Respiratory#1
List 2 symptoms of epiglottitis.
Drooling, muffled voice, sore throat, high fever (up to 102.2F), dysphagia, inspiratory stridor, anxiety, restlessness, tripod position.
Nursing Care: Do NOT attempt to examine the throat or insert anything into the mouth (this could cause a spasm that occludes the airway). Keep intubation supplies at bedside. Monitor SPO2. Do not leave patient unattended. Position patient upright. Keep patient calm. Avoid upsetting or causing child to cry.
Patient Education: encourage parents to vaccinate their children for HIB.
List 3 signs of respiratory distress in an infant
Signs of respiratory distress in an infant: nasal flaring, retractions, cyanosis, stridor, tachypnea, restlessness (or worse - lethargy), head bobbing, poor feeding tolerance, use of accessory muscles to breath
If a patient has unstable angina and the coronary angiogram reveals that they have 2 areas of narrowing in their coronary arteries - what are 2 options the doctors could choose to treat this?
1. Coronary Artery Bypass Graft (CABG)
2. Coronary angiogram with Percutaneous coronary intervention (PCI) - aka: "Heart Cath with Stent"
List 3 signs of left sided heart failure.
Right-sided heart failure: peripheral edema, weight gain, JVD, ascites, hepatomegaly, splenomegaly, anorexia
Left-sided heart failure: pulmonary edema, crackles, wheezes, dyspnea, pink frothy sputum, tachypnea, orthopnea, cyanosis, Paroxysmal nocturnal dyspnea
A patient is prescribed 2.5 grams of amoxicillin daily, divided into four doses. The pharmacy supplies 250 mg tablets. How many tablets will the patient need to take per dose?
2.5 tabs/dose
What is epistaxis and what are the nursing interventions to manage it?
-Epistaxis is a nose bleed.
Nursing interventions:
-direct, continuous pressure for 5-10 min
-tilt head forward.
-apply ice over the bridge of the nose.
-avoid NSAIDs.
-avoid blowing nose.
-do not swallow blood.
-may need nasal packing with tampon (ENT)
Interpret the following ABGs (including if there is any compensation)
pH: 7.30
PCO2: 50
HCO3: 36
Partially compensated respiratory acidosis
What is infective endocarditis in simple terms.
List 3 symptoms/physical exam findings of infective endocarditis.
Infective Endocarditis: bacteria or fungi gets into the bloodstream and attaches to the heart valves. This causes damages to the heart valves and can lead to heart failure. Often caused by IV Drug use or poor dental health.
Symptoms: fever, chills, muscle aches, malaise
Physical Exam Findings: osler's nodes, splinter hemorrhages, janeway lesions, petechiae, and heart murmur.
What is the ejection fraction?
How is it measured?
Ejection fraction: is the percentage of blood pumped out of the heart with each beat. It helps us understand how well your heart is functioning.
How Measured? most commonly measured with an echocardiogram
50-70% is normal. Heart failure is diagnosed when the EF is <40%.
A nurse is preparing to administer prednisolone 2 mg/kg/day PO to divide equally every 8 hours to a preschool-age child who weighs 18 kg. Available is prednisolone oral solution 2 mg/5 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth.)
30mL/dose
What do the following sounds indicate?
-stridor
-crackles
-wheezes
Bonus (25 points): murmur
-stridor: obstruction or narrowing of the UPPER airways (trachea/larynx). Examples: foreign body aspiration, anaphylaxis, severe asthma attack
-crackles: fluid/moisture in the lungs. it is the sound of the alveoli popping open/bubbling. Examples: pulmonary edema, pneumonia
-wheezing: narrowing of the lower airways (bronchi & bronchioles). Examples: asthma, bronchitis, allergic reactions
BONUS: Murmur: indicates turbulent bloodflow. Examples: heart valve disorders such as aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, as well as congenital heart disorders such as ventricular septal defects (VSDs), patent ductus arteriosus (PDAs).
List 2 Breathing Techniques that can be used to decrease Shortness of Breath in patients with COPD.
List 2 dietary recommendations for COPD.
Breathing Techniques: tripod breathing, diaphragmatic breathing (or abdominal breathing), pursed-lip breathing.
Dietary recommendations: high protein, high calorie, small frequent meals, high fluid intake (not during meals - in between meals).
Define the following terms:
-Arteriosclerosis
-Atherosclerosis
-Intermittent claudication
Arteriosclerosis: the hardening of arteries. they lose elasticity. part of the aging process.
Atherosclerosis: this is the most common type of arteriosclerosis. This is where the lumen of the arteries fills with plaque (occurs due to high cholesterol). Can lead to CVA, CAD, PAD, HTN, and Chronic Kidney Disease
Intermittent Claudication: a condition that is the "Hallmark Symptom" of Peripheral Arterial Disease. It is a muscular, cramp-like pain in the leg that is consistently reproduced with exercise and relieved by rest. This leg pain occurs with activity, but resolves upon rest. Almost like "the angina of the leg" as this pain occurs to compromised blood flow to the leg muscles due to PAD.
A nurse is preparing to transfuse 250 mL of packed red blood cells (RBCs) to a client over 4 hr. Available is a blood administration set that delivers 10 gtt/mL. The nurse should set the manual blood transfusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
10 gtt/min
How does Digoxin work?
Slows HR and strengthens cardiac contractions.
How would you teach a patient to use the following devices in simple terms?
-peak flow meter
-incentive spirometer
-metered dose inhaler
Peak flow meter: inhale as deeply as possible, seal lips around mouthpiece, exhale forcefully and quickly. repeat this 3 times and record the highest reading on asthma record. Purpose: to monitor asthma symptoms and allow for early recognition of exacerbations.
Incentive Spirometer: exhale. seal lips around mouthpiece. inhale slowly and deeply. hold breath 2-6 seconds. exhale normally. repeat 10 times an hour while awake. Do not rush. Slow down if dizziness occurs. Purpose: to prevent atelectasis.
Metered Dose Inhaler: exhale through pursed lips. seal lips around mouthpiece. Compress canister and inhale slowly for 5-7 seconds. Hold breath for 10 seconds. exhale slowly through pursed lips. if second puff is ordered - wait 30 seconds to 1 minute.
List 2 symptoms of pneumonia.
List 2 physical exam findings of pneumonia.
Symptoms: shortness of breath/dyspnea, fever, productive cough, chills, malaise,
Physical Exam Findings: crackles, wheezing, tactile fremitus, dullness to percussion, tachycardia, tachypnea
Lab Findings: high WBC Count
List 3 Risk Factors for Deep Venous Thrombosis.
List 3 Symptoms of a Deep Venous Thrombosis.
BONUS (50 pts:) What is a potential complication of DVTs?
Risk Factors: smoking, obesity, dehydration, pro-longed inactivity (taking long trip, being on bedrest, being post-surgical), women who take estrogen, malignancy.
Symptoms: erythema (redness), edema (swelling), warmth, tenderness/pain over the area involved (most commonly lower leg).
BONUS: Pulmonary Embolism. PEs are treated with anticoagulants OR thrombolytics.
State which disorder the following symptoms apply to (PAD vs. Venous Insufficiency):
-thickened, discolored skin
-cold, pale extremities
-wet, weeping ulcers with irregular borders
-weak or absent pulses
-intermittent claudication
-numbness & tingling
-peripheral edema
-varicose veins
BONUS (50 points): What is 1 thing you would educate a patient with PAD on (in terms of managing their illness at home).
PAD: thin hairless skin, cold/pale extremities, weak/absent pulses, "punched out" ulcers, intermittent claudication, numbness/tingling
VI: varicose veins, peripheral edema, irregular wet/weeping ulcers, thickened/discolored skin
BONUS (50 points): keep environment warm. avoid crossing the legs (can impair circulation), avoid elevating legs and compression stockings, avoid restrictive clothing, check temp of bath water before getting in, do not apply heating pads, trimming of toenails should be done by podiatrist.
List 1 side effect for each of the following meds:
-Rifampin
-Albuterol inhaler
-Beclomethasone inhaler
-Pseudoephedrine
-Diphenhydramine
BONUS (50 pts): how long does someone need to take TB meds for?
-Rifampin: hepatotoxicity, orange body fluids (urine, sweat, tears). Interferes with effectiveness of contraceptives.
-Albuterol inhaler: tachycardia, nervousness, anxiety, palpitations
-Beclomethasone inhaler: oral thrush/oral candidiasis, hoarseness, sore throat
Pseudoephedrine: tachycardia, hypertension, insomnia, tremors, anxiety, rebound nasal congestion.
-Diphenhydramine: drowsiness, dry mouth, blurred vision, dry eyes, urinary retention, constipation
BONUS: 6 - 12 months
When performing suctioning of a patient's tracheostomy:
-what position should patient be in?
-how long to preoxygenate?
-sterile or clean technique?
-when to apply suction?
-how long can you take to perform 1 suction pass?
-how many passes can you do in 1 session?
-High Fowler's Position
-1-2 min preoxygenate
-sterile technique
-apply intermittent suction only as you withdraw the suction catheter. gently rotate the catheter as you withdraw it.
-do not suction for more than 10 seconds at a time
-hyper-oxygenate in between passes
-no more than 3 passes in 1 suctioning session
Differentiate the 3 different "P.E."s.
Describe the pathophysiology of each of the following disorders in 1 sentence:
-Pleural effusion
-Pulmonary edema
-Pulmonary embolism
BONUS (50 points): what lung sounds would you expect to hear in pulmonary edema vs. pleural effusion?
-pleural effusion: abnormal collection of fluid in the pleural space. breath sounds would be diminished or absent over the affected area.
-pulmonary edema: accumulation of fluid in the alveoli of the lungs. Crackles would be expected.
-pulmonary embolism: a thrombus partially or completely obstructs one of the pulmonary arteries, leading to infarction of the lung tissue distal to the clot. Lung sounds may not be affected, but patient would feel dyspnea, chest pain, tachycardia, blood-streaked sputum, and sense of impending doom. PEs are treated with anticoagulants OR thrombolytics.
Fluid Volume Status:
-List 3 symptoms of Fluid Volume Excess
-List 3 symptoms of Fluid Volume Deficit
BONUS (50 points): list 1 cause of FVE and 1 cause of FVD
Symptoms of FVE: peripheral edema, pulmonary edema, crackles, dyspnea, ascites, weight gain, hypertension, bounding pulses, JVD, hepatomegaly/splenomegaly.
Symptoms of FVD: concentrated urine, low urine output, poor skin turgor (Aka: skin tenting), flat (nondistended) neck veins, hypotension, tachycardia, dizziness, fatigue, syncope, dry mucus membranes, increased thirst.
BONUS:
Causes of FVD: vomiting, diarrhea, burns, blood loss, dehydration, diuretic use, exposure to extreme heat, bulimia, malnourishment
Causes of FVE: heart failure, kidney failure, liver cirrhosis, pregnancy, IV therapy
List the 4 types of Shock. List 1 potential cause for each.
BONUS (50 points): which type of shock occurs due to systemic vasodilation?
1. Hypovolemic shock: hemorrhage, over-diuresis, severe diarrhea/vomiting, dehydration, burns
2. Distributive shock: anaphylaxis, sepsis, or SCI
3. Obstructive shock: cardiac tamponade, tension pneumothorax
4. Cardiogenic shock: myocardial infarction, heart failure, cardiac arrhythmia
BONUS (50 points): distributive shock occurs due to systemic vasodilation.
List 1 potential side effects for each of the following drugs:
-nitroglycerin
-digoxin
-lisinopril
-metoprolol
-atorvastatin
-nitroglycerin: headache, hypotension, dizziness
-digoxin: bradycardia, dig toxicity (yellow-green halos, anorexia, GI upset)
-lisinopril: dry cough, angioedema, hypotension, dizziness, hyperkalemia, sexual dysfunction
-metoprolol: bradycardia, hypotension, bronchospasms (non-selective BBs), dizziness, sexual dysfunction
-atorvastatin: myalgias, liver damage