Term
|
Definition
| Most common type of dehydration; fluid is lost from the plasma and interstitial fluids so intracellular fluid stays the same |
|
|
Term
| How are the early and late stages of renal failure different? |
|
Definition
| Early renal failure causes water loss/dehydration; late renal failure causes water retention/fluid overload. |
|
|
Term
| How much does 1 L of water weigh? |
|
Definition
|
|
Term
| How much additional water is lost insensibly for every 1 degree Celsius increase in body temperature? |
|
Definition
|
|
Term
| Normal urine specific gravity range? |
|
Definition
|
|
Term
| Cardiovascular assessment findings indicating dehydration? |
|
Definition
Rapid, weak pulse
Low blood pressure, especially systolic
Orthostatic Hypotension
Flat neck and hand veins |
|
|
Term
| Integumentary assessment findings indicating dehydration? |
|
Definition
Thick, sticky coating on oral mucus membranes
Cracks and fissures on oral mucus membranes
Tongue furrows |
|
|
Term
| Respiratory assessment findings indicating dehydration? |
|
Definition
| Increased respiratory rate |
|
|
Term
| Neurological assessment findings indicating dehydration? |
|
Definition
Change in mental state, especially confusion in older adults
Low grade fever due to decreased blood flow to brain |
|
|
Term
| Lab findings indicating dehydration? |
|
Definition
| Hemoconcentration: Elevated hemoglobin, hematocrit, osmolarity, glucose, protein, BUN, Cr |
|
|
Term
| Drug interventions and nursing actions for dehydration? |
|
Definition
IV fluid replacement.
Nurses monitor: Pulse rate + quality; I+O
Drugs to control the cause of dehydration (i.e. anti-diarrheal, antiemetic, etc.) |
|
|
Term
| Oral fluid replacement treatment for dehydration and the nurses role in this? |
|
Definition
ORT: certain solutions have glucose and electrolytes that can be absorbed even if the patient is vomiting/having diarrhea
Nurses urge and measure small volumes of fluids every hour, evenly spaced over 24 hours, staying with the patient while they drink |
|
|
Term
| First nursing priority for a patient with dehydration? |
|
Definition
| RISK FOR FALLS: Monitor vitals, ortho-checks, muscle weakness, dysrhythmias, confusion |
|
|
Term
| Which acid-base imbalance can cause hypokalemia? |
|
Definition
Alkalosis
*Memory trick: al K a LO sis "K lo" sounds like "K+ low" |
|
|
Term
| What electrolyte should you monitor if a patient has hyperinsulinism, and/or hyperalimentation/TPN? |
|
Definition
|
|
Term
| What are some conditions that can cause potassium loss? |
|
Definition
Hyperaldosteronism
Cushing's disease
Vomiting/diarrhea |
|
|
Term
| Name 3 drugs that cause potassium loss? |
|
Definition
Diuretics
Digitalis
Corticosteroids |
|
|
Term
| What does hypokalemia due to excitable membranes, and what are the resulting problems of this? |
|
Definition
Low potassium DECREASES excitability, leading to:
Muscle weakness
Decreased reflexes
Irritability/lethargy/confusion
Decreased peristalsis |
|
|
Term
| What are the nursing priorities for hypokalemia and why? |
|
Definition
Assess respirations every 2 hours and ensure adequate oxygenation because of the weakness of respiratory muscles.
Prevent falls because of generalized muscle weakness
Monitor cardiovascular function |
|
|
Term
| What effects does hypokalemia have on the heart? |
|
Definition
Dysrhythmias
Increased digoxin sensitivity |
|
|
Term
| What does the nurse monitor during hypokalemia? |
|
Definition
Administration--prevent injury from IV K+
Oxygenation levels and ability to cough
I&O: "P before K"
ECG
Falls precautions |
|
|
Term
| How is potassium replaced in hypokalemia? |
|
Definition
PO supplements can be mixed with liquid
Discontinue K+ wasting diuretics and replace with K+ sparing diuretics if needed
IV replacement if hypokalemia is severe:
NEVER GREATER THAN [1 MEQ/10 ML]
NEVER MORE THAN 10 MEQ/HOUR
CALL RRT IF IV SITE INFILTRATES (necrosis, phlebitis)
NEVER GIVE IM OR IV PUSH |
|
|
Term
| What are some of the causes of dilutional (relative) hyponatremia? |
|
Definition
Heart failure (fluid retention)
Syndrome of Inappropriate ADH
Polydipsia (drinking too much water) |
|
|
Term
| What are some causes of ACTUAL losses of sodium leading to hyponatremia? |
|
Definition
Cerebral salt wasting syndrome
Diuretics
Excessive sweating
Wound drainage, especially GI wounds
NPO status |
|
|
Term
| What other imbalances can cause hyponatremia? |
|
Definition
Hyperlipidemia
Hyperglycemia
Low ADH |
|
|
Term
| What does low sodium (hyponatremia) do to excitable membranes? |
|
Definition
Low sodium DECREASES excitability:
General muscle weakness
Decreased reflexes |
|
|
Term
| What assessment findings would indicate possible hyponatremia? |
|
Definition
Changes in blood pressure and pulse (vague)
Increased GI motility
Change in mental status, often confusion in older adults, due to cerebral edema and increased intracranial pressure from cellular swelling |
|
|
Term
| How is relative hyponatremia (low sodium because of increased water dilution) treated and what is the nurses role in this? |
|
Definition
Conivaptan or tolvaptan (diuretics that excrete just water and not salt), or ADH antagonists can be given. *Nurses must monitor potassium with these drugs
Fluid restrictions may be implemented.
Consult dietary. |
|
|
Term
| How is actual hyponatremia (low sodium with low or normal fluid levels) treated and what is the nurse's role in this? |
|
Definition
Discontinue loop diuretics (RN holds dose)
IV saline (RN monitors pulse rate and quality, I&O)
IV 3%NS if imbalance is severe (RN monitors vitals, I&O, lung sounds, and labs to avoid fluid overload) |
|
|
Term
| Which acid-base imbalance can cause hypocalcemia? |
|
Definition
| Alkalosis (Which can also cause hypokalemia) |
|
|
Term
| Age-related changes that lead to fluid and electrolyte imbalances |
|
Definition
Decreased skin integrity
Decreased GFR and urine concentrating ability
Decreased muscle mass
Decreased thirst reflex
Adrenal atrophy (poor regulation of K and Na) |
|
|
Term
| What are seizure precautions and when should you have them ready? |
|
Definition
Seizure precautions: Padded side rails, washcloth or padded tongue blade, suction.
When to be prepared: High OR Sodium, + low calcium, magnesium, phosphorus |
|
|
Term
| What imbalances can cause relative hypocalcemia? |
|
Definition
High phosphorus (Inverse relationship with Ca)
High protein (protein binds calcium, making it unavailable)
High citrate (blood products)
Low magnesium
Low Vitamin D |
|
|
Term
| Name some causes of actual calcium loss? |
|
Definition
Lactose Intolerance
Celiac/Crohn's disease
Vomiting/diarrhea
End-stage kidney disease |
|
|
Term
| What happens to excitable membranes when calcium is low? |
|
Definition
Hypocalcemia = INCREASED excitability because calcium is normally a stabilizer
Paresthesias
Twitching/cramps
Chvostek's/Trousseau's
Increased GI motility |
|
|
Term
| What cardiovascular changes result from hypocalcemia? |
|
Definition
Weak pulse with abnormal rate
Hypotension |
|
|
Term
| What can help alleviate the cramps and twitching from hypocalcemia? |
|
Definition
| Muscle relaxants and MgSO4 (magnesium sulfate) |
|
|
Term
| What do drug interventions focus on for hypocalcemia? |
|
Definition
Oral and IV replacements
Vitamin D and aluminum hydroxide to help the calcium be absorbed |
|
|
Term
| What nursing SAFETY interventions should be implemented for a patient with hypocalcemia? |
|
Definition
Assess ROM
Use a lift sheet when moving
Decrease stimuli, provide quiet environment
Seizure precations |
|
|
Term
| What are some non-drug causes of hypomagnesemia? |
|
Definition
Malnutrition
Starvation
Diarrhea
Steatorrhea (fat in poop)
Celiac/Crohn's disease
So basically not taking any in or losing through the GI |
|
|
Term
| What does low magnesium do to excitable membranes? |
|
Definition
Hypomagnesemia INCREASES excitability because it's a membrane stabilizer along with Calcium
Increased reflexes
Psychosis, confusion, depression
Paresthesia
Cramping
Tetany and seizures |
|
|
Term
| What other imbalances can low magnesium cause? |
|
Definition
|
|
Term
| Why does low magnesium cause skeletal muscle weakness and decreased GI motility if it also causes increased excitability? |
|
Definition
| Because Mg has many INTRACELLULAR functions: skeletal muscle contraction, ATP formation, etc. This lack of energy and contraction leads to skeletal muscle weakness and decreased GI motility intracellularly |
|
|
Term
| How can magnesium be replaced? What is the nurse's role in this? |
|
Definition
Discontinue loop diuretics, aminoglycosides, and phosphorus-containing drugs (Hold dose)
MgSO4 can be given IV if deficiency is severe (NOT PO because of diarrhea, NOT IM because of pain and tissue damage) (RN assesses reflexes q1h to know if treatment is working) |
|
|
Term
| Which drugs can cause fluid overload? |
|
Definition
| Long-term corticosteroids because they are similar to aldosterone in fluid and sodium retention |
|
|
Term
| What GI symptoms would you find in fluid overload? |
|
Definition
Increased motility
Enlarged liver |
|
|
Term
| What cardiovascular findings would expect in fluid overload? |
|
Definition
Increased blood pressure, especially diastolic
Bounding pulse |
|
|
Term
| What respiratory findings would you expect in fluid overload? |
|
Definition
Tachypnea with shallow breaths
Dyspnea
Crackles |
|
|
Term
| What integumentary findings would you expect in fluid overload? |
|
Definition
Pitting edema
Pale and cool skin |
|
|
Term
| What neuromuscular changes would you expect in fluid overload? |
|
Definition
Change in level of consciousness
Skeletal muscle weakness
Paresthesia |
|
|
Term
| What is the biggest danger of fluid overload? |
|
Definition
| It can progress to pulmonary edema and heart failure in a patient of any age or health status |
|
|
Term
| What are the nurse's responsibilities to a pt with fluid overload? |
|
Definition
Watch for skin breakdown
Track I&O
Monitor for electrolyte imbalances, especially Na, K
Track weight
Teaching about food labels and daily weight journals |
|
|
Term
| What are the medical interventions for a patient with fluid overload? |
|
Definition
Diuretics
Fluid and/or sodium restrictions |
|
|
Term
| What does HIGH potassium (hyperkalemia) do to membrane excitability? |
|
Definition
Hyperkalemia = INCREASED excitability:
Increased GI motility
Muscle twitching and paresthesia that progresses to weakness |
|
|
Term
| How would you know if kidney failure is the cause of hyperkalemia? |
|
Definition
| Look at labs: If kidney failure is the cause, there will be high BUN and Creatinine, low pH, and normal or low hemoglobin and hematocrit |
|
|
Term
| What are the cardiovascular effects of hyperkalemia and what is the nurse's responsibility? |
|
Definition
Ectopic beats (RN calls RRT if T waves spike)
Hypotension
Bradycardia (RN calls RRT if pulse is less than 60) |
|
|
Term
| What are the interventions and nursing responsibilities for hyperkalemia? |
|
Definition
1. DC K+ containing infusions, but keep IV access open and replace with NS if needed
2. Give K+ wasting diuretics unless there are kidney issues. If there are, give kayexelate. If kayexelate is too slow and the hyperkalemia needs immediate treatment, dialysis is the only option (dialysis is also the only option if the patient is in renal failure)
3. Give hypertonic IV insulin and glucose via a central line and watch for hypokalemia and hypoglycemia |
|
|
Term
| What drugs/treatments can cause hyperkalemia? |
|
Definition
ACE Inhibitors
Blood transfusions or packed RBCs |
|
|
Term
| What conditions can cause hyperkalemia? |
|
Definition
Kidney failure (hold on to K+)
Adrenal insufficiency (less aldosterone)
Tissue damage/trauma (release ICF K+)
Acidosis
Hyperuricemia
Uncontrolled DM without insulin |
|
|
Term
| What are some causes of relative hypernatremia (dehydration) |
|
Definition
Infection/fever/increased metabolism
Hyperventilation
Sweating |
|
|
Term
| What are some causes of actual hypernatremia? |
|
Definition
Cushing's
Hyperaldosteronism
Corticosteroids
Kidney failure |
|
|
Term
| What is the effect of too much sodium on excitable membranes? |
|
Definition
Hypernatremia INCREASES excitability:
Mental changes (RN should implement seizure precautions)
Muscle twitching that progresses to weakness
Slowed calcium movement, resulting in changes in blood pressure and pulse, with decreased contractility |
|
|
Term
| Interventions for hypernatremia? |
|
Definition
Hypotonic IV replacement (usually 0.225%NS, sometimes 0.45%NS)
Diuretics
Adequate water intake with sodium restriction |
|
|
Term
| What effects do malignancies have on electrolytes? |
|
Definition
| Malignancies cause relative imbalances of too much calcium and too little phosphorus |
|
|
Term
| What are some causes of hypercalcemia? |
|
Definition
Immobility
Hyperparathyroidism or hyperthyroidism (cause calcium to be taken out of bone and moved into blood)
Glucocorticoids
Thiazides
Kidney failure |
|
|
Term
| What effect does increased calcium have on membrane excitability? |
|
Definition
Since calcium is a membrane stabilizer, hypercalcemia causes decreased excitability:
Change in LOC
Muscle weakness with decreased reflexes
Decreased GI motility (RN should measure ABD girth) |
|
|
Term
| What hemodynamic and cardiovascular effects does hypercalcemia have? |
|
Definition
Faster clotting enzymes/risk for clots (RN should check calf circumference)
Changes in heart rate and blood pressure that start high and end up low |
|
|
Term
| What are some drugs that inhibit calcium resorption (resorption is the movement of calcium from the bones into the blood) |
|
Definition
Phosphorus
Calcitonin
Bisphosphonates
NSAIDS |
|
|
Term
| What effect does IV NS have on calcium levels? |
|
Definition
| Decreases serum calcium because sodium flushes calcium, but not fast enough to fix someone in cardiac distress from hypercalcemia (dialysis would be needed) |
|
|
Term
| Other than too much intake by various routes, how could hypermagnesemia develop? |
|
Definition
| From kidney disease because magnesium is absorbed in the GI and excreted by the kidneys |
|
|
Term
| What are the resulting problems of hypermagnesemia and the nurse's related responsibilities? |
|
Definition
Decreased excitability leads to skeletal muscle weakness, decreased reflexes, and lethargy/coma (RN should assess ability to breathe)
Cardiac changes lead to bradycardia, vasodilation, hypotension, and danger of cardiac arrest (RN should monitor P and BP and increase calcium to decrease cardiac side effects) |
|
|
Term
| Why is elastic recoil of the lungs so important? |
|
Definition
| Terminal and respiratory bronchioles have small diameters and no cartilage, so they depend entirely on lung elastic recoil to remain open |
|
|
Term
| What is the significance of type II pneumocytes? |
|
Definition
| They are cells in the alveolar walls that secrete surfactant. Surfactant reduces surface tension and without it, atelectasis would occur and reduce gas exchange |
|
|
Term
| What are the 2 systems of blood flow in the lungs? |
|
Definition
|
|
Term
| How many oxygen molecules does hemoglobin have bound when it is saturated? |
|
Definition
|
|
Term
| What condition produces pink, frothy sputum? |
|
Definition
|
|
Term
| What conditions can cause hemoptysis? |
|
Definition
Chronic bronchitis
Lung cancer
TB
Pulmonary infarction
Bronchial adenoma
Lung abscess |
|
|
Term
|
Definition
|
|
Term
| Conditions that increase fremitus? |
|
Definition
|
|
Term
| Sputum cytologic exam can identify which conditions? |
|
Definition
Cancer
Allergy
Autoimmunity
Asthma |
|
|
Term
| What's the difference between pulse oximetry and ABG? |
|
Definition
Pulse ox identifies hemoglobin saturation
ABG's assess arterial oxygen |
|
|
Term
| Why should you use both pulse oximetry and capnography for critically ill patients? |
|
Definition
| PETCO2 can detect changes in breathing effectiveness before hypoxia can be detected with SpO2. |
|
|
Term
| Methoglobinemia and treatment? |
|
Definition
| Altered iron state that does not carry oxygen, resulting in tissue hypoxia, can be caused by benzocaine spray; Call RRT if this occurs after benzocaine. Treatment: 1% methylene blue 1-2 mg/kg |
|
|
Term
|
Definition
Identify risks of complication before surgery
Determine cause of dyspnea |
|
|
Term
|
Definition
| Fluid in the pleural space |
|
|
Term
| Pneumothorax and signs/symptoms |
|
Definition
Air in the pleural space
Signs/symptoms:
Rapid heart rate
Rapid, shallow respirations
Air hunger
Pain at end of inhalation and exhalation
Prominence that doesn't move with ventilation
Oppositely slanted trachea
New "nagging" cough
Cyanosis |
|
|
Term
| What is it important to know before a patient has a CT scan? |
|
Definition
| If they're allergic to shellfish or iodine |
|
|
Term
| What must you monitor during follow-up care after a bronchoscopy? |
|
Definition
Return of gag reflex before NPO status is removed
Breath sounds and oxygenation
Signs of bleeding/infection |
|
|
Term
| After which respiratory diagnostic tests must you do a CXR? |
|
Definition
| Thoracentesis and lung biopsy |
|
|
Term
|
Definition
| A patient who has gradually increased CO2 levels to 60-65 mmHg and up, who has lost the normal breathing drive mechanisms |
|
|
Term
| How much oxygen is it generally safe to give a patient with chronic hypercarbia? |
|
Definition
|
|
Term
| What's the most accurate way to determine need for oxygen therapy? |
|
Definition
|
|
Term
| When do you humidify administered oxygen? |
|
Definition
| When being delivered at 4L/min or more |
|
|
Term
|
Definition
| The loss of sensitivity to high PaCO2 by central chemoreceptors, which then do not increase rate and depth of breathing |
|
|
Term
| When is it most important to monitor oxygen therapy of a patient with COPD or a similar condition that could cause a loss of the hypoxic drive to breathe? |
|
Definition
1. IF it's the patient's first time receiving oxygen
2. If the PaCO2 levels are not known
3. During the first 30 minutes of oxygen therapy--this is when hypoventilation usually first occurs |
|
|
Term
| Which is a greater priority: Oxygen-induced hypoventilation, or hypoxemia? |
|
Definition
| Hypoxemia is a greater threat to life even though CO2 narcosis/oxygen-induced hypoventilation is very serious |
|
|
Term
| What kind of damage can prolonged exposure to high levels of oxygen cause? |
|
Definition
Atelectasis
Pulmonary edema
Hemorrhage
Hyaline membrane formation |
|
|
Term
| How can the amount of oxygen administered be decreased for a patient on a mechanical ventilator? |
|
Definition
|
|
Term
|
Definition
| When high oxygen levels are delivered, nitrogen is diluted, and oxygen diffuses into the alveolar circulation, leaving less volume in the alveoli and causing collapse |
|
|
Term
| How are high-flow oxygen delivery systems different than low-flow? |
|
Definition
| High flow systems don't depend on the patient's breathing pattern to deliver adequate oxygen and tidal volume |
|
|
Term
| What are the forms of low-flow oxygen delivery? |
|
Definition
Nasal cannula
Simple face mask
Partial rebreather mask
Nonrebreather mask |
|
|
Term
| What are the forms of high-flow oxygen delivery? |
|
Definition
Venturi masks
Face tent
Aerosol mask
Tracheostomy collar + T piece |
|
|
Term
| What is the best way to deliver oxygen to a patient with chronic lung disease/danger of CO2 narcosis? |
|
Definition
| Venturi mask because it delivers the most accurate and precise oxygen concentrations |
|
|
Term
| What are the pro's and con's of noninvasive positive pressure ventilation? |
|
Definition
Pro: Keep alveoli open, prevent complications associated with intubation
Con: Can cause gastric insufflation, and only mentally intact patients who can protect their own airway can use them |
|
|
Term
| Explain the inflammatory process of pneumonia |
|
Definition
1. Organisms penetrate airway mucosa and multiply in alveoli
2. WBCs migrate to infection and cause capillary leak, edema, and exudate which makes the alveolar walls thicken
3. RBCs and fibrin enter and stiffen the lung, which can lead to atelectasis
4. The leaky fluids allow easy spread into the blood stream (sepsis) or pleural cavity (empyeme) |
|
|
Term
| 2 types of pneumonia based on LOCATION |
|
Definition
1. Lobar pneumonia: Can be in one segment or entire lobe of lung
2. Bronchopneumonia: Diffusely scattered patches around the bronchi |
|
|
Term
|
Definition
| Solidification, lack of air spaces on x-rays |
|
|
Term
| Tissue necrosis in pneumonia |
|
Definition
| Occurs when an abscess forms and perforates the bronchial wall |
|
|
Term
|
Definition
1. PPV23 vaccine if 65 or older
2. Yearly flu vaccines
3. Handwashing
4. Avoid large gatherings during flu/cold/holiday season
5. Avoid pollutants (dust, aerosoles, smoke)
6. Don't start smoking, try to quit if you do
7. Drink at least 2 L fluid/day |
|
|
Term
|
Definition
Hand hygiene
Oral care (complete care every 12 hours; antimicrobial and moisturizing rinse every 6 hours)
Head-of-bed elevation at least 30 degrees |
|
|
Term
| Why is a CXR essential for older adults in diagnosing pneumonia? |
|
Definition
| CXR is essential for early diagnosis of pneumonia in older adults because pneumonia symptoms are often vague in this population |
|
|
Term
| What are the priority problems for a patient with pneumonia? |
|
Definition
1. Hypoxemia
2. Potential for airway obstruction
3. Potential for sepsis |
|
|
Term
| Interventions for pneumonia |
|
Definition
Oxygen therapy
Incentive spirometry
TCDB q2h (at least)
2 L of fluid per day
Bronchodilators, inhaled or IV steroids, antibiotics, sometimes NSAIDS |
|
|
Term
| Important teaching points for the patient at risk for or diagnosed with pneumonia |
|
Definition
Importance of taking antibiotics AS PRESCRIBED until they're gone
Avoiding upper respiratory tract infections (flu vaccine, avoid crowds, hand hygiene, etc.)
Vaccination (flu, pneumonia)
Smoking cessation |
|
|
Term
| Susceptible lung sites for TB multiplication |
|
Definition
|
|
Term
|
Definition
| Necrotic tissue being turned into a granular mass in the center of the lesion; called a Grohn's Tubercle when it shows on X-ray of a patient with TB |
|
|
Term
| What are the 3 potential processes a necrotic area of lung might undergo in a TB patient? |
|
Definition
Calcifiation
Liquefication
Cavitation |
|
|
Term
| Miliary TB, aka Hematogenous TB |
|
Definition
| Spread of TB throughout the body when a large number of organisms enter the blood |
|
|
Term
| When is a TB patient infectious/contagious? |
|
Definition
| An infected person is not infectious until manifestations of disease occur |
|
|
Term
| What are the focus of nursing interventions for TB? |
|
Definition
| Patient education on drug therapy adherence and infection control (Encourage them to stick it out through the nausea, fatigue, and long duration of TB drug therapy. Stress about coughing and sneezing into the arm and avoiding exposure to inhalation irritants. Let them know they can expect to have to commit to follow up treatment for at least a year with active TB treatment) |
|
|
Term
| When is a TB patient no longer contagious? |
|
Definition
| Usually after 2-3 weeks of consistent drug therapy as long as there are signs of clinical improvement |
|
|
Term
| What are the cardinal symptoms you always ask about with a respiratory health history? |
|
Definition
Cough
Chest pain
Chills
Fatigue
Fever
Night sweats
Sputum |
|
|
Term
| What are the nursing actions for thoracentesis? |
|
Definition
Pre-procedure: Consent, positioning, monitor vitals
Post-procedure: Lung sounds, signs of bleeding, CXR |
|
|
Term
| Nursing actions for bronchoscopy? |
|
Definition
Pre-procedure: NPO, consent, allergies, pulse ox, remove dentures, sedation meds
Post-procedure: Monitor vitals and lung sounds, watch for hemoptysis, NPO until gag reflex returns |
|
|
Term
|
Definition
| Indicate fluid in alveoli |
|
|
Term
|
Definition
| Indicate secretions; should clear with cough |
|
|
Term
|
Definition
|
|
Term
| Where does the inflammation of pneumonia occur? |
|
Definition
|
|
Term
|
Definition
| Mostly prevalent among animals and birds, but the virus can mutate to become infectious to humans. Strict isolation precautions and antiviral drugs are used. |
|
|
Term
| 5th leading cause of death in U.S.? |
|
Definition
|
|
Term
| Risk factors for healthcare acquired pneumonia? |
|
Definition
Hospitalization in the past 90 days
Nursing home or LTC facility resident
IV ABT, chemotherapy, or wound care in past 30 days
Hemodialysis |
|
|
Term
| What do you monitor if a patient received aminoglycosides ABT? |
|
Definition
Peak and trough levels
BUN and Cr because they're nephrotoxic
I&O |
|
|
Term
| Primary risk factor for HAP? |
|
Definition
| Mechanical ventilation with endotracheal intubation |
|
|
Term
| Why would a mechanically ventilated patient be on PPIs? |
|
Definition
| To decrease the gastric pH and protect against pulmonary inflammation from aspiration of stomach contents |
|
|
Term
| Who are the populations most at-risk for TB? |
|
Definition
HIV/AIDS patients
Live in crowded areas
Older age
Homeless
Lower socioeconomic status
IV drug abusers and/or alcohol abusers
Foreign immigrants |
|
|
Term
| Which tests would be positive for a patient with latent TB infection (LTBI) even though this patient would not be contagious? |
|
Definition
TB SKin Test (TST)
QFT (quantiferon TB gold blood ELISA test) |
|
|
Term
|
Definition
Fatigue
Nausea
Anorexia, weight loss
Low grade fever
Night sweats
Cough
Hemoptysis/sputum |
|
|
Term
| What is the difference between an AFB sputum test and a Mycobacterium tuberculosis sputum test? |
|
Definition
| The mycobacterium tuberculosis test is specific to TB (not just any acid fast bacteria) and needs 3 samples to make a definitive diagnosis |
|
|
Term
| List the different TB skin test findings that would indicate positive results for different populations? |
|
Definition
5 mm induration is POSITIVE for patients with HIV, organ transplants, or any other immunosuppressants
10 mm induration is POSITIVE for recent immigrants, IV drug users, people at risk for contracting
15 mm is POSITIVE for people with no known risk factors (kids, people not around others with the infection, etc.) |
|
|
Term
| When do you measure the TB skin test? |
|
Definition
| 48-72 hours after injection of PPD solution |
|
|
Term
| What treatment do you get if your PPD skin test was positive but CXR was negative? |
|
Definition
| Isoniazid and Vitamin B6 for 6 months |
|
|
Term
| What treatment do you get if your PPD skin test was positive and your CXR was positive too? |
|
Definition
| Give sputum samples and start on isoniazid, rifampin, pyrazinamide, and ethambutol for 6-9 months with sputum's retested every 2-4 weeks |
|
|
Term
| What foods should you avoid when on isoniazid? |
|
Definition
Cheese
Chocolate
Caffeine
Red wine
Yogurt
Bananas
(tyramine-rich foods) |
|
|
Term
|
Definition
Rash
Hepatic enzyme elevation (LFT)
Hepatitis
Peripheral neuropathy |
|
|
Term
| What do you monitor during isoniazid therapy? |
|
Definition
| LFT's (especially AST and ALT) |
|
|
Term
| What increases your risk for hepatitis while on isoniazid? |
|
Definition
| Age and alcohol consumption |
|
|
Term
|
Definition
N/V/D
Bleeding problems
Flu-like symptoms
Hepatitis |
|
|
Term
| What do you monitor during rifampin therapy? |
|
Definition
CBC, platelets
Hepatic enzymes (LFTs) |
|
|
Term
| Which TB drugs decrease the effectiveness of oral contraceptives? |
|
Definition
|
|
Term
|
Definition
Hepatitis
Low platelets (thrombocytopenia) |
|
|
Term
| What do you monitor during rifabutin therapy? |
|
Definition
|
|
Term
| Which TB drugs turn your body fluids orange? |
|
Definition
|
|
Term
|
Definition
Hepatitis
Rash
N/V/D
Hyperuricemia (gout) |
|
|
Term
| What do you monitor during pyrazinamide therapy? |
|
Definition
|
|
Term
|
Definition
| Optic neuritis: visual changes, can't see color, especially red and green |
|
|
Term
| What do you monitor during ethambutol therapy? |
|
Definition
| Baseline and monthly tests of visual acuity and color vision |
|
|
Term
| How is Streptomycin administered? |
|
Definition
|
|
Term
|
Definition
| Nephrotoxicity and ototoxicity (hearing loss, vestibular dysfunction) |
|
|
Term
| What do you monitor during streptomycin therapy? |
|
Definition
|
|
Term
| For which TB drug do you apply a warm compress after administering? |
|
Definition
|
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