what would you? |
|
Definition
| hold the lasix and notify the MD |
|
|
Term
| can lasix and bumex be given at the same time? |
|
Definition
|
|
Term
diuretics:
-bumex
-what type of diuretic is it?
-indications for use
-precautions for use
-interactions
-monitor
-routes
-adverse reactions |
|
Definition
diuretics:
-bumex
-what type of diuretic is it?
loop diuretic
-indications for use
HTN, hypervolemia, ascites, anasarca, volume overload
-precautions for use
renal/hepatic impairment, sulfa allergy, hypokalemia, and DM
-interactions
digoxin and lithium
-monitor
VS, BP, K and Mg, BUN/ creatinine, I and O and weigh
-routes
PO or IV
-adverse reactions
hypotension, hypokalemia, muscle cramps, ototoxicity, rash, and hyperglycemia (loss of fluids) |
|
|
Term
diuretics:
-aldactone or (_________)
-what type of diuretic is it?
-indications for use
-precautions for use
-interactions
-monitor
-routes
-adverse reactions |
|
Definition
diuretics:
-aldactone or (_________)
-what type of diuretic is it?
potassium-sparing diuretic
-indications for use
HTN, diuresis
-precautions for use
hyperkalemia, renal impairment
-interactions
K+ supplements, lithium, ACE inhibitors, NSAIDs, digoxin
-monitor
VS, BP, K+, cocomittant meds, BUN/creatinine, I and O, and weight
-routes
PO
-adverse reactions
hyperkalemia |
|
|
Term
| K protocol should not be used if a creatinine of 2.1 |
|
Definition
| because the K protocol should only be used when creatinine is less than or equal to 2 because anything greater means that the kidneys are not functioning and can result in hyperkalemia |
|
|
Term
| for K replacement which route is preferred? |
|
Definition
|
|
Term
| if PO K cannot be tolerated, it can be given IV per K protocol |
|
Definition
1. dilute IV solution
2. hang on IV pump w/ NS or another fluids
3. cannot speed up past 10 mEq/hr
NEVER give gravity or IV push! |
|
|
Term
| if a patient who is AxOx3 and has a K level of 3.4 what would you do? |
|
Definition
| has to be IV regardless because of protocol |
|
|
Term
| according to the K protocol, a K level less than 3.5 should be replaced by what route regardless of LOC, etc? |
|
Definition
|
|
Term
| after PO administration of K when should you recheck the K level? |
|
Definition
|
|
Term
| when should you recheck K level after completion of IV administration of K? |
|
Definition
|
|
Term
| the Mg protocol should only be used if the serum creatinine is less than or equal to |
|
Definition
|
|
Term
| Mg is replaced only by what route? |
|
Definition
| IV, never push or hang gravity, always slowly on a IV pump |
|
|
Term
| you repeat the steps of the Mg protocol until the Lg level is greater than |
|
Definition
|
|
Term
| upper respiratory system includes |
|
Definition
the structures above your lungs:
-nose
-sinuses
-pharynx
-tonsils
-epiglottis
-larynx
-trachea |
|
|
Term
|
Definition
| filters, warms and humidifies air |
|
|
Term
|
Definition
| are a reservoir/cavity that holds onto oxygen as we breathe |
|
|
Term
|
Definition
| passageway that leads down from the nose to the deeper anatomy |
|
|
Term
|
Definition
|
|
Term
|
Definition
| covers the trachea to prevent aspiration with swallowing |
|
|
Term
|
Definition
|
|
Term
|
Definition
| passageway that leads down into respiratory tract |
|
|
Term
|
Definition
-are the structures inside of your lungs:
1. R and L lung
2. main stem bronchi
3. hilum
4. respiratory bronchioles
5. alveoli |
|
|
Term
| how many lobes does each lung have? |
|
Definition
|
|
Term
|
Definition
| entryway into R and L lung and allows for innervation of vessels and nerves etc |
|
|
Term
|
Definition
| made of smooth muscle and dilate and contract and important to breathing status |
|
|
Term
|
Definition
main functioning unit of the lung where O2 and CO2 are exchanged
about 300 million in lungs
must be open for stable breathing and normal functioning of the lungs |
|
|
Term
| explain the process of how O2 is breathed in |
|
Definition
air is breathed in through the NOSE
then goes to the
CAVITIES
then goes to the
TRACHEA
then goes to the
LUNGS
then goes to the
ALVEOLI
then through the alveoli, the air travels to cells that run adjacent to it and is transferred and exchanged for CO2 where it will be exhaled |
|
|
Term
| if you pluck or cut any nasal hairs what can you alter? |
|
Definition
| the ability of the nasal hairs to filter through large particles to prevent bacterial and viral infections |
|
|
Term
| mucus helps to trap ___________ with___________ and then uses what reflex? |
|
Definition
| mucus helps to trap particles with cilia and then uses the cough reflex |
|
|
Term
| what are some things that can alter our cough reflex? |
|
Definition
1. stroke
2. post surgical anesthesia such as a bronchoscopy |
|
|
Term
| the bronchioles are smooth muscles meaning |
|
Definition
| they can contract and dilate |
|
|
Term
| if the bronchioles sense anything in the environment that is noxious is is natural that they will |
|
Definition
|
|
Term
| in asthma there is an excessive |
|
Definition
|
|
Term
alveolar macrophages what are they?
what must be maintained in order for them to function? |
|
Definition
are in the blood and ingest debris to keep us free from infection
must maintain:
hydration
nutrition
a healthy body |
|
|
Term
| aging changes that affect the respiratory system |
|
Definition
1. increase in AP diameter: there is a no longer a 2:1 ratio in the diameter of the anterior chest compared to the posterior chest; it increases with age
2. increase in risk for infection/disease due to a decrease in defense mechanisms
3. decrease in life of defense effectiveness
4. decrease in O2/CO2 exchange
5. decreased respiration effectiveness to the brain
6. RR goes from 16-18 to 12-14 |
|
|
Term
| in a normal chest how much longer is the anterior diameter of our chest compared to the posterior diameter? |
|
Definition
| the anterior diameter should be about twice as long |
|
|
Term
| stressors to the respiratory system |
|
Definition
1. bacteria, virus, fungus
2. social habits: drugs or smoking
3. age
4. allergies: food/environment/animal
5. meds: narcotics/anesthesia/steroid use
6. co-morbidities: COPD/heart/renal failure
7. trauma
8. anesthesia/surgery
9. obesity- more tissue to deliver O2
10. diet/dehydration
11. activity/exercise
12. family history and genetic predisposition |
|
|
Term
| describe a normal breathing assessment in a patient |
|
Definition
RR: 12-20/min
even
unlabored
symmetrical |
|
|
Term
|
Definition
| the patient is overworking to breathe |
|
|
Term
|
Definition
| upper airway inflammation from closing or constriction of the trachea usually due to an allergic response |
|
|
Term
| can you hear stridor without a stethoscope? |
|
Definition
|
|
Term
| what does stridor sound like? |
|
Definition
| high pitched wheezing is an EMERGENCY |
|
|
Term
| if you hear your patient has stridor upon breathing would it be appropriate to tell them to lie down, breathe deep and you will check on them in 1 hour? |
|
Definition
|
|
Term
| what are some examples of abnormal breathing patterns? |
|
Definition
labored breathing
pursed lip breathing
tipod position
accessory muscle use
nasal flaring
stridor
splinting
tachypnea/bradypnea
Kussmaul's
Cheyne-Stokes |
|
|
Term
| what is the purpose of palpating the patient to assess respiratory function? |
|
Definition
| to check for equal breath expansion |
|
|
Term
| if you place your hands on the lobes of the patient and ask the patient to say 99, in a normal patient you should feel |
|
Definition
| minor equal vibrations called fremitus |
|
|
Term
|
Definition
| minor equal vibrations in the respiratory system |
|
|
Term
| if there is more fremitus in one lobe than the other it could be due to |
|
Definition
| an increase in fluid or dense tissue like in pleural effusion or pneumonia |
|
|
Term
| if the fremitus in the lungs is more distant that the other lobes this could be due to |
|
Definition
|
|
Term
| if you hear no fremitus in a lobe it could be due to |
|
Definition
| atelectasis or pneumothorax |
|
|
Term
| percussion of the lobes of the lungs of a normal patient you should hear |
|
Definition
|
|
Term
upon percussion of the lungs if you hear hyperresonance it is usually due to.....
if it is tympanic (drum-like)..... |
|
Definition
upon percussion of the lungs if you hear hyperresonance it is usually due to.....hyperinflated lungs (COPD)
if it is tympanic (drum-like)..... gas filled |
|
|
Term
| percussing an organ will cause what type of noise? what about in the lungs of an abnormal respiratory patient? |
|
Definition
a solid dull sound should be heard
in the lungs of a patient with pneumonia you would also hear a dull sound due to consolidation. no |
|
|
Term
| upon percussion a normal lung should have |
|
Definition
|
|
Term
| if you percuss over a bone the sounds should be |
|
Definition
|
|
Term
| rales/crackles are due to |
|
Definition
|
|
Term
|
Definition
|
|
Term
| wheezing is due to.....such as...... |
|
Definition
| inflammation such as asthma |
|
|
Term
| decreased or no lung sounds are due to |
|
Definition
| atelectasis/loss of alveoli/collapsed lobe or lung |
|
|
Term
friction rub sounds upon lung auscultation:
with breathing:
without breathing: |
|
Definition
with breathing: pleural rub
without breathing: cardiac rub |
|
|
Term
| stridor is due to an inflammed |
|
Definition
| trachea and anaphalactic reaction (severe allergic response) |
|
|
Term
| is stridor more associated with the upper or lower airway? |
|
Definition
| upper; inflammation of the trachea |
|
|
Term
| is it abnormal for the AP diameter to be greater than the transverse diameter? |
|
Definition
| yes, the transverse should be greater |
|
|
Term
correct this statement so that it is normal:
AP diameter > transverse diameter |
|
Definition
| AP diameter < transverse diameter |
|
|
Term
| you want a pulse oximetry that is greater than |
|
Definition
|
|
Term
| a pulse ox less than 92 requires |
|
Definition
| O2 intervention and call MD |
|
|
Term
|
Definition
arterial blood gases:
drawn by RT
gives pH of blood and how well they are in taking O2 and blowing off CO2 |
|
|
Term
| what is the difference between the BMP and the CMP? |
|
Definition
BMP: base metabolic panel
this has your electrolytes, BUN creatinine, glucose, and GFR
CMP: comprehensive metabolic panel
has BMP and liver function tests: ALT/AST/bilirubin/alkaline phosphotase levels |
|
|
Term
| what panels/labs do you need for respiratory? |
|
Definition
CBC
BMP
CMP
BNP
blood cultures
sputum cultures
PPD |
|
|
Term
|
Definition
brain natriatic peptide
gives volume status of patients.
is elevated in hypervolemic patients and those with CHF
above 100 is high and can reach the 1000s |
|
|
Term
| you would expect a high BNP is patients with |
|
Definition
|
|
Term
|
Definition
tells if patient has
bacteremia
spread of infection
septic infection
systemic blood infection |
|
|
Term
|
Definition
ID what type of infection (pneumonia)
best collected in the AM
brushing teeth and gargled is not needed
we need a deep lung culture. cough and DEEP breath |
|
|
Term
| when is the best time to collect a sputum culture? |
|
Definition
|
|
Term
| what should you tell your patient to do when you collect a sputum culture? |
|
Definition
| to cough and deep breathe |
|
|
Term
|
Definition
purified protein derivative
used to check for exposure to TB not if they have active TB |
|
|
Term
|
Definition
chest x-ray gives a flat time view of pulmonary anatomy
can see:
1. bones
2. aeration (what part of the lungs are being oxygenated)
3. atelectasis
4. pneumothorax
5. collapsed alveoli/lung
6. pleural effusion
7. fractures |
|
|
Term
| what are the advantages of a CT/ spiral CT over a CXR? |
|
Definition
| it is more in depth and there is more soft tissue assessment |
|
|
Term
| what diagnostic measure is usually done to diagnose pulmonary emboli? |
|
Definition
|
|
Term
| MRI over CT which is better? |
|
Definition
| MRI because you see more details and can pick up fine and soft tissues/tumors/masses/nodules |
|
|
Term
|
Definition
going through the bronchials into lungs for:
assessment
suctioning
cancer Dx
cytology |
|
|
Term
| do you need a consent form for a bronchoscopy? |
|
Definition
|
|
Term
| what type of anesthesia would a patient undergoing a bronchoscopy receive? |
|
Definition
|
|
Term
| what type of medications are used for conscious sedation? |
|
Definition
| diprovan (propofol) and versed (midazolam) |
|
|
Term
| does the medication used for conscious sedation wear off quickly? |
|
Definition
|
|
Term
| after a bronchoscopy it is important to |
|
Definition
| monitor patient VS, respiratory status, gag reflex BEFORE food and ice to prevent aspiration |
|
|
Term
| what is the gold standard for Dx of malignant tissue? |
|
Definition
|
|
Term
|
Definition
| scope through the chest wall |
|
|
Term
| after a lung biopsy be sure to monitor patients for |
|
Definition
| respiratory distress or bleeding |
|
|
Term
|
Definition
| injecting dye into blood vessels to look at the pulmonary vasculature and how it is perfused |
|
|
Term
|
Definition
ventilation perfusion scan:
used to Dx a pulmonary embolism
looking for a mismatch in ventilation vs. perfusion
a mismatch= high risk for pulmonary emboli |
|
|
Term
|
Definition
|
|
Term
|
Definition
how well pt is breathing
gives tidal numbers
tells whether lung capacity is able to withstand anesthesia during surgery |
|
|
Term
| educate patients about PFT that: |
|
Definition
before: NO FOOD!
during: follow the directions and give 100% effort |
|
|
Term
|
Definition
| removal of fluid from the pleural space with a needle and aspiration of excess fluid |
|
|
Term
| do you need a consent for a thoracentesis? |
|
Definition
|
|
Term
| in regards to a thoracentesis is it invasive? |
|
Definition
|
|
Term
| if a thoracentesis is about to be done on your patient, what is your responsibility as a nurse? |
|
Definition
1. to get the supplies:
sterile gloves & vacutainer
2. patient must be sitting upright and leaning over table so that gravity can all go down
3. monitor vitals and O2 level
4. assist MD to collect fluid
5. send fluid to lab
6. after- monitor site for bleeding and VS |
|
|
Term
| will a numbing agent be used for a thoracentesis? |
|
Definition
|
|
Term
| what is one complication that can arise from thoracentesis |
|
Definition
| the MD may puncture the lung causing a rapid decrease in respiratory status leading to respiratory distress |
|
|
Term
| if your patient will be having a thoracentesis who should you notify ahead of time? |
|
Definition
| your charge nurse just in case you need backup if the patient does not tolerate it well |
|
|
Term
acute viral rhinitis:
1. what is it?
2. lasts?
3. contagious? spreads?
4. limiting?
5. clinical manifestations
6. management |
|
Definition
1. what is it?
the common cold; an inflammation of the mucous membranes
2. lasts?
it is self-limiting
3. contagious?
contagious: only for the first 3 days
spread: airborne droplet
4. limiting?
self limiting
5. clinical manifestations:
fever
malaise
sneezing
sore throat
nasal congestion
yellow discharge
productive cough
6. management
-prevent secondary bacterial infection
-hygiene/hydration
-rest/nurition
-education on avoidance
-Tx: OTC drugs |
|
|
Term
acute viral rhinitis:
1. what is it?
2. occurs?
3. clinical manifestations
4. management |
|
Definition
acute viral rhinitis:
1. what is it?
inflammation of nasal mucosa secondary to an allergen
2. occurs?
is seasonal
3. clinical manifestations
-sneezing
-sore throat
-itchy watery eyes
-nasal congestion
-clear discharge
4. management
-ID/limit allergen
-keep diary
-avoid dust
-Tx:
a. allergy injection
b. antihistamines:
a. 1 st gen: benedryl
b. 2nd gen: claritin, zyrtec, allegra. clarinex
c. nasal inhalers: vancenase |
|
|
Term
|
Definition
| an infection of the sinuses |
|
|
Term
| in sinusitis instead of the sinuses being clear to serve as a reservoir for oxygen, they are |
|
Definition
|
|
Term
what is the Tx for sinusitis?
Dx: |
|
Definition
Tx: antibiotics
Dx: s/s, sinus x-ray, CT/MRI |
|
|
Term
acute sinusitis:
1. what is it?
2. what causes it?
3. clinical manifestations?
4. management? |
|
Definition
acute sinusitis:
1. what is it?
a bacterial infection that is caused by a cold has gone on for more than 2 weeks causing inflamed sinus mucous membranes
2. what causes it?
bacterial infection; cold longer than 2 weeks
3. clinical manifestations?
-fever
-malaise
-purulent drainage
-URI > 2 weeks
-h/a and facial pain
-nasty taste in mouth
4. management?
-abx: z-pack and augmentin
-rest
-hydration |
|
|
Term
chronic sinusitis:
1. what causes it?
2. clinical manifestations?
3. management?
4. how does this differ from an acute case of sinusitis? |
|
Definition
1. what causes it?
repetitive acute infections
2. clinical manifestations?
-nasal obstruction
-nasal stiffness
-nasal pressure
-hoarseness
-h/a
-nasal polyps: from excessive lymphatic tissue
3. management?
-ENT specialist
-polypectomy or surgery
-saline nasal irrigation
-humidifiers-stream
-rest
-hydration
4. how does this differ from an acute case of sinusitis?
acute comes and goes and is curable with abx for a week but in this case they experience s/s everyday |
|
|
Term
laryngitis:
1. what is it/causes it?
2. clinical manifestations?
3. management? |
|
Definition
laryngitis:
1. what is it/causes it?
-is an inflammation of larynx mucous membranes
-caused by overuse of vocal chords like too much talking or singing
-can be caused by edema of vocalchords or change in cold temperature
2. clinical manifestations?
-loss of voice
-scratchy or painful throat
-cough
3. management?
-rest voice
-hydration
-avoid irritants
-breath in steam
-cough suppressants |
|
|
Term
nasal fracture:
1. what is it?
2. clinical manifestations?
3. management? |
|
Definition
nasal fracture:
1. what is it?
associated with trauma
2. clinical manifestations?
-x-ray
-ecchymosis
-bleeding
-pain
3. management?
-control bleeding
-ice
-post surgery monitor: bleeding, swelling, and breathing
-use a straw from drinking and softer food |
|
|
Term
nasal bleeds:
1. what causes it?
2. clinical manifestations?
3. management? |
|
Definition
nasal bleeds:
1. what causes it?
-dryness
-fracture
-pathology
2. clinical manifestations?
-anterior- most common
-posterior- MORE SERIOUS, ENT specialist
3. management:
1. pinch nose
2. lean forward
3. ice
4. ENT |
|
|
Term
| which type of nose bleed is most serious and requires an ENT? |
|
Definition
|
|
Term
| for an anterior nose bleed it is best to |
|
Definition
1. pinch the nose
2. lean the patient forward to avoid the swallowing of blood
3. do NOT put their head back
4. ice |
|
|
Term
| if a patient with a nasal bleed is on O2, what should you do? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| helps to drain the congestant so that it can be blowed and coughed out. that is why hydration is so important; to keep the secretions thin |
|
|
Term
| give some examples of antihistamines |
|
Definition
-benedryl
-claritin
-clarinex
-zyrtec
-allegra |
|
|
Term
|
Definition
-blocks the histamine reaction and the blood
-used to dry out or decrease secretions
-not good for thick secretions |
|
|
Term
| 1st generation antihistamines |
|
Definition
|
|
Term
| 2nd generation antihistamines |
|
Definition
claritin, clarinex, zyrtec, allegra
- less sedating and do not cause respiratory depression |
|
|
Term
| give come examples of low dose steroid sprays |
|
Definition
|
|
Term
|
Definition
| help to decrease inflammation locally |
|
|
Term
|
Definition
|
|
Term
|
Definition
-should only be used for short term use (3 days)
-help to decrease nasal congestion and dilation
-after 3 days will cause rebound nasal congestion |
|
|
Term
| what is an analgesic and antipyretic (anti-fever)? |
|
Definition
|
|
Term
| OTC alternatives for acute upper respiratory infections |
|
Definition
-echinacea
-goldenseal
-zinc
-airborne |
|
|
Term
| what must you be careful about when dealing with OTC alternatives such as goldenseal and airborne? |
|
Definition
| the dosages are NOT regulated by the FDA |
|
|
Term
foreign bodies:
inorganic
organic |
|
Definition
inorganic- not alive
buttons, beads, earring back
organic- living tissue
food, wood, cotton, paper, tooth |
|
|
Term
| which type of foreign body is more noticed and more serious? |
|
Definition
| organic foreign bodies such as teeth, cotton, wood, and food go more noticed and cause a local inflammatory process and nasal discharge with a very foul odor |
|
|
Term
| failure to remove a foreign body that has lead to a local inflammatory response and a foul nasal discharge can lead to |
|
Definition
|
|
Term
| collaborative management for foreign bodies |
|
Definition
1. maintain patent airway: 92% O2 sat
2. remove object from route of entry
3. abx if infection present |
|
|
Term
lung abscess
-pathophysiology
-causes |
|
Definition
-pathophysiology
a. pus forming legion that becomes necrotic and forms a cavity in lung parenchyma
-causes
a. aspiration of a foreign body
b.lung infarction 2nd to pulmonary embolism
c. malignancy
d. TB
e. fungal infection |
|
|
Term
| clinical manifestations of a lung abscess |
|
Definition
1. very sick patient with systemic effects
2. fever/chills
3. leukocytosis
4. fatigue
5. lethargy/malaise
6. foul smelling and tasting sputum
7. productive cough-purulent
8. dyspnea/hemoptysis/ diminished BS
9. weight loss
10. night sweats
11. pleuritic chest pain |
|
|
Term
|
Definition
|
|
Term
| how long does it often take for a lung abscess to clear? |
|
Definition
|
|
Term
| diagnostic tests for a lung abscess |
|
Definition
1. CXR- would show a cavity
2. pleural fluids, blood, and sputum cultures
3. bronchoscopy |
|
|
Term
| management of lung abscess |
|
Definition
1. abx for 2-4 months: penicillin and clindamyacin
2. educate on med compliance
3. pulmonary toilet: all pulm. interventions
a. C and DB
b. IS
c. hydration
d. coughing into tissue and through it away
e. percussion of back to encourage mobilization of secretions and expectoration
4. mouth care
5. nutrition (due to hypermetabolic state from demand on body)
6. hydration
7. rest |
|
|
Term
| atelectasis of an entire lung is a |
|
Definition
|
|
Term
| clinical manifestations of atelectasis |
|
Definition
- diminished or absent BS
-fever
-increased in dyspnea
-pleuritic pain (chest pain)
-cyanosis/hypoxemia
-CXR changes |
|
|
Term
|
Definition
| collapsed, airless alveoli |
|
|
Term
| management of atelectasis |
|
Definition
-prevention: pulm. toileting to maintain self-ventilation
-treat the cause
-respiratory treatments
-percussion to mobilize secretions
-pain medications
-high to semi-Fowler's |
|
|
Term
|
Definition
all the pulmonary interventions taken to encourage respiratory function:
-incentive spirometer use
-coughing and deep breathing
-early ambulation
-hydration to thin secretions
-maintaining pulse sat >92%
-percussion to mobilize secretions |
|
|
Term
|
Definition
| done by RT; inhale on something that causes internal vibration of the lungs to mobilize secretions |
|
|
Term
| pneumonia is an obstruction of the |
|
Definition
|
|
Term
| how does pneumonia affect gas exchange? |
|
Definition
|
|
Term
| what are the clinical manifestations of pneumonia? |
|
Definition
- productive cough
-fever
-chills
-tachycardia
-tachypnea
-dyspnea
-pleural pain
-malaise
-respiratory distress
-decreased BS
-sputum will be yellowish-green |
|
|
Term
| your patient with pneumonia has a sputum that is greenish yellow, you suspect that they have what type of infection? |
|
Definition
|
|
Term
| your patient with pneumonia has a sputum that is yellow or blood streaked, you suspect that they have what type of infection? |
|
Definition
|
|
Term
| what MD orders would you expect for a patient who has pneumonia? |
|
Definition
-sputum culture
-CXR
-O2 > 92%
-IVF to hydrate |
|
|
Term
|
Definition
| an acute inflammation of the lung parenchyma |
|
|
Term
| what are the routes of transmission by which pneumonia can be acquired? |
|
Definition
-inhalation
-aspiration
-hematogenous spread: spread throughout the body or blood stream from one site to the other |
|
|
Term
| what are the different types of pneumonia? |
|
Definition
1. CAP (community acquired pneumonia): begins in the community of within first 2 days of hospital stay
2. HAP (hospital acquired pneumonia): is a nosocomial ifection, begins after 2 days in hospital, caused by inspiration
3. aspiration pneumonia- food was aspirated into the trachea into the lungs
4. fungal pneumonia- more seen in immunocompromised patients (oncology, AIDS/HIV) |
|
|
Term
| risk factors for developing pneumonia |
|
Definition
-closed community arrangements: tight living quarters (prisons, nursing homes)
-recent URI
-co-morbidities (heart disease, renal failure)
-immunocompromised
-younger and older
-hospitalization
-intubated patients
-trach patients: tracheostomy
-smoking
-chest trauma
-risk for aspiration
-surgery |
|
|
Term
|
Definition
-CBC for leukocytosis
-ABG for decreased O2 or increased CO2 (hypercapnia)
-sputum CS for ID of infection
-blood cultures for sepsis
-CXR- looking for infiltration and consolidation |
|
|
Term
|
Definition
1. maintain a patent airway
2. facilitate self breathing and oxygenation
3. sat >92%
4. prevent infection spread
5. sputum cultures
6. pain management: pleural rub, pleuritic pain
7. pulmonary toileting
8. increase activity and ambulation
9. hygiene and mouth care
10. small frequent meals as least 1500 cal/day or with supplemental feedings: high protein and high cars
11. good hydration |
|
|
Term
| how often is the influzena vaccine given? |
|
Definition
| influenza vaccine is annual |
|
|
Term
| how often is the pneumococcal vaccine given? |
|
Definition
once and repeated every 5 years for patients at high risk for developing pneumonia:
-recovering from a severe illness
->65 years old
-long term facility
-part of CAP protocol |
|
|
Term
| what does the influenza vaccine prevent? |
|
Definition
| certain strains of influenza or the flu |
|
|
Term
| your MD gives you an order for a patient that came into the hospital with pneumonia that says: CAP protocol. what do you do? |
|
Definition
print off CAP orders
standing orders for pulm toileting and sputum collections
ask patient if they have had vaccine or want it |
|
|
Term
|
Definition
-rocephin
-zithromax
-if they have a PCN allergy: give avelox |
|
|
Term
|
Definition
| zithromax is a macrolide antibiotic |
|
|
Term
|
Definition
| a cephalosporin antibiotic |
|
|
Term
| if your patient has CAP and is allergic to PCN, what type of abx would you expect them to recieve? |
|
Definition
|
|
Term
|
Definition
| a fluoroquinolone antibiotic used to treat CAP in patients with an allergy to PCN and also to treat pyelonephritis as well as MRSA |
|
|
Term
| antibiotics used to treat aspiration pneumonia |
|
Definition
zosyn
zithromax(azithromycin)
z-pack |
|
|
Term
| antibiotics used to treat HAP |
|
Definition
|
|
Term
| antibiotics used to treat MRSA |
|
Definition
|
|
Term
| you are educating a patient on why smoking places them at greater risk for developing or acquiring pneumonia. what points would you share? |
|
Definition
that is destroys the :
-cilia in the lungs
-muco-ciliary clearance
-alveolar macrophages
-normal line of defense |
|
|
Term
| what information can you share with your patient to prevent CAP? |
|
Definition
-hygiene
-stop smoking
-hydration
-nutrition
-treat URI immediately
-encourage vaccinations |
|
|
Term
| prevention of HAP/aspiration pneumonia |
|
Definition
1. prevent aspiration:
a. positioning of HOB
b. looking for coughing while swallowing
c. any signs notify MD and hold future feedings for a swallow study
2. frequent mouth care
3. sterile practice and procedures
4. early pulmonary toileting |
|
|
Term
| you are feeding your patient when you notice that they begin to cough while trying to swallow. what do you do? |
|
Definition
1. hold future feedings
2. notify MD
3. wait for a swallow study |
|
|
Term
| is coughing while swallowing normal? |
|
Definition
|
|
Term
|
Definition
| a serious bacterial infection in the lungs that can also spread to other parts of the body |
|
|
Term
| the transmission of tuberculosis occurs through |
|
Definition
| air-borne/respiratory droplets |
|
|
Term
| the type of bacteria that causes tuberculosis |
|
Definition
acid-fast bacilus
M. tuberculosis |
|
|
Term
| how is tuberculosis spread? |
|
Definition
| close and frequent and prolonged exposure. |
|
|
Term
| can a quick encounter with a patient with TB cause transmission? |
|
Definition
| no, only close, prolonged, and frequent encounters can, like sleeping the same bed with the person |
|
|
Term
|
Definition
-socioeconomically disadvantaged
-homeless, long term institutions
-prison inmates
-IV drug users
-foreign born persons
-HIV/AIDS
-healthcare workers |
|
|
Term
| what are the two stages of TB? |
|
Definition
| dormant/latent and active |
|
|
Term
| the dormant/latent phase of TB vs. the active clinical disease |
|
Definition
dormant/latent phase of TB:
1. a + PPD indicates exposure to TB not that you actively have it.
2. once exposed to TB it can lay dormant for years and can remain latent for years
3. the tubercle with bacilli remain encapsulated unless the patient becomes immunocompromised
active clinical disease of TB:
1. if an exposed person becomes immunocompromised (cancer, AIDS) then bacilli escape tubercle
2. they invade and infect the lung and it becomes an active clinical disease
3. a radiologist will see a calcified Ghon complex on a lung x-ray |
|
|
Term
|
Definition
| exposure to TB not that you actively have it |
|
|
Term
| in active TB a radiologist will see what in a lung x-ray? |
|
Definition
|
|
Term
| clinical manifestations of TB |
|
Definition
-chronic cough
-night sweats
-hemoptysis
-productive cough
-weight loss
-low grade temperatures
-fatigue and malaise
-loss of appetite |
|
|
Term
| diagnostic measures for TB |
|
Definition
-PPD will be + with induration
-CXR will show a Ghon tubercle (calcified nodules)
-acid fast bacilli sputum smear and culture |
|
|
Term
T or F:
a +PPD will be negative in 3 months? |
|
Definition
| false, a +PPD is positive for life |
|
|
Term
|
Definition
purified protein derivative
-an antigen-antibody reaction
- a + means you have been EXPOSED to TB not necessarily that you have the active phase |
|
|
Term
| if you have a +PPD what precautions should you take? |
|
Definition
| CXRs every 1-2 years looking for the active phase |
|
|
Term
|
Definition
| not only erythema of the skin but also induration or hardening of the skin that is greater than 5 |
|
|
Term
| you have a +PPD that shows +5 induration, what is your next step? |
|
Definition
|
|
Term
| explain the process of collecting an acid fast bacilli sputum smear and culture for the detection of TB |
|
Definition
1. need 3 specimens
2. collected in 3 consecutive days
3. early in the AM (morning)
4. it is looking for the acid-fast bacilli which indicates TB |
|
|
Term
| what is important to implement for a patient who has had a PPD, CXR, and an acid fast bacilli sputum smear and culture and displays the s/s of TB? |
|
Definition
| they need to be on reverse isolation until they have 3 negative cultures, a negative PPD, and negative CXR before you remove them off of isolation. you must use a mask and filter, close the door and notify engineering to get a HEPA filter |
|
|
Term
|
Definition
1. drug therapy
2. reverse isolation until there are 3 negative acid-fast bacilli smears
3. diet and supportive care
4. education and compliance
5. THEY MUST TAKE THEIR MEDS: a public nurse will come to your house to make sure! |
|
|
Term
| HEPA masks and reverse isolation are required for a person who might have |
|
Definition
| TB; this can be removed when it is proven that they do not have TB with 3 negative acid fast bacilli smear cultures |
|
|
Term
| pharmacological therapy for a patient with dormant phase TB |
|
Definition
| single therapy INH for 6-9 months, the patient has a choice, it is not mandatory |
|
|
Term
|
Definition
| isoniazid (laniazid, nydrazid) first-line antituberculosis medication in prevention and treatment. |
|
|
Term
| pharmacological therapy for a patient with active phase of TB: +PPD, +CXR, +smear cultures: |
|
Definition
MANDATORY!!!!!!!!!!!!!!!!!!!!!!!!!!!
-4 drug combo for 6-9 months:
1. rifampin
2. isoniazid (INH)
3. pyrazinamide (PZA)
4. ethambutol (EMB)
5. streptomycin (SM)
-these drugs are very VERY strong antibiotics due to a very smart and resistant bacteria |
|
|
Term
| nursing considerations for a patient on INH |
|
Definition
L: liver enzyme monitoring throughout therapy
U: use caution with patients with renal impairment and monitor BUN/creatinine/renal status
N: no alcohol to avoid harsh vomiting and increase in liver enzyme
G: give pyroxydine/vitamin B6 to prevent peripheral neuropathies
S: stomach empty when taking medication. need a screen vision to test sight and look for skin rashes |
|
|
Term
| nursing considerations for rifampin |
|
Definition
-turns urine orange
-has multiple drug-drug interactions |
|
|
Term
| what drugs turn your urine orange? what are they used for? |
|
Definition
-pyridium: used as a urinary analgesic in cystitis (UTI)
-rifampin: used a an antibiotic in the 4 drug comb treatment of the active phase of TB |
|
|
Term
| COPD is an umbrella term used to encompass an increased resistance to... |
|
Definition
airflow due to obstruction or narrowing of air flow due to:
-inflammation
-secretions
-bronchospasm
-tissue destruction |
|
|
Term
| what are the 3 types of COPD |
|
Definition
1. asthma
2. chronic bronchitis
3. emphysema |
|
|
Term
|
Definition
is a hypersensitivity reaction consisting of excessive bronchiole constriction (hyperresponsive) to all types of stimuli is a
-airway inflammation
-patients can outgrow it
-adult onset is usually caused by acid reflux
-usually brings in childhood |
|
|
Term
| adult onset asthma is usually due to |
|
Definition
|
|
Term
|
Definition
-inflammation of the bronchioles which is chronic
-airflow obstruction due to excessive yellow mucus production in the bronchi
-always coughing loogies |
|
|
Term
| what is the difference between asthma and chronic bronchitis? |
|
Definition
| asthma is an excessive constriction of the bronchioles in a hyperresponsive manner causing airway inflammation while bronchitis is an inflammation of the bronchioles along with excessive mucus production causing airway obstruction |
|
|
Term
|
Definition
| abnormal permanent enlargement of alveoli and destruction of alveolar walls |
|
|
Term
what are the triggers for
asthma? |
|
Definition
allergens
temp changes
exercise
URI
stress |
|
|
Term
what are the triggers for
chronic bronchitis and emphysema? |
|
Definition
| these are chronic conditions so there are no triggers because the s/s are ALWAYS there |
|
|
Term
| what are the diagnostic tools for asthma? |
|
Definition
-PFT:
1. perform test with patient's regular breathing status
2. then give them a bronchodilator and then perform test again
3. if there is a 15% improvement= asthma
-peak expiratory flow rates to see how well patient is breathing
-CXR: will be altered only during an acute attack
-ABG will be altered during an acute attack
-allergy skin test to ID allergens and triggers |
|
|
Term
| can an acute asthmatic attack be fatal? |
|
Definition
|
|
Term
| diagnositic tools for Dx chronic bronchitis and emphysema |
|
Definition
PFT- will be poor
CXR- permanent alterations
ABG- altered; hold on CO2 (retainers), O2 will be altered |
|
|
Term
| specific management of asthma |
|
Definition
| -identify and avoid the triggers |
|
|
Term
| specific management of chronic bronchitis and emphysema |
|
Definition
1. low flow of O2
2. can be CO2 retainers
3. may be pursed lip breathers |
|
|
Term
| in a normal patient, the drive to breathe is stimulated by |
|
Definition
| hypercapnia, or elevated levels of CO2 |
|
|
Term
| unlike a regular person that has a breathing drive that is stimulated by hypercapnia, individuals with chronic bronchitis and emphysema are more than likely _____________ which means that their body gets used to having high levels of _______ in the blood. the body compensates by allowing the _______ to lower to then stimulate the body to breathe. this is why it is important to not give COPD patients with chronic bronchitis and emphysema such ___________ levels of oxygen because you will diminish their _______________. |
|
Definition
| unlike a regular person that has a breathing drive that is stimulated by hypercapnia, individuals with chronic bronchitis and emphysema are more than likely CO2 retainers which means that their body gets used to having high levels of CO2 in the blood. the body compensates by allowing the O2 to lower to then stimulate the body to breathe. this is why it is important to not give COPD patients with chronic bronchitis and emphysema such high levels of oxygen because you will diminish their drive to breathe |
|
|
Term
| what is an acceptable oxygen flow rate for a COPD patient? |
|
Definition
| 1-3 L, with 2 L being the most common |
|
|
Term
| is it realistic to get a COPD patient to have an oxygen saturation of 100%? |
|
Definition
| no because their bodies need a lower O2 sat in order to breathe. this is why it important to keep them on low flow oxygen |
|
|
Term
| what is a reasonable O2 saturation to aim for with a COPD patient? |
|
Definition
|
|
Term
| general management of COPD patients |
|
Definition
-O2 as needed
-upright position: most effective gas exchange as possible
-rest and hydration: to keep secretions thin
-immunizations since they are at risk for lung infection
-psych/emo support especially during acute attach
-nutrition: small meals, pureed or liquid food, TPN
-encourage don't force feeding to avoid aspiration, remember they will have dyspnea which causes causes anorexia
-avoid infection spread |
|
|
Term
| in acute situation with a COPD patient going through severe respiratory distress would you still want to give low and slow oxygen? |
|
Definition
| no, this is a different case. give them as much O2 as needed |
|
|
Term
| pharmacology management for all COPD |
|
Definition
1. bronchodilators- for all acute processes
2. steroids- decrease inflammation
solucortef
prednisone
solumedrol
3. leukotriene modifiers (for asthma) such as singulair: helps to block the inflammatory process that takes place during asthma
4. abx to prevent and treat infections |
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Term
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Definition
-some type of exposure to irritant or allergen causing bronchospasm and inflammatory response
-retractions: intercostal muscles are pulled in sharply during dyspnea: sign of acute attack
-hypoxemia
-tachycardia
-tachypnea
-restlessness & anxiety
-SOB
-dyspnea
-expiratory wheezing & cough
-increased CO2 retention
-prolonged expiration
-increased mucus production |
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Term
| in asthmatics the release of leukotrienes, prostaglandins, and cytokines as part of the inflammatory response in response to bronchospasm caused by exposure to an allergen or irritant, what occurs? |
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Definition
| this causes smooth muscle constriction of the bronchioles causing the wheezing |
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Term
| asthma occurs more in which gender? by what age is it typically diagnosed? |
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Definition
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Term
| is there a familial link to asthma? |
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Definition
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Term
| in an acute asthma attack that is not responding to normal treatment |
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Definition
| get them to the ER within 30 minutes |
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Term
in a status asthmaticus patient
goal? |
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Definition
get to the ER quickly:
1. QUICKLY give O2, steroids, antihistamines
goal: keep patient stable and prevent acute attack |
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Term
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Definition
| is an acute exacerbation of asthma that does not respond to standard treatments of bronchodilators and steroids. |
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Term
| bronchial obstruction due to increased mucous production. have mucous gland hyperplasia, increase in goblet cells, cilia destruction, chronic inflammatory changes, altered alveolar macrohages, retain CO2 |
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Definition
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Term
| what is the criteria for diagnosing chronic bronchitis? |
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Definition
| have a chronic productive cough for 3 months in 2 years in a row (successive) |
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Term
| what do patients with chronic bronchitis look like? what "color" are they typically assessed as? why? |
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Definition
-blue (cyanotic) because they cannot get the O2 past the plugged up bronchioles.
-productively coughing
-increased sputum production
-hypercapnic
-acidotic
-edematous
-tachypnea and dyspnea
-digital clubbing
-thickening of the nails
-cardiomegaly
-use of accessory muscles to breath
-usually on low flow of O2 (2L) |
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Term
| emphysema pathological and physical changes |
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Definition
-alveolar wall destruction
-loss of alveolar elastic recoil
-barrel chest: AP diameter> transverse diameter [not normal, T should be 2x the AP]
-alpha 1 antitrypsin deficiency
-CO2 retainers
-thin and frail with the barrel chest
-pursed lip breathing
-prolonged expiration
-anxious, jerky
-use of accessory muscles to breathe
-can lead to right sided heart failure, cardiac problems |
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Term
| the usual cause of emphysema is |
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Definition
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Term
| what genetic deficiency can lead to early onset of emphysema? |
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Definition
alpha 1 antitrypsin deficiency
causes <1% |
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Term
| why does smoking contribute to the development of emphysema? |
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Definition
| it destroys the alveolar wall |
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Term
| why would you give a patient benedryl? what would you monitor? |
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Definition
| you would give a patient benedryl who is in need of an antihistamine which serves to block the histamine reaction that occurs in the inflammatory process. because benedryl is sedating you should monitor LOC/sedation, respiratory rate, and neuro status. and always start with lowest dose |
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Term
| what are some advantages to giving 2nd generation antihistamines over the 1st generation? |
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Definition
| 2nd generations antihistamines like claritin, zyrtec, and allegra and less sedating and the person can carry out their daily activities |
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Term
| why would you give a patient afrin? |
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Definition
| afrin is an OTC nasal spray that is used to decrease nasal congestion and dilation |
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Term
| if you give a patient afrin for more than 3 days what would happen? |
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Definition
| rebound congestion; afrin if for short term use only! do not use for more than 3 days |
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Term
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Definition
| direct observation treatment: for noncompliant patients who are mandated to take medications for the active phase of TB |
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Term
| there will be a decrease in the effectiveness of rifampin if taken with |
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Definition
corticosteroids
beta blockers
digoxin
heparin
birth control pills (BCP) |
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Term
| who would be in charge of ordering the multiple medications for a COPD pt? |
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Definition
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Term
| a COPD patient will most likely be on what type of medication? |
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Definition
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Term
| what types of bronchodilators are there? |
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Definition
| beta 2 short and long acting |
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Term
| how long do beta 2 agonist short acting bronchodilators |
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Definition
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Term
| beta 2 agonist short acting bronchodilator examples |
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Definition
albterol
xopenex
epinephrine |
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Term
| beta 2 agonist long acting bronchodilator examples |
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Definition
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Term
| how often are beta 2 agonist long acting bronchodilators to be taken? |
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Definition
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Term
albuterol: trade names?
different routes? |
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Definition
ventolin, proventil
multi-dose inhaler (MDI)
nebulizer
oral |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| name some example of anticholinergic bronchodilators |
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Definition
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Term
| name some example of methylxanthine derivatives used as bronchodilators |
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Definition
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Term
| because the methyxanthine derivates: theophyline and aminophylline have a therapeutic dosing range therefore you can expect patients on these |
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Definition
| to have their blood drawn |
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Term
| aminophylline may be ordered IV for a patient who is NPO and used to be on |
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Definition
| theophyline which is only PO |
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Term
| corticosteroids primarily are used to |
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Definition
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Term
| give some example of systemic corticosteroids |
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Definition
prednisone
medrol
solu-medrol
solu-cortef |
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Term
| what must be monitored in patients taking systemic corticosteroids? |
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Definition
| monitor blood sugar for hyperglycemia |
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Term
| give some examples of inhaled corticosteroids |
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Definition
azmacort
pulmicort
cromolyn
aerobid
flovent |
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Term
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Definition
| combines a long acting bet 2 antagonist and steroid |
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Term
| leukotriene modifiers such as singulair and accolate are combination drugs usually for |
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Definition
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Term
| leukotriene combination drugs |
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Definition
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Term
| magnesium IVPB is a less common intervention in the hospital used in the treatment of |
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Definition
| COPD as a combination drug |
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Term
| nursing considerations for the use of a corticosteroid inhaler |
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Definition
A: action is used to decrease respiratory tract inflammation
S: spacer use is recommended to prevent...
T: thrush
H: have bronchodilater used FIRST! then after steroid inhaler second after bronchioles are dilated. hold breath for 3-5 seconds
M: must taper off steroids gradually. rinse mouth after use to prevent thrush in mouth
A: asthma control is the reason and the goal to to prevent acute attacks |
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Term
| nursing consideration for the use of bronchodilators and obstructive airway |
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Definition
B: breathing and coughing techniques: whatever position (tripod, semi/hi Fowler's) or technique (pursed-lip) optimizes breathing
R: rest/relaxation techniques
E: encourage 8 glasses of water
A: avoid infection
T: tremors & tachycardia: because bronchodilators cause tachycardia and also tremors in patients
H: heart rate and BP increase
E: emphasize NO smoking! |
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Term
| a COPD patient you have has a heart rate of 140 and a BP of 150/100 and the RT comes to give them there bronchodilator. what would you do? |
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Definition
| NO!!!!!!!!! bronchodilators increase HR and BP |
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Term
| nursing considerations for antibiotics |
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Definition
M: monitor for superinfections
E: evaluate renal/liver functions
D: diarrhea: take yogurt/acidophilus
I: inform MD prior to taking other meds to prevent drug interaction
C: cultures prior to initial dose
A: alcohol cessation and awareness of allergies
T: take full course
E: evaluate WBCs/C&S/temp |
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Term
| why is it important to monitor your patient who is on antibiotics for super infections? |
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Definition
| because the antibiotics will also knock out the good bacteria in your intestines which can lead to infection |
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Term
| if your patient is allergic to PCN, what medications should you NOT give them? |
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Definition
amoxicillin
augmentin
V-Kay |
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Term
| be careful with the cephalosporins because there could be a |
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Definition
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Term
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Definition
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Term
| a patient who has pneumonia with an organism unidentified what precautions should be taken? |
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Definition
| stardard, droplet, contact precaution |
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