Med Surg Exam 3

these are interventions for which respiratory issue? -Endotracheal intubation and mechanical ventilation with positive end-expiratory pressure or continuous positive airway pressure -Drug therapy -Nutrition therapy; fluid therapy -Prone positions / frequent positioning

ARDS

these are the signs and symptoms of which respiratory issue? -Low PaO2 value on arterial blood gas -Dyspnea -Refractory hypoxemia poor response to higher concentrations of oxygen -Cyanosis -Diaphoresis, Skin Cool and pale -Hypotension, Tachycardia -Abnormal breath sounds -White spots on X-Ray

ARDS

Located between the cells and outside of the blood vessels

Interstitial fluid

The liquid part of blood or the plasma

Intravascular fluid

invasive respiratory diagnostic test: -Not as common -In a surgical setting (surgical asepsis) -enables visualization of the contents of the mediastinum, usually for the purpose of obtaining a biopsy -Neuromuscular blockades paralyze patients; must establish an airway before paralysis and have emergency airway equipment at the bedside after surgery

Mediastinoscopy

How do we know the lung has re-expanded in a patient with a chest tube?

No fluctuations in the water seal, return of breath sounds, pulse ox of 95%

measure of the number of dissolved particles in a fluid; looks at the concentration of particles in a particular compartment

Osmolality

Atrial contraction from SA node to AV node and blood emptying from the atria to the ventricles is what part of the EKG?

P wave

-Intermittent and reversible airflow obstruction affects only the airways, not the alveoli -Allergens bind to specific IgE on mast cells -Results from inflammation and airway bronchospasm, edema of the mucous membranes, and copious, thick secretions

asthma

these are interventions for which respiratory issue? -Improve airflow -Relieve symptoms -Prevent episodes -Bronchodilators, steroidal and nonsteroidal agents to reduce inflammation

asthma

these are the signs and symptoms of what respiratory issue? wheezing, tachycardia, tachypnea, hypoxia, dyspnea, chest tightness, coughing, and excessive mucous production

asthma

this is patient education for which respiratory issue? avoid triggers, take prescribed meds, how to use inhaler, pre-medicate when appropriate

asthma

Chronic lung diseases of chronic airflow limitation include:

asthma, chronic bronchitis, pulmonary emphysema

99% of this electrolyte is located in the bone as hydroxyapatite; necessary for structure of bones and teeth, blood clotting, hormone secretion, cell receptor function, plasma membrane stability, transmission of nerve impulses, muscle contraction; serum concentration 8.8 to 10.5 mg/dl

calcium

osmotically attracts water from the interstitial space back into the capillary.

capillary (plasma) oncotic pressure

facilitates the outward movement of water from the capillary to the interstitial space.

capillary hydrostatic pressure (blood pressure)

The lungs control gas exchange to blow off or retain:

carbon dioxide (CO2)

when you think of potassium think of __________ changes: ekg changes, tachycardia, arrhythmias

cardiac

Underlying conditions where fluid replacement may not be the solution:

cardiovascular (heart failure) and end stage renal

how do diuretics affect acid-base imbalances?

cause a loss of H+ ions and lead to alkalosis

-Placed to assist in the drainage of fluid, blood or air; reestablish negative pressure; facilitate lung expansion; and restore normal pressure -Care required: --Monitor hourly to ensure sterility and patency. --Tape tubing junctions. --Keep occlusive dressing at insertion site. --Position correctly to prevent kinks and large loops. --Maintain pulmonary hygiene. --Monitor fluid in the water seal.

chest tube

invasive respiratory intervention; long term management due to continuous fluid drainage or lung reinflation

chest tube

2-D Imaging done to help diagnose pulmonary edema, pneumonia, pneumothorax; air shows black, fluid and masses show white

chest xray

what test determines if TB is active or latent?

chest xray

what are the two main ways to diagnose pneumonia?

chest xray and sputum culture

In a normal situation, an increase in sodium causes an increase in __________ and vice versa (direct relationship)

chloride

Primary ECF anion, provides electroneutrality

chloride

the most dominant negative ion.

chloride

-Inflammation of the bronchi and bronchioles caused by chronic exposure to irritants (smoking) -Chronic inflammation→ hypertrophy & hyperplasia of mucous glands→excess mucus →decreased airflow -Affects only the airways (ventilation issue), not the alveoli

chronic bronchitis

what medication interventions are needed for TB?

combination of 3-4 medications

refers to the process by which the body attempts to correct changes and imbalances in pH levels.

compensation

Imbalances occur when what fails?

compensatory mechanisms

renal system regulation of bicarb and H+ ions (acid)

conserves bicarb and excretes acid

3 mechanisms of acid elimination:

conserving (reabsorption) of bicarb, generating HCO3 to increase pH of plasma, secreting buffered H+ into the urine eliminates it from the body

right sided heart failure; backflow of blood from the lungs; symptoms: lower extremity edema and weight gain

cor pulmonale

what disease mimics ARDS?

covid

Adventitious breath sounds include:

crackle, wheeze, rhonchus, pleural friction rub

adventitious breath sound: sounds like velcro, at end of inspiration, indicates fluid overload and pneumonia or mucus production (collapsed or waterlogged alveoli)

crackles

these are the nursing interventions for which adventitious breath sound: fluid restriction, diuretics, coughing and deep breathing, encourage ambulation

crackles

used to insert a hollow needle to assist in breathing when other attempts have failed (procedure is also known as an emergency airway puncture or cricothyrotomy; results in a tracheostomy or an opening/stoma for the purpose of an alternative airway); located below the level of the vocal cords.

cricoid cartilage (Adam's apple)

when endotracheal intubation doesn't work, what is the next option to establish an airway?

cricothyroidotomy (emergency procedure, small incision in cricoid cartilage and place trach through the area)

burn treated at the scene and followed up at a local ED; analgesia is priority intervention; -full thickness burns of less than 2% TBSA -partial thickness of less than 10% TBSA

minor burn

are these nursing actions for moderate symptoms of hyponatremia (Na <115 mEq/L) or severe symptoms (Na <110 mEq/L)? -administer 3% NS at 1 ml/kg/hr

moderate

high-flow oxygen delivery system: a soft, oxygen-delivery mask that fits under the patient's chin, loosely covers the mouth and nose, and is held in place by an adjustable elastic strap; mainly in pediatric population; not so restricting

face tent

true or false: When there are facial fractures or fractures of the nose, you can still insert an NG tube

false

true or false: only TB disease is treated, latent TB does not need treatment

false

true or false: oxygen is not harmful if given in excess amounts

false

true or false: tracheostomy tubes and inner cannulas are only disposable, not reusable

false

-free-floating rib segments -Inward movement of the thorax during inspiration, below rib fractures, ballooning out on exhalation -Paradoxical chest movement (unilateral chest rise), cyanosis, hypotension, dyspnea, tachycardia, anxiety

flail chest

percussion sound heard over bone or spine

flatness

an excess of fluid or water, such as with water intoxication; this includes hemodilution, which makes the amount of blood components (blood cells, electrolytes) seem lower; patients at risk for developing pulmonary edema or congestive heart failure.

fluid overload

phase of burn care: -lab values begin to shift -starts at about 24 hours (diuretic stage begins 48-72 hours after injury) -Using a lot of WBCs and left shift releases premature WBCs as the body begins to deal with the totality of the damage -Hgb and hct: decreased due to fluid shift from interstitial to vascular fluid -sodium: decreased -potassium: decreased -glucose: elevated -ABGs: slight hypoxemia and metabolic acidosis -total protein and albumin: low

fluid remobilization

these are expected findings of what: -VITAL SIGNS: Tachycardia, bounding pulse, hypertension, tachypnea, increased central venous pressure -NEUROMUSCULAR: Weakness, visual changes, paresthesias, altered level of consciousness, seizures (result of electrolyte imbalance resulting from delusional fluid volume overload) -GASTROINTESTINAL: Ascites, increased motility, liver enlargement -RESPIRATORY: Crackles, cough, dyspnea -OTHER SIGNS: Peripheral edema due to an excess of fluids within the body and lungs, resulting in weight gain, distended neck veins, and increased urine output, skin cool to touch with pallor

fluid volume overload

these are the signs and symptoms of which respiratory issue? -Hoarseness -Persistent Cough -Sputum production (rust, bloody) -Hemoptysis -SOB, dyspnea -Change in endurance -Weight loss

lung cancer

beta 2 agonists affect the:

lungs

respiratory disorders focus on the ________ while metabolic disorders focus on the _________

lungs, kidneys

Intracellular cation; serum concentration 1.8 to 3.0 mEq/L; acts as a cofactor in intracellular enzymatic reactions; increases neuromuscular excitability

magnesium

The goal of osmosis is to:

maintain a proper balance of water

burn requiring emergency treatment at nearest facility, then immediate transfer to a burn center; provide humidified supplemental oxygen to prevent further fluid volume loss and make sure patient is receiving good analgesia; -full thickness burn greater than 10% TBSA -partial thickness burn >25% TBSA -age older than 60 -presence of chronic cardiac, respiratory, or endocrine condition -electrical burn injury -inhalation or other complicated injury -burns to the eyes, face, ears, hands, feet, perineum

major burn

These are the causes of which acid-base imbalance: GI loss of bicarbonate or accumulation of acid (DKA, severe diarrhea, renal failure, shock)

metabolic acidosis

characterized by pH <7.35 and a low bicarbonate concentration (<22 mEq/L); decreased ability of the kidney to excrete acid or conserve base

metabolic acidosis

these are the manifestations of which acid-base imbalance: warm and flushed skin (vasodilation), Kussmal respirations / tachypnea (compensatory hyperventilation), confusion, hypotension, and decreased cardiac output, hyperkalemia, muscle twitching, nausea and vomiting, changes in LOC (confusion, increased drowsiness)

metabolic acidosis

These are the causes of which acid-base imbalance: gain of bicarbonate or a loss of H+; severe vomiting, excessive GI suctioning, diuretics, excessive NaHCO3

metabolic alkalosis

characterized by pH > 7.45 and a high serum bicarbonate concentration (>26 mEq/L).

metabolic alkalosis

these are the manifestations of which acid-base imbalance: restlessness followed by lethargy, tachycardia, compensatory hypoventilation, confusion (decreased LOC, dizziness, irritable), nausea, vomiting, diarrhea, hypokalemia, tremors, muscle cramps, tingling of fingers and toes

metabolic alkalosis

burn treated at the scene, then the patient transferred to a burn center or specialized medical facility; provide humidified supplemental oxygen to prevent further fluid volume loss and make sure patient is receiving good analgesia; -full thickness burns of 2-10% TBSA -partial thickness burns of 15-25% TBSA

moderate burn

when you think of magnesium think of _____________ and cardiac = deep tendon reflexes changes

musculoskeletal

-least invasive and first-line treatment of O2 therapy -safe, easy to apply, comfortable, well-tolerated, pt able to eat, talk, and ambulate -do not always get a specific delivery of oxygen bc sometimes pts breathe through their mouth so it doesn't always work -Interventions: assess patency of nares, if sinus congestion this will not help, make sure prongs fit properly in nose, provide humidified oxygen at greater flow rates (4 L or more) to prevent drying of mucous membranes -Flow rates of 1 (24%)-6L(44%)/min -Greater then 6L/min does not increase oxygenation because of anatomic dead space

nasal cannula

what test indicates that a client is no longer infected with TB?

negative sputum culture

forces favoring filtration minus forces opposing filtration

net filtration

how does fluid move in the capillary

net filtration

When you think of sodium (low or high) think of ___________ changes: seizures, lethargy, coma, airway protection

neurological

infection precautions for burn patients

neutropenic precautions

type of compensation: pH outside the expected reference range, and either HCO3 or the PaCO2 is outside the expected reference range

no compensation

-Provides the highest concentration of oxygen (90%) -Client tends to be very compromised -Flaps and reservoir bag -Not a good sign bc this amount of FIO2 is 80-95 at flow rates at 10-15 -Next step up would be ventilation if patients are still satting in the high 80s

non-rebreather mask

isotonic fluid used to expand volume, dilute medications, and keep the vein open; give during resuscitation to normalize and mimic what the body has lost

normal saline 0.9% NaCl

what structures are included in the upper respiratory tract?

nose, sinuses, pharynx, larynx

what can fracture of the nose cause? -Assess for respiratory distress and for tolerance of packing or tubes. -Administer humidification, oxygen, bedrest, antibiotics, pain medications. -Good oral hygiene

nosebleed (epixstaxis)

obstructive or restrictive pulmonary function test: upper airway; airways are narrowed and obstruct airflow getting in and out and causes an increased time to empty the lungs; causes include emphysema, bronchitis, infection (which produces inflammation), and asthma.

obstructive

what is the purpose of inspiration?

provide O2 to tissues

The kidneys reabsorb filtered bicarbonate in the (proximal or distal) tubules and generate new bicarbonate in the (proximal or distal) tubules, where there is a net secretion of hydrogen ion.

proximal, distal

-Bruising of lung tissue→bleeding into alveoli, can be lethal -Hemoptysis, Hypoxia, Dyspnea, Increased bronchiale secretions, decreased breath sounds, crackles, wheezes, hazy shadows on chest X-Ray -Interventions: maintain ventilation and oxygentation

pulmonary contusion

-A collection of particulate matter—solids, liquids, or gases—enters venous circulation and lodges in the pulmonary vessels -Affects immobile patients, injuries, trauma, surgeries

pulmonary embolism

intracellular or extracellular: -One third of body water -Body fluids outside of the cell membrane

extracellular

acid-base regulatory mechanism: react immediately to prevent major changes in the pH of body fluids by removing or releasing H+

buffers

what are acid-base regulatory mechanisms?

buffers, respiratory system, renal system

primary intervention for potential sepsis

prescription of anti-infectives (for eradication of organism causing the infection)

Interventions for aspiration pneumonia:

preventing lung damage and treating infection

difference between primary and secondary hypercapnia

primary: respiratory acidosis; secondary: metabolic alkalosis

difference between primary and secondary hypocapnia

primary: respiratory alkalosis; secondary: metabolic acidosis

cellular destruction of skin layers and underlying tissue; results in loss of temperature regulation, sweat and sebaceous gland function, and sensory function

burns

how do antacids affect acid-base imbalances?

by killing the acid in the stomach, gastric secretions are alkalized

lung injury in ARDS: intrinsic or extrinsic? the alveolar-capillary membrane is injured from conditions such as aspiration or inhalation injury

extrinsic

transudate or exudate: in pleural space, due to inflammatory or infectious or cancerous response

exudate

high pressure or low pressure ventilator alarm: -Disconnected tube -Cuff leak -Total or partial extubation

low pressure

nursing actions for fluid overload respiratory compromise:

prioritize airway, then auscultate lung sounds (to ensure pt doesn't have rhonchi or crackles)

why would you obtain ABGs?

tell more accurate levels of oxygen, co2, and pH

treatment of metabolic alkalosis focuses on what?

underlying metabolic disorder, K+ replacement, fluid volume replacement.

head and neck cancer postoperative nutritional needs

-Nasogastric, Gastrostomy, Jejunostomy (until head and neck heal) -Parenteral nutrition (until the gastrointestinal tract recovers from the effects of anesthesia)

what nursing actions should be done for respiratory failure as a result of hypokalemia?

-maintain an open airway -monitor vital signs, LOC, hypoxemia and hypercapnia -assist with intubation and mechanical ventilation if indicated.

what nursing actions should be done for cardiac arrest as a result of hypokalemia?

-perform continuous cardiac monitoring -treat any dysrhythmias

each smaller box on an EKG is how much time?

0.04 seconds

each larger box on an EKG is how much time?

0.20 seconds

for hyponatremia, weigh daily and notify the provider of a _______ lb gain in 24 hr, or 3-lb (1.4 kg) gain in 1 week.

1-2 lb

Urine specific gravity range

1.010-1.025

Magnesium levels

1.3-2.1 mEq/L

BUN range

10-20 mg/dL

what serum sodium levels have these manifestations: Acute: headache, confusion, lethargy, nausea Chronic: occasionally none to mild confusion or lethargy

110-120 mEq/L

Replacement of sodium should not exceed ___ mEq/L in a 24-hr period because rapid rise in sodium level risks development of neurologic damage due to demyelination.

12

The interstitial fluid amounts to how many liters?

12

Hemoglobin range

12-16 g/dL females, 14-18 g/dL males

what serum sodium levels have these manifestations: Acute: nausea, malaise, gait instability Chronic: none or gait instability (fall risk in elderly)

120-125 mEq/L

Sodium levels

135-145 mEq/L

what serum sodium levels have these manifestations: often asymptomatic

146-150 mEq/L

what serum sodium levels have these manifestations: Acute: nausea, weakness, confusion, lethargy, Chronic: occasionally none to mild

151-160 mEq/L

bicarbonate (HCO3) normal range

22-26 mEq/L

intracellular fluid amounts to how many liters?

25

plasma amounts to how many liters?

3

Phosphorus levels

3-4.5 mg/dL

Potassium levels

3.5-5 mEq/L

PaCO2 (partial pressure of CO2 in arterial blood) normal range

35-45 mmHg

Hematocrit range

37%-47% females, 42%-52% males

continuous leak of plasma from vascular space to interstitial space, resulting in electrolyte imbalance and hypotension

3rd spacing

4 boxes on an EKG is equivalent to how many seconds?

4

homeostasis is maintaining a pH within what range

7.35-7.45

body fluids account for what % of body weight in pediatric patients?

75% to 80%

PaO2 (partial pressure of O2 in arterial blood) normal range

80-100 mmHg

Calcium levels

9-10.5 mg/dL

Oxygen is a drug; often outstanding orders in the chart that say to apply oxygen if pulse ox is less than or greater to ____

92%

Chloride levels

98-106 mEq/L

what serum sodium levels have these manifestations: Acute: nausea, seizures, coma Chronic: rarely none, greater confusion or lethargy

<110 mEq/L

SaO2 (arterial O2 saturation) normal range

> 95%

what serum sodium levels have these manifestations: Acute: stupor, coma Chronic: moderate to severe CNS symptoms

>160 mEq/L

the passage of a tube through the nose or mouth into the trachea to establish or maintain an open airway

endotracheal intubation

released from the posterior pituitary gland and vasoconstricts arteries and capillaries; directs the kidneys to hold on to water, and where water goes sodium follows; causes increase in BP

ADH (antidiuretic hormone)

Where water goes sodium will follow = sodium will stay in = increase in blood pressure = decrease in renin production = stimulate negative feedback loop = stops production of _______ when fluid is balanced

ADH

leaf shaped, elastic structure that attaches along one edge to the top of the larynx; role in prevention of aspiration

epiglottis

provide information about acid-base status, underlying cause of imbalance, the body's ability to regulate pH, and overall oxygen status

Arterial blood gas (ABG) values

CPAP or BiPAP: -Non-invasive -Keeps upper airways open -Higher pressure setting for inspiration and lower pressure for expiration

BiPAP

these are the complications of what respiratory issue? -Hypoxemia -Acidosis -Respiratory tract infection -Cardiac failure/Cor Pulmonale

COPD

these are the laboratory assessments for which respiratory issue? -Arterial blood gas -Sputum samples -Hemoglobin and hematocrit blood tests -Serum alpha1-antitrypsin levels (looking for deficiency) --AAT enzyme breaks down pollutants (Protective) -Chest x-ray -Pulmonary function test

COPD

what may cause hyponatremia in a hypervolemic state?

CHF, cirrhosis

these are interventions for which respiratory issue? -Treat infections -Airway management -Drug Therapy -Oxygen therapy -Nutrition --CO2 is a by product of food metabolism therefore need to have smaller meals to decrease the need to exhale CO2 -Energy management -Surgical management for end-stage disease (lung transplant)

COPD

these are signs and symptoms of which respiratory issue? -Productive cough -Bronchospasm (muscle spasm) -Hypoxemia (PaO2 decreases and PaCO2 increases → Respiratory Acidosis) -Thin with loss of muscle mass in the extremities -Enlarged neck muscles -Easily fatigued, slowed response, stooped -Sit leaning or bending forward -Barrel chest, clubbing, pursed lip-breathing, dusky -Increased respiratory rate→fatigue -treat with muscle relaxants and steroids

COPD

-A group of lung diseases that block airflow and make it difficult to breathe -most common are Emphysema and Chronic Bronchitis -5th leading cause of death for men of all ages and the 4th leading cause of death in women -Smoking most important risk factor and others include air pollution, occupational hazards -increases risk of cancer

COPD (chronic obstructive pulmonary disease)

CPAP or BiPAP: -Continuous gentle air to keep airways open -Best treatment for obstructive sleep apnea and some preterm infants -Uses nasal mask, face mask or nasal prongs

CPAP

forces favoring filtration

Capillary hydrostatic pressure (blood pressure) and interstitial oncotic pressure (water-pulling)

how do you count heart rate on an EKG?

Count for 6 seconds, multiply by 10

how often can suctioning be done

every 15 minutes (if coming off of sedation or neuromuscular blockade or paralytic; may be less frequently depending on diagnosis)

how often should you assess and reposition an endotracheal tube to prevent skin breakdown?

every 24 hours

hypertonic fluid used for sodium and volume replacement; caution: go slow, monitor BP, pulse rate, quality of lung sounds, serum Na, and urine output

D5 1/2 NS

isotonic fluid until inside the body, then becomes hypotonic after metabolizing glucose; do not give to infants or head injury patients (may cause cerebral edema)

D5W (5% dextrose in water)

If my body is becoming acidotic, we would try to (excrete or retain) chloride since it's acidic

excrete

Rule of 9's

Each arm= 9%, Anterior leg=9%, Posterior leg=9% Head=9%, Back=18% Chest=18%, Perineum=1%

what are two main causes of hypervolemia?

End stage renal disease (not able to urinate causing fluid overload) and congestive heart failure (patients have difficulty circulating the excess volume, leading to hypertension and fluid overload, crackles in lungs, peripheral edema, JVD)

type of compensation: pH within reference range, but PaCO2 and HCO3 are both outside reference range. pH will hint towards underlying cause. < 7.40, think "acidosis", > 7.40, think "alkalosis

Full compensation

aspiration precautions

HOB > 30, frequent handwashing, assess feeding tube, assess for residuals, swallow study, ETT cuff at appropriate level, suction

a pushing pressure; pushing volume out of the artery into interstitial area

Hydrostatic pressure

involves an excess of water and electrolytes, so that the two are still in the right proportions; for example, excessive sodium intake causes the body to retain water, so that there is too much of both.

Hypervolemia (fluid volume excess)

a lack of both water and electrolytes, causing a decrease in circulating blood volume

Hypovolemia (isotonic dehydration/fluid volume deficit)

Forces favoring reabsorption

Plasma (capillary) oncotic pressure (water-pulling) and interstitial hydrostatic pressure

ventricles contracting is what part of the EKG?

QRS complex

acid-base pneumonic

ROME (respiratory opposite, metabolic equal)

what is the pacemaker of the heart?

SA node

cardiac conduction system order

SA node, AV node, AV bundle, bundle branches, Purkinje fibers

lubrication at end of alveoli sacs

Surfactant

what is the common response for a lung injury in ARDS?

Systemic inflammatory response

the atria refilling is what part of the EKG?

T wave

high-flow oxygen delivery system: for clients with tracheostomy, laryngectomies, endotracheal tube; allows suction

T-piece

these are signs and symptoms of which respiratory issue? -Progressive fatigue, lethargy -Nausea -Anorexia and Weight loss -Irregular menses -Low-grade fever -Productive cough for mucopurulent sputum, which may be blood streaked -Often goes undiagnosed because of Insidious Onset

TB

latent tuberculosis or TB disease: -Person is infected and unable to fight of the proliferation of the disease -They are contagious

TB disease

EKG changes with hyperkalemia

Tall peaked T waves, widened QRS, wide flat P wave

treatment of respiratory alkalosis focuses on what?

Treating the underlying cause of respiratory alkalosis.

represent repolarization of the Purkinje fibers on the EKG

U wave

are these causes of actual calcium deficit or relative calcium deficit? -Inadequate intake of calcium, including lactose intolerance, malabsorption issues -Diarrhea or steatorrhea -Inadequate vitamin D intake -End-stage kidney disease

actual

are these causes of actual potassium deficit or relative potassium deficit? Overuse of diuretics, digitalis, corticosteroids, Increased secretion of aldosterone, Cushing's syndrome, Loss via GI tract: vomiting, diarrhea, prolonged nasogastric suctioning, and excessive use of laxatives or tap water enema administered repeatedly because tap water is hypotonic, and gastrointestinal losses are isotonic, NPO status, Kidney disease, which impairs the reabsorption of potassium

actual

Normal ET tube placement is

above the bifurcation of the bronchus

what are the two most important identifiers of a pneumothorax?

absent lung sounds on affected side, tracheal deviation to unaffected side

mild collapse of alveoli / dead space

absorption atelectasis

If I administer a/an ________ __________ I am no longer allowing angiotensin 1 to convert into angiotensin 2, which would stop the constriction of the arterioles and indirectly decrease BP

ace inhibitor

<7.35 indicates

acidosis

hyperkalemia indicates acidosis or alkalosis?

acidosis

Often see potassium changes when a patient is shifting into what state

acidotic

Metabolic processes produce __________ that must be neutralized and excreted

acids

how does fluid move in the cell?

active and passive forces

actual or relative dehydration: a lack of fluid in the body

actual

When there is an acid-base imbalance, the blood chloride levels change independently of sodium, causing chloride to act as a

buffer

are these causes of actual potassium excess or relative potassium excess? -Older adult clients due to decreases in renin and aldosterone, and increased use of salt substitutes, ACE inhibitors, and potassium-sparing diuretics -Overconsumption of high-potassium foods or salt substitutes -Excessive or rapid potassium replacement (oral or IV) -RBC transfusions -Adrenal insufficiency -ACE inhibitors or potassium-sparing diuretics -Kidney failure

actual

are these causes of actual sodium excess or relative sodium excess? -Kidney failure -Cushing's Syndrome -Excess intake of oral sodium -Glucocorticosteroids

actual

phase of burn care: -begins 36-48 hours after injury when fluid shift resolves and (if possible) wound closes -assessment and maintenance of cardio, respiratory, and GI systems; wound care; pain control

acute

•A form of Acute Respiratory failure, indicators include: -Hypoxia that persists even when oxygen is administered at 100% -Decreased pulmonary compliance -Dyspnea -Noncardiac-associated bilateral pulmonary edema -Dense pulmonary infiltrates seen on x-ray -High mortality rate

acute respiratory distress syndrome (ARDS)

•Determined by ABG's •Defined as -Ventilatory failure: --perfusion is normal but no ventilation --something wrong with the lungs i.e. resp. muscles -Oxygenation failure --ventilation is normal but perfusion is decreased (i.e. pulmonary embolism) -Combination of both ventilatory and oxygenation failure --A risk in individuals with underlying lung diseases (COPD & Cystic Fibrosis)

acute respiratory failure

how is influenza spread?

air droplets

Displacement of either the bone or cartilage of the nose can cause

airway obstruction or cosmetic deformity (potential source of infection)

Potassium levels = dysrhythmia = cardiac arrest = need for __________ _______________

airway protection

protein in blood that helps pull the volume back from the interstitial space into the intravascular area; if someone is 3rd spacing and septic and hypotensive, we might use this to help pull that volume which creates a oncotic vs osmotic pressure

albumin

what is the first-line of therapy against asthma

albuterol (beta 2 agonist)

Angiotensin II causes vasoconstriction that raises the blood pressure (to counteract the low volume and increase perfusion to the heart, brain, and lungs) and releases ______________ from the adrenal gland.

aldosterone

leads to sodium and water reabsorption back into the circulation and excretion of potassium

aldosterone

>7.45 indicates

alkalosis

hypokalemia indicates acidosis or alkalosis?

alkalosis

what respiratory changes occur with aging?

alveolar surface area decreases, protective mechanisms decline (cilia, cough reflex, mucous production, immune compromise), decreased exercise tolerance (due to decreased response to hypoxia and hypercapnia), decreased compliance (lung tissues begin to not expand)

asthma affects the bronchioles and upper airway while COPD affects the:

alveoli

basic unit for gas exchange; surfactant (chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing)

alveoli

after renin is secreted by the kidneys in response to low blood pressure, it combines with an enzyme called angiotensinogen from the liver and converts to _____________

angiotensin 1

anions or cations: chloride, bicarbonate (HCO3-), phosphates (H2PO4- and HPO4-), calcium (Ca++), potassium (K+), magnesium (Mg++).

anions

what should palpation of the thorax include?

any areas of tenderness (traumas, pneumothorax or contusion), anything affecting ability for patients to take deep breaths and expand the lungs, crepitus (subcutaneous emphysema, air accumulating in subq tissue, indicative of pneumothorax, air is leaking out of chest cavity and going outside lung and into subq area), fremitus (vibration felt with consolidation, decreased with volume or pleural effusion)

what medications shouldn't be used with bronchodilators in asthma?

aspirin and other NAIDs

what is the first thing to do after inserting an ET tube?

assess for symmetrical chest rise and lung sounds (to determine if ET tube is in the correct place or if it has gone into the right bronchus)

what nursing interventions should be done first with status asthmaticus?

assess respiratory rate and breath sounds

what is the priority intervention for facial trauma?

assessment of airway

Negative feedback loop stops production of ADH when fluid is ___________

balanced

nerve endings that are sensitive to changes in volume and pressure; stimulate the release of ADH from the pituitary gland and stimulate thirst.

baroreceptors

what are the three main signs of COPD and emphysema?

barrel chest, finger clubbing, muscle wasting

CO2 generated in tissues is transported in plasma as:

bicarbonate

Angiotensin 2 leads to arterial vasoconstriction and increases ________

blood pressure

what laboratory tests should be done for respiratory issues?

blood tests, sputum, radiology (chest xray, CT), pulmonary function test, ventilation and perfusion scanning, pulse oximetry

In an acidotic state, potassium likes to shift into _______ and cause hyperkalemia and potentially arrhythmias (put patient in telemetry or get EKG)

bloodflow

Osmolality imbalances occur when:

body fluid becomes either hypertonic or hypotonic

Total body water varies by:

body mass, age, gender, muscle mass, BMI

Respiratory center in medulla controls _________ (neurotrauma patients have difficulties regulating)

breathing

what do normal breath sounds include?

bronchial, bronchovesicular, and vesicular

invasive respiratory diagnostic test: -Assess airway: visualizing pharynx, trache, and bronchi (flexible tube through nose or airway) -To look at any type of abnormality (tumor, inflammation, stricture), biopsy, perform for therapeutic reasons (removal of foreign bodies, secretions, aspiration) -Interventions: assess for allergies for anesthetic agents, consent, remove dentures or false teeth, NPO to reduce aspiration risk (gag reflex paralyzed during anesthesia), give small sips of water after procedure, sitting patient up, monitor vitals and respiratory pattern

bronchoscopy

in metabolic acidosis, as pH decreases, HCO3 would:

decrease

in respiratory alkalosis, as pH increases, PaCO2 would:

decrease

Increased respirations lead to (increased or decreased) CO2 in blood

decreased

The older adult has an impaired compensatory ability because of:

decreased respiratory function

why does aging decrease the percent of total body water?

decreased thirst, decreased free fat mass and decreased muscle mass, renal decline

A good time for hypotonic (to pull water into the cells) is when the cells are _____________ (ex: diabetic ketoacidosis)

dehydrated

A lack of fluid in the body, from insufficient intake or excessive loss

dehydration

causes of dehydration or hypovolemia: Hyperventilation or excessive perspiration without water treatment, prolonged fever, diabetic ketoacidosis, insufficient water intake (enteral feeding without water administration, decreased thirst sensation, aphasia), diabetes insipidus, osmotic diuresis, excessive intake of salt, salt tablets, or hypertonic IV fluids

dehydration

three basic types of IVF

dextrose, crystalloids (saline, ringer's lactate), plasma expanders

what 3 main health problems lead to acid-base imbalances?

diabetes mellitus, COPD, kidney disease

percussion sound heard over organs (posterior or inferior)

dullness

Organ ___________ negatively affects the ability to compensate (CKD, COPD, etc.)

dysfunction

accumulation of fluid within the interstitial spaces

edema

these are the causes of which fluid and electrolytes issue: increase in capillary hydrostatic pressure, decrease in plasma oncotic pressure (vessel walls become porous), increase in capillary permeability, lymph obstruction (lymphedema)

edema

what would my role as a nurse be in smoking cessation for a patient?

education (big picture down the road)

chemicals or nutrients present in the body's fluid compartments; they impact fluid volume, regulate cardiac contractions, and provide stimulation to skeletal muscles that allow for movement; these ions have either positive charges (cations) or negative charges (anions).

electrolytes

end stage COPD lab values

elevated CO2 and bicarb level, positive sputum samples, low hemoglobin

phase of burn care: -Immediately following the burn injury and continues for 24-48 hours -Focus on ABCs (securing airway, supporting circulation and organ perfusion by fluid replacement, manage pain, prevent infection)

emergent

what may cause hyponatremia in a hypovolemic state?

emesis, diarrhea, diuresis

-Loss of lung elasticity and hyperinflation of the lung -Dyspnea and the need for an ↑ RR -Hypercapnia (PaCO2 ↑) -Air trapping, loss of elastic recoil in the alveolar walls, overstretching and enlargement of the alveoli into bullae, and collapse of small airways (bronchioles)

emphysema

Chronic obstructive pulmonary disease includes:

emphysema and chronic bronchitis

-most common type of mechanical airway for short term basis -entry via mouth (easiest) or nose -inflated cuff produces a seal -check for placement by hearing bilateral breath sounds, seeing symmetric lung movement, and assess any air escaping from the tube -make sure the tube isn't too deep into the right main bronchus (only hear sounds on right side and none on the left side) -Considerations with mechanical ventilation: always maintain patent airway, suction as frequently as needed, assess and reposition tube, keep head of bed at least 30 degrees, have pt on proton pump inhibitor (protonix or omeprazole) to decrease chance of developing gastric ulcers (prophylactic GI proton pump inhibitor to reduce likelihood of stress ulcer development)

endotracheal intubation

these are the nursing interventions for which fluid/electrolyte imbalance? -place client in the semi‑Fowler's or Fowler's position, reposition to prevent tissue breakdown in edematous skin, use a pressure‑reducing mattress, assess bony prominence on a regular basis. -encourage rest, the client discussing use of over‑the‑counter medications with the provider (some of these contain sodium) -maintain a sodium‑restricted diet as prescribed, fluid restrictions if prescribed -assess breath sounds (for crackles) -monitor I&Os, daily weight (weight gain or loss of 1 kg (2.2 lb) in 24 hr is equivalent to 1 L of fluid)), peripheral edema, clients receiving diuretics, blood sodium and potassium levels

fluid volume overload

an excessive accumulation of fluid in the interstitial space throughout the body and occurs as a result of conditions such as cardiac, renal or liver failure (3rd spacing, heart failure, end stage renal failure)

generalized edema

In older adult clients, the risk of fluid imbalance is (greater or lesser) due to changes in the body with age (such as reduced kidney function).

greater

-disrupt breathing, eating, facial appearance, self-image, speech, and communication. -assess for signs of hoarseness or difficulty swallowing (indicative of airway issues) -Present with hoarseness, difficulty swallowing, sore throat and/or lump on neck, wgt loss -curable if diagnosed early -Major risk factors: ETOH and smoking -Men affected three times more then females -Metastasis usually to the lungs and liver -Diagnosed with Radiographic Studies

head and neck cancer

these are postoperative interventions for which respiratory procedure: -Monitor airway patency, vital signs, hemodynamic status, comfort level. -Monitor for hemorrhage. -Assess for complications (airway obstruction, hemorrhage, wound breakdown, tumor recurrence)

head and neck cancer

these are the interventions for which -smoking cessation -remove or eradicate the cancer while preserving as much normal function as possible (get pt to swallow or speak again)

head and neck cancer

what subjective data should be assessed with respiratory issues?

health history (smoking, family history), shortness of breath (at rest, exertion, orthopnea), cough (frequency, timing, productive), sputum (color, consistency, timing), chest pain (location, quality, intensity, radiating?)

beta 1 agonists affect the:

heart

Alkalosis should be aggressively corrected in critically ill patients in whom perfusion of the ________ and _________ is essential.

heart and brain

In hyperkalemia the T waves on an EKG will be:

heightened

-Most common problem associated with blunt trauma -Bleeding into thoracic cavity -Blood visible on chest x-ray -Assessment same as pneumothorax -Percussion of dullness on affected side -Intervention: remove blood with chest tubes, bigger evacuation of blood requires a thoracotomy

hemothorax

blood in pleural space

hemothorax

what IV medication is given for an DVT or PE?

heparin

what is a common and important cause of primary hypocapnia?

hepatic failure

diet after a burn

high calorie, high protein

diet for COPD

high calorie, high protein, low carb

oxygen delivery system; push the air in; are consistent and accurate; provides saturation of 24-100%

high flow systems

high pressure or low pressure ventilator alarm: -Coughing -Biting the tube -Condensation -Kinked tube -Bronchospasm -Decreased Compliance (pneumothorax or pulmonary edema)

high pressure

normally requested by social worker or case manager on the floor; Education: oxygen is combustible so no smoking, "oxygen-in-use signs" to alert fire hazard, know where closest fire extinguisher is located

home oxygen therapy

the erythrocyte hemoglobin (Hb) also contributes to CO2 transport. Hemoglobin buffers _________ __________ derived from carbonic acid.

hydrogen ions

these are the causes of which electrolyte imbalance? -Hyperparathyroidism -Bone metastases with calcium resorption from breast, prostate, renal, and cervical cancer (most common cause) -Sarcoidosis -Excess vitamin D -Many tumors that produce PTH

hypercalcemia

these are the manifestations of which electrolyte imbalance? -Many nonspecific: fatigue, weakness, lethargy, anorexia, nausea, constipation -Impaired renal function, kidney stones -Dysrhythmias, bradycardia, cardiac arrest -Bone pain, osteoporosis Subjective -Lethargy, personality changes, memory impairment -N/V, constipation -Muscle weakness, renal calculi Objective -Depressed/absent DTR's -Global CNS dysfunction -Obtain PTH, thyroid panel (TSH, Free T4), Vit. D levels

hypercalcemia

these are the nursing interventions for which electrolyte imbalance? -Severe (often seen in malignancy): Fluids, fluids, fluids (IV 0.9% at least 200ml/hr to induce diuresis -Chronic: steroid use (indicated for sarcoidosis/elevated Vit. D levels), lasix, reduced Ca diet treat with lots of fluid bc it is toxic to kidneys (have to help flush kidneys out) See 0.9 at very high rates to induce diuresis, aggressive lasix orders (80 mg 3x per day), calcitonin (induce diuresis)

hypercalcemia

Rare bc the majority of people do not have trouble excreting fluids or kidney disease; potassium level >5.5 mEq/L; rare because of efficient renal excretion

hyperkalemia

a tall, peaked T wave indicates:

hyperkalemia

hyperkalemia or hypokalemia: renal failure patients, acidosis, potassium-sparing diuretics

hyperkalemia

these are the causes of which electrolyte imbalance? increased intake (K supplements), shift of K+ from ICF into ECF, decreased renal excretion, insulin deficiency, metabolic acidosis, digoxin toxicity or cell trauma

hyperkalemia

-A leading cause of cancer deaths worldwide -Poor prognosis because metastasizes -Paraneoplastic syndromes -Smoking causes 85% of all cases -Health promotion & prevention is primarily through education aimed at to reducing tobacco smoking

lung cancer

these are the manifestations of which electrolyte imbalance? Subjective -Muscle cramps, paralysis (monitor underlying causes) Objective -Muscle tenderness/weakness -EKG changes - Peaked t-waves, wide QRS complex -Elevated BUN/creatinine (due to kidney failure) -Vital signs: Slow irregular pulse, hypotension -Neuromusculoskeletal: Restlessness, irritability, weakness to the point of ascending flaccid paralysis, paresthesia -ECG: Premature ventricular contractions, ventricular fibrillation, peaked T waves, widened QRS -Gastrointestinal: Increased motility, diarrhea, hyperactive bowel sounds -Other manifestations: Oliguria

hyperkalemia

these are the nursing interventions for which electrolyte imbalance? -Urgency and level of intervention is based on absence or severity of EKG changes (trend electrolytes, serial EKG's) -Monitor cardiac rhythm, and intervene promptly as needed. -Monitor I&O. -Assess for muscle weakness. -Observe for GI manifestations, such as nausea and intestinal colic. -For clients who have elevated potassium levels, report and stop IV infusion of potassium, maintain IV access, stop all potassium supplements, and promote a potassium-restricted diet. -Monitor for manifestations of hypokalemia while receiving medications to reduce the potassium level. -Monitor blood potassium levels. -Severe elevation can require administration of calcium gluconate. Chronic or severe elevation can require dialysis. -Promote movement of potassium from ECF to ICF.

hyperkalemia

Serum Mag >2.5, clinical consequences unusual at serum mag <4.0

hypermagnesemia

these are the causes of which electrolyte imbalance? -Usually renal insufficiency or failure -Excessive intake of magnesium-containing antacids -Adrenal insufficiency

hypermagnesemia

these are the manifestations of which electrolyte imbalance? -Skeletal smooth muscle contraction, excess nerve function, loss of deep tendon reflexes, nausea and vomiting, muscle weakness, hypotension, bradycardia, respiratory distress Subjective -Weakness = paralysis, difficulty swallowing -Lethargy -N/V Objective -Hypotension -Diminished DTR's (mag levels >4.0) -Weakness/flaccid, respiratory muscle paralysis (mag levels 8-11) -Coma or death (mag levels >12)

hypermagnesemia

these are the nursing interventions for which electrolyte imbalance? -manage cardiac irritability -mag supplements/dietary intake -Calcium gluconate - 1g 10% into PIV over 3-5 mins up to 3 doses -Calcium Chloride - 1g 10% into CVC over 3-5 mins -Consider Lasix -Last resort hemodialysis

hypermagnesemia

mainly caused by dehydration; serum sodium level >145 mEq/L; affects 0.3-1.0% of hospitalized patients (more common in elderly/critically ill 3-9%)

hypernatremia

these are the manifestations of which electrolyte imbalance? -Mostly neurological r/t brain cell shrinkage from water loss -Thirst/polydipsia -VITAL SIGNS: Hyperthermia, tachycardia, orthostatic hypotension -NEUROMUSCULOSKELETAL: Restlessness; irritability; muscle twitching to the point of muscle weakness, including respiratory compromise; decreased or absent DTRs; seizures; coma -GASTROINTESTINAL: Thirst, dry mucous membranes, nausea, vomiting, anorexia, occasional diarrhea

hypernatremia

these are the nursing interventions for which electrolyte imbalance? -Monitor level of consciousness, and ensure safety. -Monitor vital signs and heart rhythm. -Auscultate lung sounds. -Provide oral hygiene and other comfort measures to decrease thirst. -Monitor I&O, and alert the provider of inadequate urinary output. -encourage water intake and discourage sodium intake or sodium tabs, administer loop diuretics, bring nutritional services for low sodium diet

hypernatremia

percussion sound indicating hyperinflated lungs (COPD)

hyperresonance

causes cell shrinkage, pulls water out of the cell and into the intracellular space 3% (neurosurgical cases and TBIs)

hypertonic solution

complications of hypovolemia or hypervolemia? -pulmonary edema -Position client in high fowlers to maximize ventilation, give oxygen or positive airway pressure such as bipap (if that doesn't work may need to intubate for airway protection), morphine (decreased RR and distress), diuretic

hypervolemia

these are causes of what: -Compromised regulatory systems (heart failure, kidney disease, cirrhosis) -Overdose of fluids (oral, enteral, IV) -Fluid shifts that occur following burns -Prolonged use of corticosteroids -Severe stress -Hyperaldosteronism -circulatory issues and excretion issues (compromise of the heart, kidneys, or liver)

hypervolemia

are these the nursing actions for mild/no symptoms of hyponatremia in a hypovolemic state or hypervolemic state? -address origin of Na loss (CHF, cirrhosis, etc), order fluid restriction, consider diuresis (to restore euvolemia)

hypervolemic

these are the manifestations of which electrolyte imbalance? Subjective -Numbness, tingling -Mental status changes, depression, confusion -Tetany, weakness, tremors, Sz's Objective -Tetany is most common manifestation -Chvostek's sign: facial twitch -Trousseau's sign: carpal spasm -Hyperactive DTR's -Dry skin, brittle hair, nails -EKG changes - prolonged QTc/T-wave changes

hypocalcemia

these are the nursing interventions for which electrolyte imbalance? -Administer oral or IV calcium supplements. Vitamin D supplements enhance the absorption of calcium. -Implement seizure and fall precautions. -Avoid overstimulation. Keep the client's room quiet, limit visitors, and use soft lighting in the room. -Have emergency equipment on standby. -Encourage foods high in calcium, including dairy products, canned salmon, sardines, fresh oysters, and dark leafy green vegetables. -A client exhibiting life-threatening manifestations will require rapid treatment with calcium gluconate or calcium chloride (not used as often due to risk of tissue damage if infiltrated). IV administration should be diluted in dextrose 5% and water and given as a bolus infusion (using an infusion pump). If administered too quickly, cardiac arrest could occur.

hypocalcemia

Potassium level <3.5 mEq/L; affects ~20% of inpatient, and 1-40% of outpatients (consider correlation with diuretic use); potassium balance is described by changes in plasma potassium levels

hypokalemia

an inverted T wave and prolonged U wave indicates:

hypokalemia

hyperkalemia or hypokalemia: diuretics that waste potassium, NG suction, N/V, influenza, poor appetite for a few days

hypokalemia

these are the manifestations of which electrolyte imbalance? -VITAL SIGNS: Decreased blood pressure, thready weak pulse, orthostatic hypotension -NEUROLOGIC: Altered mental status, anxiety, and lethargy that progresses to acute confusion and coma ECG: Flattened T wave, prominent U waves, ST depression, prolonged PR interval -GASTROINTESTINAL: Hypoactive bowel sounds, nausea, vomiting, constipation, abdominal distention. Paralytic ileus can develop. -MUSCULAR: Weakness. Deep‑tendon reflexes can be reduced. -RESPIRATORY: Shallow breathing

hypokalemia

these are the nursing interventions for which electrolyte imbalance? -Prioritize anything regarding cardiac rhythm (EKG changes: flattened t wave, prominent U wave, st depression, prolonged QR interval) -Respiratory: conductivity concerns leading to ekg changes and arrhythmias -Administer prescribed potassium replacement. Never give potassium via IM or subcutaneous route, which can cause necrosis of the tissues. -Monitor and maintain adequate urine output. -Observe for shallow ineffective respirations and diminished breath sounds. -Monitor cardiac rhythm, and intervene promptly as needed. -Monitor clients receiving digoxin. Hypokalemia increases the risk for digoxin toxicity. -Monitor level of consciousness, and maintain client safety. -Monitor bowel sounds and abdominal distention, and intervene as needed. -Monitor oxygen saturation levels, which should remain greater than 95%. -Assess hand grasps for muscle weakness. -Assess DTRs. -Implement fall precautions due to muscle weakness

hypokalemia

these are the causes of which electrolyte imbalance? -often due to inadequate intake or inadequate absorption -Malnutrition -Malabsorption syndromes -Alcoholism -Urinary losses (renal tubular dysfunction, loop diuretics) -Celiac or Crohn's, ETOH or alcohol patients, loop diuretic patients

hypomagnesemia

these are the manifestations of which electrolyte imbalance? -Behavioral changes, irritability, hyperactive DTRs, muscle cramps, ataxia, nystagmus, tetany, convulsions, tachycardia, hypotension Subjective -Muscle weakness -Neurological changes from tremors Objective -Tremors (mostly facial tremors) -Prolonged QTc intervals numbness, tingling, seizures, muscle tetany (musculoskeletal); irritability and behavioral changes (neuro); dysrhythmias or PVCs (cardiac); hypoactive bowel sounds, constipation, abdominal distention, paralytic ileus (GI) PRIORITIZE EKG CHANGES (presence of PVCs) AND SEIZURES

hypomagnesemia

these are the nursing interventions for which electrolyte imbalance? -Correct concurrent imbalance of other electrolytes to prevent worsening of either condition. -Encourage foods high in magnesium (dark green vegetables, nuts, whole grains, seafood, peanut butter, cocoa). If imbalance is mild, dietary changes can be used to correct it. -Discontinue magnesium-depleting medications (loop diuretics, osmotic diuretics, medications that contain phosphorus). -Administer oral magnesium sulfate for mild imbalance. Oral magnesium can cause diarrhea and increase magnesium depletion. -IV magnesium sulfate is prescribed if imbalance is severe. Administer via an infusion pump not to exceed 150 mg/min, or 67 mEq over an 8‑hr period. Monitor DTRs hourly during administration. -Monitor clients taking digitalis closely if magnesium is low because it predisposes the client to digitalis toxicity. -Have calcium gluconate readily available to reverse imbalance

hypomagnesemia

Net gain of water or loss of sodium-rich fluids resulting in serum levels dropping; serum sodium level <135 mEq/L; affects 5-15% of hospitalized patients

hyponatremia

these are risk factors for which electrolyte imbalance? Actual deficit: excessive sweating, diuretics, NG tube suction, hyperlipidemia, wound drainage (GI section), low sodium diet, inadequate sodium intake (NPO) Relative deficit: secondary to dilution (things causing fluid overload); kidney failure, heart failure, SIADH (antidiuretics leading to a delusional hyponatremia)

hyponatremia

these are the manifestations of which electrolyte imbalance? -Most life-threatening: cerebral edema and increased intracranial pressure -Lethargy, confusion, decreased reflexes, seizures, and coma -If leads to loss of ECF and hypovolemia, see hypotension, tachycardia, decreased urine output -If dilutional from excess water, see weight gain, edema, ascites, jugular vein distention

hyponatremia

If i am intravascularly depleted / if a patient is hypotensive, we don't want to give hypotonic solution bc it will pull water into the cells, decreasing intravascular volume, and cause further:

hypotension

with a burn injury, does the body become hyperthermic or hypothermic?

hypothermic (damage to skin results in lack of temp control)

lower than the body's typical concentration; helps pull water into the cells, decreasing the intravascular volume 0.45 normal saline (half of the concentration of 0.9)

hypotonic solution

complications of hypovolemia or hypervolemia? -hypovolemic shock (occurs with significant loss of body fluid), mean arterial pressure (ultimately BP) -decreased perfusion to tissue leading to shock, hypoxia to tissues causing tissue and cell death -Administer oxygen, stay with patient, have colleagues try to help, monitor vitals every 15 minutes, provide fluid replacement (colloids, crystalloids, packed RBCs, lactated ringers, normal saline (LR and NS are for resuscitation bc these volumes will go into the intravascular component and help with circulating volume), vasoconstrictors, hemodynamic monitoring)

hypovolemia

these are expected findings of what: -VITAL SIGNS: Hypothermia, tachycardia (in an attempt to maintain a normal blood pressure and to compensate for low cardiac output), thready pulse, hypotension, orthostatic hypotension, decreased central venous pressure, tachypnea (increased respirations to compensate for lack of fluid volume within the body), hypoxia -NEUROMUSCULOSKELETAL: Dizziness, syncope, confusion, weakness, fatigue -GASTROINTESTINAL: Thirst, dry furrowed tongue, nausea, vomiting, anorexia, acute weight loss -RENAL: Oliguria (decreased production and concentration of urine)

hypovolemia

causes of dehydration or hypovolemia: -Excessive gastrointestinal (GI) loss: vomiting, nasogastric suctioning, diarrhea -Excessive skin loss: diaphoresis without sodium and water replacement -Excessive renal system losses: diuretic therapy, kidney disease, adrenal insufficiency -Third spacing: burns -Hemorrhage or plasma loss -Altered intake: anorexia, nausea, impaired swallowing, confusion, nothing by mouth (NPO) (decreased intake of water and sodium)

hypovolemia (isotonic fluid volume deficit)

these are the laboratory assessments for which respiratory issue? -Sputum Cytology -Chest X-Rays -CT Scan -Pet Scan -Bronchoscopy -Thoracoscopy

lung cancer

these are the nursing interventions for which fluid/electrolyte imbalance? -Provide oral and IV rehydration therapy -monitor weights every 12 hours (while fluid replacement is in progress), I&Os, vital signs (orthostatic blood pressure, heart rate), changes in mentation and confusion (an indication of worsening fluid imbalance) -encourage client using the call light and asking for assistance because of the increased risk for falls, the client changing positions, rolling from side to side or standing up slowly -assess level of gait stability

hypovolemia and dehydration

are these the nursing actions for mild/no symptoms of hyponatremia in a hypovolemic state or hypervolemic state? -address origin of Na loss (emesis, diarrhea, diuresis), administer 0.9% NS (to correct free water deficit)

hypovolemic

low levels of oxygen in the blood

hypoxemia

Prolonged suctioning time can lead to __________

hypoxia

decreased tissue oxygenation

hypoxia

in metabolic alkalosis, as pH increases, HCO3 would:

increase

in respiratory acidosis, as pH decreases, PaCO2 would:

increase

Increased respirations lead to (increased or decreased) CO2 elimination

increased

lab values for hypovolemia

increased hct, >1.030 urine specific gravity

after a burn, the metabolic rate (increases or decreases) to compensate for the loss of body heat from dermis loss

increases

To compensate for acidosis, the kidneys can generate additional bicarbonate and eliminate excess H+. How does this affect the blood pH and the urine pH?

increases blood pH and decreases urine pH

if you do not provide humidified oxygen and the secretions dry up by giving too much O2, the secretions will stay there and ultimately get _____________ (sometimes can't expel secretions)

infected

2 main priorities in burn patients:

infection control and pain management

-Highly contagious respiratory illness cased by the influenza virus -"At risk populations" (immunocompromised) -Most will recover within 2 weeks without intervention -Treatment: rest, fluids, Tylenol, Antivirals -Best prevention is the vaccination

influenza

these are signs and symptoms of which respiratory issue? fever, chills cough, runny nose, body aches, H/A, Fatigue, vomiting & diarrhea

influenza

the loss of water not noticeable by a person, such as through evaporation from the skin and exhalation from the lungs during breathing; immeasurable

insensible water loss

what 2 compartments are located in the extracellular compartment?

interstitial and plasma compartment

facilitates the inward movement of water from the interstitial space into the capillary; pushing volume out if the interstitial area and back into the artery

interstitial hydrostatic pressure

osmotically attracts water from the capillary into the interstitial space; pulling the volume out of the artery and into interstitial space

interstitial oncotic pressure

Intracellular or extracellular total body water: gives us an idea of how swollen or dehydrated the cell is

intracellular

intracellular or extracellular: -Two thirds of body water -Body fluids within the cell

intracellular

Body fluids are distributed between two compartments:

intracellular and extracellular

what two components make up total body water

intracellular and extracellular fluid

extracellular fluid is divided into:

intravascular fluid, interstitial fluid, transcellular body fluids

lung injury in ARDS: intrinsic or extrinsic? the alveolar-capillary membrane is injured from conditions such as sepsis and shock

intrinsic

mirroring what the normal body composition is; equal concentration of the solution 0.9 normal saline or lactated ringers

isotonic solution

why does a nasal jejunal tube decrease the risk of aspiration?

it is post-pyloric

Under normal conditions, the body depends on the ________ to reabsorb and conserve all of the bicarbonate they filter and excrete a portion of the acid produced by cellular metabolism.

kidneys

Fluid output occurs in which organs?

kidneys, skin, lungs, and GI

isotonic fluid used for fluid resuscitation to normalize and mimic what the body has lost

lactated ringers

complication, uncontrolled muscle contraction of laryngeal chords that impede ability to inhale and leads to hypoxia; stridor sound; be mindful when removing an endotracheal tube

laryngeal spasm

invasive respiratory diagnostic test: -To look at back of throat (includes voicebox) -To assess cancers of throat, swallowing issues, dysphagia following stroke, epiglottis closure -Interventions: --NPO before and after (aspiration precautions)

laryngoscopy

voice box; contains the vocal cords

larynx

latent tuberculosis or TB disease: -Person is infected but the body combats the spread of the disease -Not infectious -Test positive

latent

do crackles and dyspnea indicate right sided or left sided heart failure?

left

increased interstitial fluid at a specific sight; gives us a better idea if there is an infection going on at a specific site, if it's surgically related, or if there's trauma to the site

localized edema

If a patient is intubated, (low or high) pressures need to be maintained to prevent erosion of posterior wall (called a tracheoesophageal fistula)

low

-Breathing disruption during sleep that lasts at least 10 seconds and occurs a minimum of 5 times in an hour -S & SX: Excessive daytime sleepiness, inability to concentrate, and irritability -Interventions --Nonsurgical management and change of sleep position, wgt loss, Bi-PAP,CPAP --Surgical management: uvulopalatopharyngoplasty -Usually occurs in obese patients with enlarged neck circumference

obstructive sleep apnea

hydrostatic or oncotic pressure: water-pulling

oncotic

how does fluid move between intracellular and extracellular space?

osmosis

external pressure required to be applied so that there is no net movement of solvent across a membrane; amount of pressure needed to push the fluid from one area to another

osmotic forces/pressure

Too much fluid in the body from excessive intake or ineffective removal from the body.

overhydration

these are causes of what: -Water replacement without electrolyte replacement, excessive water intake (forced or psychogenic polydipsia) -Syndrome of inappropriate antidiuretic hormone (SIADH) -Excessive administration of IV D5W; use of hypotonic solutions for irrigations

overhydration

results from higher concentrations of oxygen above 50% for long durations of time; causes non-productive cough, substernal pain, nausea, vomiting, fatigue, sore throat, headache, hypoventilation

oxygen toxicity

possible complications of a ventilator:

oxygen toxicity, infection, pneumothorax

Measure of H+ ion concentration

pH

type of compensation: pH, HCO3, and PaCO2 are outside expected reference range

partial compensation

-Oxygen concentrations of 60% to 75%, with flow rates of 6-11L/min. -Rebreathes 1/3 of exhaled tidal volume which is rich in oxygen -Bag should be inflated at the end of inspiration -may cause skin breakdown, not very comfortable, not easy to eat -When we plug these bags in we have to fill the reservoir bag with oxygen bc patients will be rebreathing this in; make sure they're rebreathing in oxygen and not CO2

partial rebreather

what subjective data is important to assess in acid-base imbalances?

past health history (COPD, CKD, gastric resection), medications (diuretics, opioids, antacids), surgery or other treatments

what does a low VQ ratio indicate

perfusion exceeds ventilation (severe hypoxia)

-Inflammation of the of the pharynx. -Assess for odynophagia, dysphagia, fever, and hyperemia. -Strep throat can lead to serious medical complications

pharyngitis

passageway for air and food

pharynx

most is also located in the bone; provides energy for muscle contraction; parathyroid hormone, vitamin D3, and calcitonin act together to control electrolyte absorption and excretion; normal value = 2.5-5.0 mg/dl

phosphate

adventitious breath sound: continuous, dry grating sound caused by inflammation of pleural surfaces and loss of lubricating pleural fluid; end of inspiration & beginning of expiration

pleural friction rub

-Excess of fluid in the lungs resulting from an inflammatory process -Triggered by bacteria, viruses, fungi and irritants -S & SX: chest or pleuritic pain, flu like symptoms, dyspnea, tachypnea, adventitious breath sounds -Complications: atelectasis (collapsed alveoli) and hypoxemia -Elevated WBC count, fluid volume deficit

pneumonia

these are the interventions for which respiratory issue? -Cough and deep breathing -Postural draining -Incentive Spirometer -Hydration -Bronchodilators, antibiotics and analgesics

pneumonia

-Chest injury that results in air entering the pleural space --Reduced breath sounds on the effected side, hyperresonance, chest pain, trachea deviation, shallow and increased RR --Interventions: return to negative pressure and chest tube monitoring

pneumothorax

air in pleural space

pneumothorax

tracheostomy possible complications

pneumothorax and hemothorax

what is the main risk factor associated with TB?

poorly ventilated crowded environment (correctional facilities, long term care facilities, lower income housing, group homes)

Major intracellular cation; regulates intracellular electrical neutrality in relation to Na+ and H+; essential for transmission and conduction of nerve impulses, normal cardiac rhythms, and skeletal and smooth muscle contraction

potassium

what is an important nursing intervention for suctioning

preoxygenation

these are the nursing interventions for which respiratory issue: •Non-surgical management -Oxygen Therapy and ABG's -Monitor VS, respiratory, cardiovascular indicators -Anticoagulant therapy --Heparin (PTT) --Coumadin (PT) •Surgical management -Embolectomy (surgical removal of embolus) -Inferior Vena Cava filter (filter to prevent further emboli from reaching the pulmonary vasculature)

pulmonary embolism

these are the signs and symptoms of which respiratory issue? -Respiratory manifestations: dyspnea, tachypnea, tachycardia, pleuritic chest pain, dry cough, hemoptysis, hypoxia -Cardiac manifestations: distended neck veins, syncope, cyanosis, hypotension, abnormal heart sounds, abnormal electrocardiogram findings -Low-grade fever, petechiae, symptoms of flu

pulmonary embolism

this is the patient education for which respiratory issue? stop smoking, reduce weight, increase activity, refrain from massaging or compressing leg muscles, get up frequently, drink plenty of fluids

pulmonary embolisms

non-invasive test used to diagnose emphysema, asthma, and COPD; evaluate lung volumes and capacities, flow rates, diffusion capacity, gas exchange, airway resistance, and distribution of ventilation; looks to see of results are obstructive or restrictive

pulmonary function test

-Highly communicable infection caused by Mycobacterium tuberculosis -Transmitted via aerosolization -Initial infection multiplies freely in bronchi or alveoli -Secondary TB (reactivation of the virus) -Increase related to the onset of HIV (immucompromised) -Airway precautions: N95s, negative airflow room, test with skin test

pulmonary tuberculosis

after oxygenation of the RBCs in the lungs, through which vessel does oxygenated blood return to the left atrium?

pulmonary veins

phase of burn care: - begins when most of burn area has healed and ends when we are trying to get them the highest level of functioning possible out of their scar tissue -may last for years -psychosocial support, prevention if scars and contractures, resuming activities

rehabilitative

actual or relative dehydration: involves a shift of water from the plasma (blood) to the interstitial space

relative

are these causes of actual calcium deficit or relative calcium deficit? -Conditions: alkalosis, acute pancreatitis, hyperproteinemia, hyperphosphatemia, immobility -Treatments: calcium chelators, citrate, mithramycin, sodium cellulose phosphate, penicillamine, pamidronate -Immobility -Parathyroid removal or damage

relative

are these causes of actual potassium deficit or relative potassium deficit? Alkalosis, Hyperinsulinism, Hyperalimentation, Total parental nutrition, Water intoxication, Older adult client with poor nutrition

relative

are these causes of actual potassium excess or relative potassium excess? -Extracellular shift caused from decreased insulin production (type 1 diabetics) -Acidosis (diabetic ketoacidosis) -Tissue damage (sepsis, trauma, surgery, fever, myocardial infarction)

relative

are these causes of actual sodium excess or relative sodium excess? -DI -lack of ADH -Burns -GI loss -Water deprivation (NPO) -Dehydration (elderly), post-CVA, infants -Overuse of hypertonic solution (to much 3%)

relative (due to decreased concentrated fluid volume)

what do RBCs do in the lungs?

release CO2 and pick up O2

what is the purpose of expiration?

removes CO2

acid-base regulatory mechanism: takes 2 to 3 days to respond maximally, but the kidneys can maintain balance indefinitely in chronic imbalances.

renal system

When ADH senses an adequate amount of water in the body, there is an increase in blood pressure and decrease in ________ production

renin

when the kidneys detect low blood pressure, what do they secrete?

renin

When a patient loses fluid from diarrhea, blood loss, vomiting, or nasogastric tube to suction, fluid must be ___________

replaced (ex: IV fluids)

are these the nursing interventions for hyponatremia with replacing sodium or without replacing sodium: encourage PO foods and fluids (beef broth, tomato soup), IV fluids (lactated ringers, 0.9% isotonic saline)

replacing sodium

percussion sound heard over lung fields

resonance

what five notes of percussion are we listening for during percussion of the thorax?

resonance, hyperresonance, flatness, dullness, tympany

These are the causes of which acid-base imbalance: respiratory depression (anesthesia, overdose, increased intracranial pressure), airway obstruction, decreased alveolar capillary diffusion (pneumonia, COPD, ARDS, PE)

respiratory acidosis

characterized by pH <7.35 and PaCO2 is >45 mm Hg; retention of CO2 by lungs

respiratory acidosis

these are the manifestations of which acid-base imbalance: hypoventilation, hypoxia, rapid and shallow respirations ("i can't catch my breath), headache, arrhythmias (increased K+), disorientation (drowsiness and dizziness), hypotension, skin/mucosa pale or cyanotic, hyperkalemia, headache, muscle weakness, hyperreflexia

respiratory acidosis

what acid-base imbalance is always due to inadequate excretion of CO2 with inadequate ventilation.

respiratory acidosis

ABG imbalance related to late PE:

respiratory acidosis (body is exhausted)

These are the causes of which acid-base imbalance: hyperventilation (anxiety, pain, fear, PE) causing hypocapnia, mechanical ventilation

respiratory alkalosis

characterized by pH >7.45 and PaCO2 is <35 mm Hg; increased loss of CO2 from lungs; most frequent acid-base disturbance

respiratory alkalosis

these are the manifestations of which acid-base imbalance: lightheadedness due to vasoconstriction and decreased cerebral blood flow, inability to concentrate, hyperventilation (increased rate and depth), numbness and tingling of extremities (decreased calcium ionization), tachycardia, decreased or normal BP, hypokalemia, hyperreflexes and muscle cramping, seizures, increased anxiety and irritability

respiratory alkalosis

ABG imbalance related to early PE:

respiratory alkalosis (hyperventilating)

what objective data is important to assess in acid-base imbalances?

respiratory assessment, EKG, I&Os, serum CO2, hypo/hyperkalemia

if metabolic alkalosis becomes severe it may lead to what?

respiratory depression

what are two main complications of hypokalemia?

respiratory failure and cardiac arrest

what should an inspection of the thorax include?

respiratory rate, body weight, hypertrophied neck and chest muscles (COPD), 1:2 ratio of A/P to transverse diameter, use of accessory muscles

acid-base regulatory mechanism: responds in minutes and reaches maximum effectiveness in hours.

respiratory system

obstructive or restrictive pulmonary function test: lower airway; loss of lung tissue and decreased compliance (ability of lungs to expand), decreased lung's ability to transfer oxygen to blood or CO2 out of blood = screws up alveoli; causes include pneumonia, lung cancer, scleroderma, pulmonary fibrosis, sarcoidosis, or multiple sclerosis. Other restrictive conditions include some chest injuries, being very overweight (obesity), pregnancy, and loss of lung tissue due to surgery.

restrictive

phase of burn care: -initial fluid shift -occurs within first 12 hours and continues for 24-36 hours -obtain laboratory values to get a baseline: --CBC --glucose (increased) --BUN (elevated) --hct and hgb (elevated due to loss of fluid volume and shift of fluid into interstitial space) --carboxyhemoglobin (>10% indicates the pt has inhaled smoke) --plasma lactate (elevated if cyanide toxicity) --electrolytes (sodium decreased, potassium increased, chloride increased, etc.) --total protein and blood albumin (decreased) --ABGs (metabolic acidosis)

resuscitation

If my body is becoming alkalotic, the kidneys would tell the kidneys to (excrete or retain) acids to maintain a proper acid-base balance

retain

Decreased respirations lead to CO2 (retention or elimination)

retention

adventitious breath sound: bubbling heard throughout inspiration and expiration; louder than rales due to larger and thicker secretions; results from air bubbling past secretions in the airways

rhonchi

these are the nursing interventions for which adventitious breath sound: deep breathing, coughing, hydration (encourage fluids, if no restriction), humidify air, mobilize

rhonchi

-Result of blunt force to the chest, increases risk for intrathoracic injury -Pain and Splinting

rib fracture

in pulmonary circulation, oxygen-depleted blood leaves the (right or left) ventricle through the pulmonary arteries, which carry it to the lungs.

right

of the mainstem bronchi, which side is wider and has the most incidence of an endotracheal tube accidentally being inserted?

right

Why is aspiration pneumonia more common in the right mainstem bronchus instead of the left?

right bronchus is wider, shorter, and more vertical and are more likely to aspirate into that side

Most common cause of death after a burn is:

sepsis

are these nursing actions for moderate symptoms of hyponatremia (Na <115 mEq/L) or severe symptoms (Na <110 mEq/L)? -free water restriction (<1L / 24 hrs), administer 3% NS 100ml over 10 minutes, redraw BMP (repeat twice q4-q6 PRN to achieve improvement in symptoms or to see 4-6 meq/L rise)

severe

EKG changes with hypokalemia

shallow T wave, prominent U wave, slightly peaked P wave

-Minimum of 5L/min up to 8L/min(40%-60%) concentration -helps for mouth-breathers -eating can be difficult (usually wear this at night and NC during day) -moisture and pressure can collect on mask causing skin breakdown; although it seems non-invasive we have to be mindful of skin breakdown (mouth, lip, tongue ulcers possible)

simple face mask

-Inflammation of the mucous membranes of the sinuses -S & Sx: --Nasal swelling --Congestion --Headache --Facial Pressure --Pain --Tenderness --Low grade temperature --Purulent Drainage

sinusitis

what can the presence of cerebrospinal fluid indicate?

skull fracture

Aldosterone is released by the adrenal gland and works on the kidneys by directing the nephron units of the kidney to reabsorb ________ (and water follows along). This increases the absorption of water by holding on to salt (Na+).

sodium

Primary ECF cation; regulates osmotic forces (thus water); Roles: neuromuscular irritability, acid-base balance, and cellular chemical reactions and membrane transport

sodium

the key positive ion in the extracellular fluid compartment (plasma and interstitial fluid)

sodium

A life-threatening, acute episode of airway obstruction that intensifies once it begins and often does not respond to common therapy; prolonged period of an asthma attack; if the condition is not reversed, the client may develop pneumothorax and cardiac or respiratory arrest

status asthmaticus

maintains a patent airway and promotes gas exchange; done through the nose or the mouth; assess pt need if they cannot cough adequately

sunctioning

-a pneumothorax with rapid accumulation of air in the pleural space -Life Threatening, early detection is critical (detectable on X-Ray) -Causes: blunt trauma, ventilator with Peep, chest tubes (clamped or occluded) -S & SX: asymmetry of the thorax, tracheal deviation, respiratory distress, absent breath sounds on effected side, distended neck veins, cyanosis

tension pneumothorax

why would you not hyperoxygenate in COPD?

the body is running on elevated co2, not decreased oxygen

treatment of metabolic acidosis focuses on what?

the underlying metabolic disorder

Tachypnea is an attempt to

thermoregulate

as compliance decreases, what happens to the lung tissues?

they don't expand

invasive respiratory diagnostic test: -aspiration of pleural fluid or air from the pleural space -short term (few minutes) fluid removal or biopsies - surgical perforation of chest wall -biopsy, transudate and exudate removal, empyema and pneumonia -Goal is to get large-bore needle into bottom of pleural space to get rid of pleural effusion to drain it out (causing breathing issues) and make sure we can send it off for culture and properly treat with antibiotics -Pre-procedure interventions: position client upright with arms and shoulders raised, stay still to not puncture lung

thoracentesis

why would you give fluids to a patient with pneumonia?

to thin the secretions in the lungs

Goal of oxygen therapy:

to use the lowest fraction of inspired oxygen for an acceptable blood oxygen level without causing harmful side effects

Volume imbalances occur when:

too little or too much isotonic fluid is present

amount of water within the body (40 liters or about 60% of body weight in adult males)

total body water

what structures are included in the lower respiratory tract?

trachea, mainstem bronchi, bronchioles, alveolar ducts/alveoli

created by the surgeon if esophageal speech is ineffective, requires a finger placed over the stoma to create sound

tracheoesophageal fistula

-surgical creation of an opening into the trachea through the neck -Cannot have endotracheal tube sitting in mouth on oral mucosa for longer than 7-10 days bc of skin breakdown -ET tube sits between vocal cords so may be issues with vocalizing -Cuff at the end of the tracheostomy, make sure it's not high pressure due to erosion of posterior wall or tracheoesophageal fistula (lead to aspiration)

tracheostomy

these are nursing actions for which respiratory intervention: -Preop: talking and education patients on what to expect after procedure -Postop: ensure patent airway, frequently assess need for suctioning, assess gag reflex, pain control around incisional site (decreased cough effort results), have emergency airway equipment at bedside, obturator for obstructions and dislodgement

tracheostomy

high-flow oxygen delivery system: for patients with a tracheostomy; deliver oxygen through trach via incision in neck vs through mouth or nose

tracheostomy collar

fluid secreted by epithelial cells (cerebrospinal, pleural, peritoneal, synovial fluids)

transcellular body fluids

transudate or exudate: systemic from underlying system breakdown: heart failure, liver failure, kidney issues; not infectious

transudate

Excessive suction pressure pulls tissue away from trachea causing:

trauma, bleeding, or infection

What issues can hurt the kidneys?

trauma, certain IV contrast, hypoperfusion

treatment of respiratory acidosis focuses on what?

treating the cause of the hypoventilation

true or false: some respiratory problems may be worsened by stress

true

true or false: Acute respiratory acidosis is typically much more symptomatic than acute metabolic acidosis

true

true or false: If a respiratory problem is the cause of an acid-base imbalance (e.g., respiratory failure), the respiratory system loses its ability to correct a pH alteration.

true

true or false: If the renal system is the cause of an acid-base imbalance (e.g., renal failure), it loses its ability to correct a pH alteration.

true

true or false: Regardless of the cause of the hypovolemia (actual or relative), our body will still present with the same hypovolemic signs and symptoms of decreased circulating volume

true

true or false: The percentage of the total amount of burn on body is used to determine how much fluid is given, medication given, and caloric needs to recover; depth of burn is used to determine treatment and location (hands, face, genitals, feet = immediate care at a burn center instead of hospital)

true

true or false: Tracheal deviation to the unaffected side of a pneumothorax is a medical emergency

true

true or false: a U wave is only seen in severe cases of hypokalemia

true

true or false: every major body system is affected after a major burn

true

true or false: hypoxemia leads to hypoxia

true

true or false: posterior nasal bleeding is an emergency

true

true or false: when the dermis is destroyed, skin can no longer regrow over the affected area

true

percussion sound heard over abdominal cavity

tympany

Acid-base imbalance is not a disease but a manifestation of a what?

underlying health problem

-Life-threatening emergency in which an interruption in airflow through the nose, mouth, pharynx, or larynx occurs. -Early recognition is essential to prevent further complications, including respiratory arrest. -Causes: tongue/laryngeal edema, occlusion, head and neck cancer, CVA, smoke inhalation edema, thick secretions

upper airway obstruction

these are the nursing interventions for which respiratory issue: -assessment for cause of the obstruction -assessment for signs of distress -maintenance of patent airway and ventilation

upper airway obstruction

When you hyperoxygenate a COPD patient you are killing their drive to ________ (their drive to breathe is based on elevated CO2 levels)

ventilate

-standard test for a pulmonary embolism -Ratio: amount of air reaching the lungs / amount of blood reaching the lungs -VQ mismatch: --When part of lung receives oxygen without blood flow or vice versa --From obstructed airway (choking) or obstructed blood vessel (blood clot in lung) --High-suspicion PE or atelectasis

ventilation / perfusion ratio

what does a high VQ ratio indicate

ventilation exceeds perfusion and dead space develops (atelectasis or PE)

high-flow oxygen delivery system: a face mask and reservoir bag; can get specific with oxygen delivery; delivers most precise oxygen concentration by mixing oxygen with inhaled air

venturi mask

Characteristics of body fluid:

volume, concentration (osmolality), composition (electrolyte concentration), and acidity (pH)

how is a wheeze different from a stridor?

wheeze: expiration, low pitch; stridor: inspiration, high pitch

adventitious breath sound: musical, whistling sound; usually more pronounced during expiration; caused by narrowed airways (bronchoconstriction or secretions)

wheezing

these are the nursing interventions for which adventitious breath sound: bronchodilator= albuterol (positive effect: decreased cough, decreased wheeze); encourage PO liquids (1.5-2 L per day) to help thin secretions to more easily expel them (if an older patient has a lot of sputum production with a weak cough)

wheezing

When asked about symptoms of electrolyte imbalances, first check to see:

which electrolytes are within range

are these the nursing interventions for hyponatremia with replacing sodium or without replacing sodium: restrict water intake for fluid overload, I&Os, daily weight, vitals, level of consciousness

without replacing sodium