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Adult Health Exam 3
~Jesus Loves Us~
471
Nursing
Undergraduate 3
10/19/2011

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Cards

Term
there are three types of urinary incontinence, what are they?
Definition
1. stress incontinence
2. urge incontinence
3. overflow incontinence
Term
stress incontinence
Definition
-caused by any increase in stress such as laughing, coughing, or sneezing
Term
urge incontinence
Definition
there is an urgency to go with a rapid onset, where is the bathroom!
Term
overflow incontinence
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
behavioral therapy
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
kidney/renal stone
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
explain hydronephrosis
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
90%
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
toradol
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
diagnosis of UTI
Definition
1. UA and UC
Term
what is the most common bacteria that causes a UTI?
Definition
E.coli
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
management of UTI
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
fluoroquinolones
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
ascending UTI
Term
pyelonephritis
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
FALSE!
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
PKD
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
childhood or adulthood
Term
describe PKD
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
no
Term
management of PKD
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
kidney cancer
Term
renal cell carcinoma is commonly caused by
Definition
adenocarcinoma
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
men
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
surgical treatment
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
the aorta
Term
T or F:
both kidneys have a renal artery and vein?
Definition
true
Term
what drains the kidneys?
Definition
the left and right ureters
Term
what serves as a reservoir for urine?
Definition
the urinary bladder
Term
what drains the urinary bladder?
Definition
the uretha
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
erythropoietin
Definition
triggers RBC production
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
7.35-7.45
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
25%
Term
overtime HTN can
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
distension
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
describe a kidney punch?
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
BMP
Definition
basic metabolic panel
Term
CMP
Definition
comprehensive metabolic panel
Term
what are the lab tests for kidney functioning
Definition
BUN and creatinine
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
GFR
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
a low creatinine level
Term
BUN-creatinine ratio that is normal
Definition
10:1 to 15:1
Term
is a urinaylsis dipstick test sterile?
Definition
no it is clean catch
Term
what is a normal value for urine
color
Definition
yellow to amber
Term
what is a normal value for urine
clarity?
Definition
clear
Term
what is a normal value for urine
pH
Definition
6.0 or 4.0-8.0
Term
what is a normal value for urine
specific gravity?
Definition
1.010-1.026
Term
what is a normal value for urine
glucose?
Definition
NONE
Term
what is a normal value for urine
ketones?
Definition
NONE
Term
what is a normal value for urine
bilirubin?
Definition
NONE
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
NONE
Term
what is a normal value for urine
leukocyte esterase?
Definition
NONE
Term
leukocyte esterase
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
culture and sensitivity
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
residual urine
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
KUB
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
renal ultrasound
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
CT scan
Definition
-more specific
-can see thin slices
-can see tumors or masses
Term
MRI
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
retrograde pyelogram
Definition
insert catheter into bladder and inject dye into it into ureter and kidneys to see flow of urine, structure, masses, and tumor
Term
IVP
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
renal arteriogram
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
cytoscopy
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
cystometrogram
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
pre renal biopsy
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
post renal biopsy
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
urinary retention
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
neurogenic bladder
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
Foley catheter
Term
what type of procedure is Foley catheter insertion?
Definition
a sterile technique
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
at least every month
Term
suprapubic catheter
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
illeal conduit
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
ureterostomy
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
paralytic ileus
Definition
when peristalsis does not return to the bowels
Term
what measures can be taken to monitor for a paralytic ileus?
Definition
auscultate bowel sounds
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
contact your surgeon
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
LOW and INTERMITTENT
Term
LIS
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
zofran is usually given
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
no, one or the other
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
oral
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
IV
Term
after PO administration of K when should you recheck the K level?
Definition
after 2 hours
Term
when should you recheck K level after completion of IV administration of K?
Definition
1 hour
Term
the Mg protocol should only be used if the serum creatinine is less than or equal to
Definition
2
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
2
Term
upper respiratory system includes
Definition
the structures above your lungs:
-nose
-sinuses
-pharynx
-tonsils
-epiglottis
-larynx
-trachea
Term
nose
Definition
filters, warms and humidifies air
Term
sinuses
Definition
are a reservoir/cavity that holds onto oxygen as we breathe
Term
pharynx
Definition
passageway that leads down from the nose to the deeper anatomy
Term
tonsils
Definition
lymphatic tissues
Term
epiglottis
Definition
covers the trachea to prevent aspiration with swallowing
Term
larynx
Definition
voice box
Term
trachea
Definition
passageway that leads down into respiratory tract
Term
lower respiratory system
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
R-3
L-2
Term
hilum
Definition
entryway into R and L lung and allows for innervation of vessels and nerves etc
Term
respiratory bronchioles
Definition
made of smooth muscle and dilate and contract and important to breathing status
Term
alveoli
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
constrict
Term
in asthma there is an excessive
Definition
bronchial constriction
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
labored breathing
Definition
the patient is overworking to breathe
Term
stridor is due to
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
yes
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
NO it is an emergency!
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
fremitus
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
hyperinflation or COPD
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
resonant noise
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
resonance
Term
if you percuss over a bone the sounds should be
Definition
flat
Term
rales/crackles are due to
Definition
fluid in the lungs
Term
rhonchi are due to
Definition
secretions in the lungs
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
92%
Term
a pulse ox less than 92 requires
Definition
O2 intervention and call MD
Term
ABGs
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
BNP
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
hypervolemia or CHF
Term
blood cultures
Definition
tells if patient has
bacteremia
spread of infection
septic infection
systemic blood infection
Term
sputum cultures
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
the morning
Term
what should you tell your patient to do when you collect a sputum culture?
Definition
to cough and deep breathe
Term
PPD
Definition
purified protein derivative

used to check for exposure to TB not if they have active TB
Term
CXR
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
spinal CT
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
bronchoscopy
Definition
going through the bronchials into lungs for:
assessment
suctioning
cancer Dx
cytology
Term
do you need a consent form for a bronchoscopy?
Definition
yes!
Term
what type of anesthesia would a patient undergoing a bronchoscopy receive?
Definition
conscious sedation
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
yes
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
biopsy
Term
mediastinoscopy
Definition
scope through the chest wall
Term
after a lung biopsy be sure to monitor patients for
Definition
respiratory distress or bleeding
Term
pulmonary angiography
Definition
injecting dye into blood vessels to look at the pulmonary vasculature and how it is perfused
Term
VQ scan
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
PFT testing are done by
Definition
pulmonary techs
Term
PFT tell
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
thoracentesis
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
YES!
Term
in regards to a thoracentesis is it invasive?
Definition
yes
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
yes
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
sinusitis
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
infected, pus-filled
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
posterior
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
ask RT for a humidifier
Term
list some decongestants
Definition
sudafed
sinutab
Term
decongestant
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
antihistamines
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
benedryl
more sedating
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
flonase
vancenase
Term
low dose steroid sprays
Definition
help to decrease inflammation locally
Term
OTC nasal sprays example
Definition
afrin
Term
OTC nasal sprays
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
tylenol
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
an abscess and infection
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
hemoptysis
Definition
coughing up blood
Term
how long does it often take for a lung abscess to clear?
Definition
4-6 weeks
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
pneumothorax
Term
clinical manifestations of atelectasis
Definition
- diminished or absent BS
-fever
-increased in dyspnea
-pleuritic pain (chest pain)
-cyanosis/hypoxemia
-CXR changes
Term
atelectasis
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
pulmonary toileting
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
flutter valve
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
bronchioles
Term
how does pneumonia affect gas exchange?
Definition
it decreases it
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
streptococcal infection
Term
your patient with pneumonia has a sputum that is yellow or blood streaked, you suspect that they have what type of infection?
Definition
staphylococcal infection
Term
what MD orders would you expect for a patient who has pneumonia?
Definition
-sputum culture
-CXR
-O2 > 92%
-IVF to hydrate
Term
pneumonia
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
diagnosis of pneumonia
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
management of pneumonia
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
CAP antibiotics
Definition
-rocephin
-zithromax
-if they have a PCN allergy: give avelox
Term
z-pack
Definition
zithromax is a macrolide antibiotic
Term
rocephin
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
avelox
Term
avelox
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
zosyn
zithromax
tobramycin
Term
antibiotics used to treat MRSA
Definition
vancomycin
avelox
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
no
Term
tuberculosis
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
who is at risk for TB?
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
a +PPD indicates
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
a calcified Ghon complex
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
PPD
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
a +PPD test shows
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
CXR
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
management of TB
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
INH
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
asthma
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
acid reflux
Term
chronic bronchitis
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
emphysema
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
yes
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
at least above 92%
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
Term
asthma s/s
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
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?
Definition
this causes smooth muscle constriction of the bronchioles causing the wheezing
Term
asthma occurs more in which gender? by what age is it typically diagnosed?
Definition
males; age 12
Term
is there a familial link to asthma?
Definition
yes
Term
in an acute asthma attack that is not responding to normal treatment
Definition
get them to the ER within 30 minutes
Term
in a status asthmaticus patient
goal?
Definition
get to the ER quickly:
1. QUICKLY give O2, steroids, antihistamines

goal: keep patient stable and prevent acute attack
Term
status asthmaticus
Definition
is an acute exacerbation of asthma that does not respond to standard treatments of bronchodilators and steroids.
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
Definition
chronic bronchitis
Term
what is the criteria for diagnosing chronic bronchitis?
Definition
have a chronic productive cough for 3 months in 2 years in a row (successive)
Term
what do patients with chronic bronchitis look like? what "color" are they typically assessed as? why?
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)
Term
emphysema pathological and physical changes
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
Term
the usual cause of emphysema is
Definition
smoking
Term
what genetic deficiency can lead to early onset of emphysema?
Definition
alpha 1 antitrypsin deficiency
causes <1%
Term
why does smoking contribute to the development of emphysema?
Definition
it destroys the alveolar wall
Term
why would you give a patient benedryl? what would you monitor?
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
Term
what are some advantages to giving 2nd generation antihistamines over the 1st generation?
Definition
2nd generations antihistamines like claritin, zyrtec, and allegra and less sedating and the person can carry out their daily activities
Term
why would you give a patient afrin?
Definition
afrin is an OTC nasal spray that is used to decrease nasal congestion and dilation
Term
if you give a patient afrin for more than 3 days what would happen?
Definition
rebound congestion; afrin if for short term use only! do not use for more than 3 days
Term
DOT
Definition
direct observation treatment: for noncompliant patients who are mandated to take medications for the active phase of TB
Term
there will be a decrease in the effectiveness of rifampin if taken with
Definition
corticosteroids
beta blockers
digoxin
heparin
birth control pills (BCP)
Term
who would be in charge of ordering the multiple medications for a COPD pt?
Definition
the pulmonologist
Term
a COPD patient will most likely be on what type of medication?
Definition
bronchodilators
Term
what types of bronchodilators are there?
Definition
beta 2 short and long acting
Term
how long do beta 2 agonist short acting bronchodilators
Definition
last only a few hours
Term
beta 2 agonist short acting bronchodilator examples
Definition
albterol
xopenex
epinephrine
Term
beta 2 agonist long acting bronchodilator examples
Definition
serevent
foradil
Term
how often are beta 2 agonist long acting bronchodilators to be taken?
Definition
BID, twice a day
Term
albuterol: trade names?
different routes?
Definition
ventolin, proventil
multi-dose inhaler (MDI)
nebulizer
oral
Term
MDI
Definition
multi-dose inhaler
Term
DPI
Definition
dry powder inhaler
Term
xopenex route?
Definition
nebulizer
Term
epinephrine route?
Definition
SQ and endotracheal tube
Term
servent route?
Definition
MDI and DPI
Term
foradil route?
Definition
DPI and inhaler
Term
name some example of anticholinergic bronchodilators
Definition
atrovent
combivent
duoneb
Term
name some example of methylxanthine derivatives used as bronchodilators
Definition
theophyline
aminophylline
Term
because the methyxanthine derivates: theophyline and aminophylline have a therapeutic dosing range therefore you can expect patients on these
Definition
to have their blood drawn
Term
aminophylline may be ordered IV for a patient who is NPO and used to be on
Definition
theophyline which is only PO
Term
corticosteroids primarily are used to
Definition
reduce inflammation
Term
give some example of systemic corticosteroids
Definition
prednisone
medrol
solu-medrol
solu-cortef
Term
what must be monitored in patients taking systemic corticosteroids?
Definition
monitor blood sugar for hyperglycemia
Term
give some examples of inhaled corticosteroids
Definition
azmacort
pulmicort
cromolyn
aerobid
flovent
Term
advair diskus inhaler
Definition
combines a long acting bet 2 antagonist and steroid
Term
leukotriene modifiers such as singulair and accolate are combination drugs usually for
Definition
younger asthma patients
Term
leukotriene combination drugs
Definition
singulair and accolate
Term
magnesium IVPB is a less common intervention in the hospital used in the treatment of
Definition
COPD as a combination drug
Term
nursing considerations for the use of a corticosteroid inhaler
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
Term
nursing consideration for the use of bronchodilators and obstructive airway
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!
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?
Definition
NO!!!!!!!!! bronchodilators increase HR and BP
Term
nursing considerations for antibiotics
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
Term
why is it important to monitor your patient who is on antibiotics for super infections?
Definition
because the antibiotics will also knock out the good bacteria in your intestines which can lead to infection
Term
if your patient is allergic to PCN, what medications should you NOT give them?
Definition
amoxicillin
augmentin
V-Kay
Term
be careful with the cephalosporins because there could be a
Definition
crossover reaction
Term
cephalosporins
Definition
a class of antibiotics
Term
a patient who has pneumonia with an organism unidentified what precautions should be taken?
Definition
stardard, droplet, contact precaution
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