Patho/ HCCL 2. Test 1
A client is admitted to the hospital with a diagnosis of chronic obstructive pulmonary disease (COPD). Which action would the nurse take to prevent client fatigue? Provide small, frequent meals . Encourage pursed-lip breathing Schedule nursing activities to allow for rest. Encourage bed rest until energy level improves.
Schedule nursing activities to allow for rest.
Anemia
A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume. can be cause by blood loss- acute or chronic (hemorrhage, trauma, surgery, aneurisms, mensuration, cancers ulcers) (could lead to a low BP and possible heart failure) Impaired gas exchange reaching the blood types: iron deficient, pernicious, aplastic, hemolytic, megaloblastic often a SYMPTOM of a disease
Which assessment finding indicates that sodium polystyrene sulfonate has been effective? Control of diarrhea An increase in serum sodium level An increase in serum calcium level A decrease in serum potassium level
A decrease in serum potassium level
Epogen
antiemetics, erythropoiesis stimulating agents maintains and elevates RBCS for transfusions Anemias related to CKD, HIV, and chemo s/s, hypertension, headache, MI, mess with menses reduces needs for blood transfusions
Folic Acid
antiemetics/ vitamins important for the function of hematopoiesis (DNA synthesis) prevent and treat megaloblastic anemias given during pregnancy for fetal development (neural tube defects) *needs b-12 for activation can turn urine a dark yellow
Which instruction would the nurse provide when teaching about the use of a nebulizer to a client with chronic obstructive pulmonary disease ? "Hold your breath, spray the medication into your mouth, then inhale deeply." "Depress the canister as you inhale deeply, then hold your breath for at least 10 seconds." "Seal your lips around the mouthpiece and breathe in and out, taking slow, deep breaths." "Inhale the medication from the nebulizer, remove the mouthpiece to exhale and then repeat
"Seal your lips around the mouthpiece and breathe in and out, taking slow, deep breaths."
Pleural Friction Rub
- rough, grating
Wheezes
("musical" sounds -small airways - usually don't clear with coughing) Bronchoconstriction
pulmonary function tests (PFTs)
(noninvasive) (Often the initial test for lung function and breathing problems - measures air flow, lung volume & capacity, and gas exchange)
What can cause an inaccurate finding of a pulse ox
(patient movement, hypothermia, decreased peripheral blood flow, decreased hemoglobin, edema, fingernail polish)
A health care provider prescribes 0.2 mg of cyanocobalamin (vitamin intramuscularl A vial of the medication labeled 100mcg = 1mL is available. How many milliliters of solution will the nurse administer? Record your answer using a whole number.
2
how quickly do you need to administer blood after receiving it from the blood bank?
30 min
How many liters of oxygen must be given before adding humidity
4
What is the maximum a nasal cannula should be set to
6 L
Erythropoietin
A hormone produced and released by the kidney that stimulates the production of red blood cells by the bone marrow.
collecting duct
A segment of the nephron that returns water form the filtrate to the bloodstream.
A client has chronic obstructive pulmonary disease (COPD). To decrease the risk of C*O_{2} intoxication ( C*O_{2} narcosis), which would the nurse do? Initiate pulmonary hygiene to clear air passages of trapped mucus. Instruct to deepbreathe slowly with inhalation longer than exhalation. Encourage continuous rapid panting to promote respiratory exchange. Administer oxygen at a low concentration to maintain respiratory drive.
Administer oxygen at a low concentration to maintain respiratory drive.
What to do in the event of a client having an air embolism
Air embolism (place client on L side in Trendelenburg, Monitor for sudden onset SOB, decrease in SaO2 levels, chest pain, anxiety, and air hunger - Rapid Response!)
Beta2-Adrenergic Agonists : short acting
Albuterol Inhaled short-acting beta2 agonists (SABAs) Taken PRN to abort an ongoing attack (acute) EIB: Taken before exercise to prevent an attack (15 min) Nebulized SABA is the traditional treatment of choice for asthma attack for the hospitalized patient Delivery with an MDI in the outpatient setting may be equally effective. Smooth muscle of lungs and beta 2 receptors in airway Overdose can lead to dangerous adverse effects, such as tachydysrhythmias, angina, seizures, cardiac arrest and death may occur.
acute stress disorder
An anxiety disorder in which fear and related symptoms are experienced soon after a traumatic event and last less than a month
Hemoglobin
An iron-containing protein in red blood cells that reversibly binds oxygen.
hemoglobin
An iron-containing protein in red blood cells that reversibly binds oxygen.
CKD: Hematologic & Immunity Changes
Anemia -Worsens CKD symptoms (perfusion problem) -Causes Decreased erythropoietin level with reduced red blood cell (RBC) production Decreased RBC survival time r/t uremia, and iron and folic acid deficiencies Impaired Platelet Function results in increased bruising or bleeding Reduced immunity Increases risk for infection Cause: uremia disrupts white blood cell (WBC) production and function
Vancomycin
Anti- infectives Bactericidal action against susceptible organisms treatment of potentially life threatening infections (endocarditis, pneumonia, meningitis Hypotension, phlebitis, nausea, vomiting, eosinophilia) Cloudy and pink urine (nephrotoxicity ) Monitor Peak and trough- RED mans syndrome, Look for rash, redness, swelling, Monitor for phlebitis Monitor IV site Endocarditis prophylaxis
Prednisone
Anti- inflammatory (steroidal) Immune modifiers (ORAL) Can be used for chronic diseases and inflammatory, allergic, hematologic, neoplastic and autoimmune related issues s/s- hypertension, headaches, adrenal suppressions, weight gain, Cushing syndrome avoid vaccinations, discontinue slowly
Which information is needed to determine oxygen administration for a client with chronic obstructive pulmonary disease (COPD) and an oxygen saturation of 87%? Level of orientation Arterial blood gases Bilateral lung sounds Complete blood count
Arterial blood gases
Which schedule will the nurse teach a client who presented to the emergency room for an acute asthma attack at the time of discharge who is prescribed theophylline 300 mg orally to be taken daily at 9:00 AM? One hour before or 2 hours after eating At bedtime At the specific time prescribed Daily until symptoms are gone
At the specific time prescribed
Glucocorticoids: steroids
Beclomethasone( inhaled) Prednisone( oral) Long-term control of airway inflammation of both Asthma & COPD Suppress inflammation by Decreasing synthesis and release of inflammatory mediators (e.g., leukotrienes, histamine, prostaglandins) Decreasing infiltration and activity of inflammatory cells (e.g., eosinophils, leukocytes) Decreasing edema of the airway mucosa (secondary to a decrease in vascular permeability) Uses Given mostly through inhalation but may also be IV or oral. Prophylaxis of chronic asthma Dosing must be on a fixed schedule, not as needed (PRN) - not for acute attacks beneficial effects develop slowly Adverse effects of INHALED forms Adrenal suppression- decreased immune response hypoglycemia, hypotension, mental status alterations, esp. in children Oropharyngeal candidiasis (thrush)-WASH MOUTH AFTER USE Dysphonia (hoarse voice) Bone loss (however, much lower than with oral glucocorticoids Adverse effects of ORAL forms Adrenal suppression Can slow growth in children and adolescents; Promotion of bone loss (osteoporosis) Immunosuppression Increased risk of hyperglycemia/hyperkalemia Increased risk of Peptic Ulcer Disease (bleeding stomach ulcers) Discontinuing treatment Must be done slowly, never abruptly stop a glucocorticoid
Adrenergic drugs
Beta 2 Agnoists (albuterol) - ventolin rescue inhaler- quick relief as needed treatment
Which foods will the nurse include when suggesting dietary sources of iron to a client with anemia? Select all that apply . One, some, or all responses may be correct. Raw carrots Boiled spinach Dried prunes Brussel sprouts Asparagus spears
Boiled spinach Dried prunes
Signs and symptoms of hypoxia
Changes in mental status-confusion, agitation, lethargy, impaired judgment Tachypnea, dyspnea, use of accessory muscles Sympathetic response: tachycardia, vasoconstriction, increased B/P - initially (unless hypoxia caused by hypovolemic shock) Later signs: Diaphoresis Cardiac arrhythmias ↓ B/P Bradypnea (due to respiratory fatigue) Cyanosis central or peripheral
Who is at increased risk of interpersonal violence
Children Older adults Pregnant women
Population's most at risk for impaired gas exchange
Children infants and older adults
Which abnormal finding would the nurse monitor for during the oliguric phase of acute kidney injury? Hypothermia Hyperkalemia Hypocalcemia Hypernatremia
Hyperkalemia
Which assessment with the nurse perform before administering a dose of Vancomyosin to a client? Creatinine Trough level Hearing ability Intravenous site Blood urea nitrogen
Creatinine Trough level Hearing ability Intravenous site Blood urea nitrogen
Mast Cell Stabilizers
Cromolyn- nebulizar Used for prophylaxis, not for quick relief Suppresses inflammation; not a bronchodilator Alternative to inhaled glucocorticoids for prophylactic therapy of asthma. Mechanism of action: Stabilizes cytoplasmic membrane of mast cells Preventing release of histamine and other mediators Inhibits eosinophils, macrophages, and other inflammatory cells Therapeutic use Chronic asthma Exercise-induced bronchospasm (EIB) Allergic rhinitis Adverse effects Safest of all antiasthma medications Cough Bronchospasm
When does cyanosis normally appear?
Cyanosis usually appears when arterial oxygen saturation is 80 to 85% Usually a sign that the client has been oxygen deprived for a while
Aging and Renal Function
Decrease in renal blood flow and GFR Altered sodium and water balance Number of nephrons decrease due to renal vascular and perfusion changes Response to acid-base changes delayed Increased risk for drug toxicity Alterations in thirst and water intake
Pediatric Renal Function
Decreased ability to remove excess water and solutes Decreased concentrating ability Narrow margin for fluid and electrolyte balance Increased risk of drug toxicity
oliguria
Decreased urine output
Kussmaul respirations
Deep, rapid breathing; usually the result of an accumulation of certain acids when insulin is not available in the body.
Which goal is the priority for a client with asthma who has a prescription for inhaled bronchodilators Is able to obtain pulse oximeter readings Demonstrates the use of a metered dose inhaler Knows the healthcare providers office hours Can identify triggers that may cause wheezing
Demonstrates the use of a metered dose inhaler
The nurse is caring for a client with emphysema. During assessment, the nurse would expect to auscultate which type of breath sounds? Crackles Pleural friction rub Diminished breath sounds Expiratory wheezes
Diminished breath sounds
What are early versus late signs of respiratory distress? Why is it important to recognize EARLY signs of deterioration?
Early: Increased heart rate Increased respiratory rate, anxious, nervous, and tripod positions Late: confusion, cyanosis, decreased respiratory rate, no longer as oriented, reduced heart rate
Which assessment finding in a hospitalized client with a history of chronic kidney disease would alert the nurse to suspect kidney insufficiency ? Facial flushing Edema and pruritus Dribbling after voiding Diminished force of urination
Edema and pruritus
Sevelamer
Electrolyte Modifiers Reduces serum phosphate levels in patients Associated with end state renal disease Nausea, vomiting, diarrhea, dyspepsia, dysphagia, flatulence Notify doctor if GI effects such as bloody stools or constipation worsen Must be taken with meals
epoetin alfa
Erythropoiesis stimulating agents (ESA) Maintaining and may elevates RBCs decreasing the need for transfusions. Anemia associated chronic kidney disease (CKD) and chemotherapy Hypertension, headache, seizures, HF, MI, Stroke, thromboembolic events, resumption in menses Monitor BP before and during therapy. Monitor symptoms of anemia Monitor dialysis shunts Monitor hemoglobin
neglect
Failure to provide the person with the goods or services needed
Calcitriol
Fat soluble vitamins- vitamin D replacement Treatment and prevention of deficiency states, particular bone manifestations affects the PTH to help balance the calcium and phosphate levels Improve calcium and phosphorous homeostasis in patients with chronic kidney disease and hypoparathyroidism used with Rickets Pancreatitis Headaches, weakness, conjunctivitis, photophobia, hypertension, arrhythmias Watch for signs of toxicity and overdose.
Which laboratory test result would the nurse expect to be decreased in a client with iron- deficiency anemia? Ferritin level Platelet count White blood cell count Total iron-binding capacity
Ferritin level
lanthanum carbonate
Fosrenol Phosphate binder Reduces serum phosphate levels associated with end stage renal disease Nausea, vomiting, diarrhea, fecal impaction, GI obstruction , GI perforation, ileus, hypocalcemia Need to administer with meals
Which intervention would the nurse implement for a client admitted for an exacerbation of asthma? Determine the client's emotional state. Give prescribed medications to promote bronchiolar dilation. Provide education about the effect of a family history Encourage the client to use an incentive spirometer routinely
Give prescribed medications to promote bronchiolar dilation.
Furosemide
Loop diuretic Uses: renal failure, HF SE: hypokalemia, ototoxicity Diuresis, and mobilization of excess fluid (pleural effusions) Decreases BP Edema due to heart failure, hepatic impairment or renal disease. Increased urinary output and BP hypovolemia, hypokalemia, dehydration, hypocalcemia, hyponatremia Assess for patient for skin rashes (SJS) monitor glucose and potassium levels in labs
Which laboratory value would the nurse assess to evaluate response to the medication epoetin? Hemoglobin Platelet count Prothrombin time Partial thromboplastin time
Hemoglobin
A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute pneumonia. The client is in moderate respiratory distress. The nurse would place the client in which position to enhance comfort? Sidelying with head elevated 45 degrees Modified left lateral recumbent with head elevated 90 degrees SemiFowler with legs elevated High Fowler using the bedside table to rest the arms
High Fowler using the bedside table to rest the arms
Aldosterone
Hormone that stimulates the kidney to retain sodium ions and water increasing potassium excretion
Which client statement indicates to the nurse that further teaching about epoetin for the treatment of anemia associated with chronic renal failure is necessary? I realize it is important to take this medication because it will cure my anemia. Because am at risk for seizures, I need to avoid hazardous activities. I recognize that may still need blood transfusions if my hemoglobin is very low." I understand that I will still have to take supplemental iron therapy with this medication
I realize it is important to take this medication because it will cure my anemia.
Bronchodilators: Anticholinergic Drugs: Ipratropium
Improves lung function by blocking muscarinic receptors in the bronchi reducing bronchoconstriction Action and use: Administered by inhalation to relieve bronchospasm Therapeutic effects begin within 30 seconds, reach 50% of maximum in 3 minutes, and persist about 6 hours Adverse effects: drys out the body! Dry mouth and irritation of the pharynx Glaucoma(systemic adverse reaction) Cardiovascular events (heart attack, stroke, death
Which side effect would the nurse monitor for in a client receiving dexamethasone to treat an acute exacerbation of asthma? Hyperkalemia Liver dysfunction Orthostatic hypotension Increased blood glucose
Increased blood glucose
Inhaled medications
Increased speed of relief by inhaling and accessing the alveoli quicker to reach those specific capillaries Coughing, nausea, vomiting, BP changes
Mean Corpuscular Volume (MCV)
Indicates the oxygen-carrying capacity of blood
Bronchiodilators: anticholinergic drugs
Ipratropium: first inhaled anticholinergic. Tiotropium Block the action of acetylcholine. bronchodilators cause the airways to relax and open. Improve lung function by blocking muscarinic receptors in the bronchi, reducing bronchoconstriction. These drugs are approved only for COPD!!! administered by inhalation Systemic effects are minimal. Use with caution in geriatrics and breast feeding S/s- decreased bp, increase HR, nausea, vomiting
Ferrous Sulfate/ Gluconate *main difference?
Iron Supplement. Used to treat iron deficiency anemia. Educate client that black, tarry stools are expected. may cause GI bleeding take on empty stomach with 8 oz water, or with food to lessen nausea (only if necessary) Vitamin C helps absorption. Coffee, milk, and tea interfere with absorption. * ferrous sulfate is more concentrated, needs less of a dose
The registered nurse provides information to a group of student nurses regarding the actions of parathyroid hormone (PTH). Which statement made by a student nurse indicates the need for further teaching? Select all that apply . One, some, or all responses may be correct . It activates vitamin D in the kidneys." Its secretion increases serum calcium levels It allows reabsorption of phosphorus in the kidney tubules It decreases serum calcium levels by increasing bone resorption." It regulates calcium and phosphorous metabolism by acting on the gastrointestinal (gi) tract
It allows reabsorption of phosphorus in the kidney tubules It decreases serum calcium levels by increasing bone resorption."
The nurse is teaching the parent of a child prescribed high dose of oral prednisone for asthma, which information is critical for the nurse include when teaching about this medication It protects against infection It should be stopped gradually An early growth spurt may occur Hey moon face shape will develop
It should be stopped gradually
Non-Calcium phosphate binders
Lanthanum carbonate Sevelamer
Leukotrienes antagonist/ inhibitors
Leukotrienes promote: Smooth muscle constriction Blood vessel permeability= more mucus Inflammatory responses- recruitment of eosinophils and other inflammatory cells Uses- prophylactic Long acting and long onset Reduce bronchoconstriction and inflammatory responses such as edema and mucous secretion (asthma) 2nd line therapy if an inhaled glucocorticoid cannot be used or as an add-on Neuropsychiatric effects: depression, anxiety, suicidal thinking, and behavior* Liver toxicity Prototype Zafirlukast [Accolate] (oral) And monolukast (singulair)
risk factors for COPD
Men> women Chronic debilitating disease Risk factors: Smoking passive smoking Onset - 20-50 years Many patients have both conditions concurrently Chronic Bronchitis: Inflammation of bronchi and bronchioles Productive cough with thick, white sputum (be aware of color and consistency of sputum - PaO2 level decreases (hypoxemia) and arterial PaCO2 level increases (respiratory acidosis)
What do we know about safe use of oxygen therapy in clients with COPD?
Needs to be given slowly to not overwhelm patient and not to risk o2 toxicity
Normal respiratory rates of different age groups
Newborn/Infant (30-60) Toddler (24-40) Child (18-30) Adolescent (12-20) Adult (12-20)
Are PRN restraints legal?
No
What are normal values of pulse ox?
Normal: PaO2 - > 70 95-100 Mild Impair: PaO2 60- 80 93-95 Mod Impair: PaO2 40-60 75-90 Severe Impair: PaO2 < 40 75
Which action would the nurse take first when a client with acute bronchitis and emphysema reports feeling anxious and short of breath ? Obtain the oxygen saturation . Provide oxygen at 2 L per minute. Offer the prescribed rescue inhaler. Suggest use of pursed-lip breathing
Obtain the oxygen saturation
Cues of elder abuse
Physical abuse/neglect Psychological/Emotional abuse -verbal threats Sexual abuse- homes and nursing homes Exploitation - theft, fraud, misuse, financial, abandonment Self Neglect - Behavior threatens own health or safety (uncleanliness, too many pets, hoarding, etc.)
Which high-risk nutritional practice must be assessed for when a pregnant client is found to be anemic? Pica Caffeine intake Alcohol abuse Artificial sweetener use
Pica
CKD and Metabolic System Changes: potassium
Potassium Hyperkalemia = changes in cardiac rate and rhythm Also caused by potassium in drugs, dietary potassium, tissue breakdown, blood transfusions, bleeding or hemorrhage
Which finding provides evidence that the intervention is effective after the nurse administers sodium polystyrene sulfonate to a client with chronic renal failure? Pruritus decreases Mental status improves Sodium decreases to 137 mEq / L; (137mmol / L) Potassium decreases to 4.2mEq / L * \langle4, 2mmol / L\rangle
Potassium decreases to 4.2mEq / L * \langle4, 2mmol / L\rangle
What happens when a person is exposed to an allergen?
Release of mast cells These stimulates release of inflammatory mediators : histamines and leukotrienes And release of inflammatory cells: neutrophils and eosinophils
Why are women often targeted for violence
Rape- females under age 25 at greatest risk Harassed more frequently than men Women more likely to be controlled (financially, emotionally, physically) Can be culturally-based (e.g. female genital mutilation) Factors that may trigger or escalate violence: person moving toward independence (going back to school or getting a job); pregnancy; visiting friends/family without partner's permission; threatening to leave or leaving the relationship; perpetrator abusing alcohol and/or drugs
Pathophysiology- acute kidney injury (AKI)
Rapid onset (hours to days) Kidneys failure to eliminate waste, maintain fluid & electrolyte balance, & acid-base balance. Creatinine level is used to evaluate kidney function (most common- need to know baseline) Biomarkers specific to kidney injury (within 12- 24 hours) Glomerular filtration rate (GFR)- best indicator of kidney function (not accurate during acute illness and critical illness) Kidney compensate by increasing blood volume/improving perfusion (Constricting blood vessels- increasing bp, Activating the renin-angiotensin-aldosterone pathway, Releasing antidiuretic hormones (ADH) Compensatory actions in turn result in: Reduce urine elimination, Oliguria (UOP less than 400mL/day), Azotemia (buildup of nitrogenous wastes in blood) Toxins constrict blood vessels in the kidney= reduced blood flow, oliguria, & azotemia Activated immunity & toxins causes intracellular damage in kidneys Causes of AKI Perfusion, Damage to kidney tissue, Obstruction of urine outflow Risk factors Shock, cardiac surgery, hypotension, prolonged mechanical ventilation, sepsis Higher risk of AKI when hospitalized: Diabetes, hypertension, peripheral vascular disease, liver disease, or CKD
hormones effected by the kidneys
Renin Erythropoietin vitamin D aldosterone angiotensin
When a client with chronic obstructive, pulmonary disease has a new prescription for daily low does prednisone which information will the nurse include when teaching a client? Take the medication hour before eating Report any dark schools to the healthcare provider Weight loss is a common side effect of the medication Take the medication as soon as you experienced dyspnea
Report any dark schools to the healthcare provider
The nurse administers albuterol to a child with asthma. Which common side effect would the nurse monitor for in the child? Flushing Dyspnea Tachycardia Hypotension
Tachycardia
Which action would the nurse perform when administering fluticasone propionate to a client with asthma? Assessing heart rate and rhythm Monitoring liver function blood tests Rinsing the oral cavity with water after use Obtaining blood glucose levels before meals
Rinsing the oral cavity with water after use
Beta2-Adrenergic Agonists : long acting
Salmeterol- Inhaled long-acting beta2 agonists (LABAs) Long-term control in patients who experience frequent asthma attacks-prophylactic Effective in treating stable COPD Indicated for long-term maintenance in adults and children Dosing is on a fixed schedule, not PRN When used to treat asthma, must always be combined with a glucocorticoid Use alone in asthma is contraindicated Inhaled LABAs may increase the risk for severe asthma and asthma-related death when used as one type of tx for long-term control.
Why are children more at risk for impaired gas exchange
Small airways Weaker immune system
Metered-dose inhalers (MDI)
Small, handheld, pressurized devices that deliver a measured dose of drug with each actuation. Dosing is usually accomplished with one or two inhalations. When two inhalations are needed, an interval of at least 1 minute should separate the first inhalation from the second. When using most MDIs, the patient must begin to inhale before activating the device. MDI can be used with or with out a spacer; however, with a space more drug is delivered directly to the lungs and less deposition to the mouth and oropharynx
5 stages of classification based on GFR
Stage 1: normal GFR (>90 mL/min/1.73 m2) but abnormal urine findings, structural abnormalities, or genetic traits that point to kidney disease Stage 2: Mild kidney damage with mildly decreased GFR (60-89 mL/min) Stage 3: Moderate damage with moderate decreased GFR (30-59 mL/min) Stage 4: Severe kidney damage with severely decreased GFR (15-29 mL/min) Stage 5: End-stage kidney damage (ESKD) GFR less than 15 mL/min
interpretation of ABGs
Step 1 - Assess pH (7.35-7.45) Step 2 - Determine if PaCO2 normal (35-45) (partial pressure of arterial carbon dioxide) Step 3 - Determine if HCO3 normal (bicarbonate) 22-26 Step 4 - Compensated (pH is normal) or uncompensated (not or partially) Step 5 - Assess oxygenation status PaO2 (partial pressure arterial oxygen) 80-100
When preparing a client who is scheduled for a pulmonary function test (PFT) because of possible adult-onset asthma, which action would the nurse take? Have client use the prescribed as needed bronchodilator before testing. Teach client how to take a deep breath and exhale forcefully . Explain the reason for not eating for 6 hours before testing. Check to be sure that the informed consent form is signed.
Teach client how to take a deep breath and exhale forcefully .
shilling test
Test for pernicious anemia
voluntary commitment
The circumstance in which the individual agrees to be admitted to a psychiatric hospital and is permitted to leave at any time. Can choose to leave UNLESS deemed to be a danger to self or others
Glomerular Filtration Rate (GFR)
The filtration of the plasma per unit of time (e.g., 120 to 140 ml/min), which is directly related to the perfusion pressure of the glomerular capillaries autoregulation of the glomerular blood flow helps keep the GFR fairly constant This is necessary to maintain the clearance of metabolic wastes and the reabsorption of filtered electrolytes and nutrients
Anti-inflammatory drugs: gas exchange
These medications are for prophylaxis and are used to decrease airway inflammation. Decrease synthesis and release of inflammatory mediators: histamine and leukotrienes And Reduce infiltration and activity of inflammatory cells: neutrophils and eosinophils Decrease edema of the airway mucosa Usually administered by inhalation, but IV and oral routes are also options Classifications: SLM Glucocorticoids: #1 Leukotriene receptor antagonist Mast cell stabilizers
Who is an increased risk for becoming a perpetrator in a bullying situation?
Those who have been abused or bullied before
Titrate
To determine the effective dosage of analgesic by increasing the dosage until the desired effect is achieved
Assult
Unlawful threat or attempt to do bodily injury to another
Urinary tract obstruction
Urinary tract obstruction is an interference with the flow of urine at any site along the urinary tract Obstructions may be relieved or partially alleviated by correction of the obstruction, although permanent impairments occur if a complete or partial obstruction persists over a period of weeks to months or longer. Common causes of upper urinary tract obstruction include kidney stones (calculi) or tumor within the kidney or a stricture or compression from a tumor
Therapeutic communication
Verbal and nonverbal communication techniques that encourage patients to express their feelings and to achieve a positive relationship.
cyanocobalamin
Vitamin B12- essential for DNA synthesis essential for the conversion of folic acid to its active form absorption of b12 requires intrinsic factor (from the stomach cells) most b12 stores are in the liver and have slow excretion Oral preparations are more comfortable
Which assessment findings would indicate a possible asthma exacerbation ? Select all apply . One , some , or all responses may be correct . Fever Stridor Wheezing Tachycardia Hypotension
Wheezing Tachycardia
Tort
Wrongful act, intentional or unintentional, that results in harm to another
Megaloblatic anemia
a blood disorder characterized by anemia in which the red blood cells are larger than normal
Reticulocyte count
a count of the number of immature forms of the RBCs per a specific total number of RBCs
leucovorin
active form of folic acid
phenylephrine
adrenergic ( helps with bronchospasm and EIB) increase BP by constricting blood vessels included in alot of decongestion agents
risks factors for anemia
age- older adults dietary intake/poor diet intestinal disorders blood loss- acute or chronic malabsorption bone- marrow suppression
24 hour urine collection
all urine collected in a 24 hour period ask pt to void and discard the first void keep refrigerated or on ice in no preservatives include last void send labeled container to lab
risks for asthma
allergies older adults children family history GERD exercise
Non-rebreather mask
allows higher levels of oxygen to be added to the air taken in by the patient To a valves prevent patient from rebreathing expired air
important jobs of the kidneys
balancing solute and water transport, excreting metabolic waste products, conserving nutrients, regulating acids and bases. secretes the hormones renin for regulation of blood pressure, erythropoietin for red blood cell production, and vitamin D3 for calcium metabolism. The kidney also can release glucose into the circulation when needed
cues of asthma
barrel chest, dyspnea, nasal flaring use of accessory muscles absent breath sounds
melena
black, tarry stools; feces containing digested blood
Mean Corpuscular Hemoglobin Concentration (MCHC)
calculation of the average hemoglobin concentration in each red blood cell using HGB and HCT results: MCHC=HGB/HCT
Mean Corpuscular Hemoglobin (MCH)
calculation of the content (weight) of hemoglobin in the average red blood cell using HGB and RBC results: MCH = HGB/RBC
chronic obstructive pulmonary disease (COPD)
permanent, destructive pulmonary disorder that is a combination of chronic bronchitis and emphysema long term and hard to breathe exposure to irritants that damage lungs groups of diseases that cause airflow blockage risks- smoking and alpha1 deficiency related, exposure to pollutants chemicals and fumes
strangulation
caused by compression and closure of the blood vessels and air passages resulting from external pressure on the neck
arterial blood gases
clinical test on arterial blood to identify the levels of oxygen and carbon dioxide Typically done by RT in hospital settings! Nurse's Role: Monitor for Complications - Hematoma, arterial occlusion - notify provider Air embolism
common cues of anemia
cold, pale yellow- hemolysis (bilirubin) chest pain angina heart attack fainting enlarged spleen pica- especially pregnant women
Pica
compulsive eating of nonnutritive substances such as clay or ice
calcium carbonate
phosphate binder Mineral and electrolyte replacement Replaces calcium in deficient states Control of hyperphosphatemia in end-stage renal disease without promoting aluminum absorption Treatment and prevention of hypocalcemia Prevents postmenopausal osteoporosis Arrhythmias, constipation, nausea, diarrhea, vomiting, bradycardia Give 60-90 min after meals and give at bedtime
asphyxia
deprivation of oxygen for tissue use; suffocation
Renin
hormone secreted by the kidney; it raises blood pressure by influencing vasoconstriction (narrowing of blood vessels)
cues of COPD
dyspnea, decreased o2 saturation barrel chest wheezing clubbing history of resp infections rapid and shallow breathes
Vitamin D
hormone that is necessary for the absorption of calcium and phosphate by the small intestine. It can be obtained in the diet or synthesized by the action of ultraviolet radiation (sun exposure) on cholesterol in the skin.
Effects of NSAIDs on the kidney
effects perfusion to the kidneys leading to Kidney injury
Packet RBCS
elevate hemoglobin increase in O2 and blood cells sepsis, HF, circulatory overload, hemolytic transfusion reactions, thromboembolisms, anaphylaxis, headaches, confusion stop infusion if there is any sort of new reaction
Iron studies
evaluate iron metabolism and storage Serum iron, Total iron binding capacity, Transferrin saturation, Ferritin
aplastic anemia
failure of blood cell production in the bone marrow autoimmune- body attacking itself can also be caused by viral infections, exposure to toxins, hepatitis, espstine barr
which is absorbed better? ferrous or Ferric
ferrous
most commonly used form of iron
ferrous gluconate
iron preparations
ferrous salts ferric salts- better absorption and most common Oral( preferred), IM, IV give with an empty stomach - 30 min before and 2 hrs after meals-with full glass of water or juice- DO NOT chew or crush give drops in back of throat parenteral iron is used only hen oral is ineffective or intolerable
crackles
fine crackling or bubbling sounds, commonly heard during inspiration when there is fluid in the alveoli; sounds almost like popping/rattling - can often be cleared by coughing or suctioning (if not, more cause for concern)
proximal convoluted tubule
first section of the renal tubule that the blood flows through; reabsorption of water, ions, and all organic nutrients excrete metabolic wastes, drugs, toxins.
pteroglutamic acid
folic acid- activation takes place not long after absorption used for megaloblastic anemia (folic acid deficient or compensate for b12 deficiency prophylaxis of folate deficiency during pregnancy
Mental Health Parity Act
forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits
Kidneys
function includes: -Excretion of waste- Drugs & toxins -Fluid and electrolyte balance: Sodium, potassium, magnesium, calcium, phosphorus - Regulation of acid-base balance: Hydrogen ions and bicarbonate -Hormone secretion: Renin, erythropoietin, 1,25 dihydroxy vitamin D3 (vitamin D) Kidney is a target for other hormones Aldosterone, angiotensin natriuretic peptides
nephron
functional unit of the kidney- forms urine tubular structure which contributes to the formation of final urine allows all components of the blood to be filtered with the exception of blood cells and plasma proteins with a high molecular weight (most of the plasma proteins). The glomerulus is supplied by the afferent arteriole and drained by the efferent arteriole Nephron subunits: Renal corpuscle (Bowman capsule & Glomerulus), proximal tubule, loop of Henle, distal tubule, & collecting duct
steroids for asthma
glucocorticoids- reduced inflammation and immune response increase in HR, RR, possible adrenal crisis
tripod posture
hands on knees and hunched over often in a chair
Venturi mask
high-flow face mask that uses a Venturi system to deliver relatively precise oxygen concentrations.
Distal convoluted tubules
hollow tubes located between the loops of Henle and the collecting tubules that are involved in secretion
why are older adults more predisposed to gas exchange complications?
immune systems are depleted and loss of vital capacity/ elasticity
hyperpnea
increase in depth and rate of breathing
3 causes of impaired gas exchange
ineffective ventilation, reduced capacity for gas transportation, inadequate perfusion
chronic bronchitis
inflammation of the bronchi persisting over a long time, causes productive cough for at least 3 months excess mucus is present
glomerular filtration
is the movement of fluid and solutes across the glomerular capillary membrane into the Bowman space. capillary pressures also affect glomerular filtration The fluid filtered across the glomerular capillary filtration membrane is protein free but contains electrolytes (e.g., sodium, chloride, and potassium) and organic molecules (e.g., creatinine, urea, and glucose) in the same concentrations as are found in plasma Obstruction of the outflow of urine (e.g., caused by strictures, stones, or tumors along the urinary tract) can cause a retrograde increase in hydrostatic pressure at the Bowman space and a decrease in the GFR. Bicarbonate is completely filtered at the glomerulus
Anticholinergic drugs
ipratropium and tiotropium. block the muscarinic receptors on the bronchial smooth muscles and the exocrine gland cells in the bronchial passage. Blocking acetylcholine activity in the airway relaxes the airway muscles, reduces mucus congestion, and eases breathing.
in order for eurythropoetin to be productive in the making of RBCs, what 3 vitamins are needed
iron folate b-12
iron Dextran
iron supplement (IV form) (helps in iron deficient anemia) - increases iron stores for patients who can not tolerate or receive oral iron s/s- seizures, dizziness, hypotension, flushing, stain at IM site
treatments of anemia
iron supplements iron rich diet Folic acid and vitamin supplements blood transfusions bone marrow transplant O2 (sickle cell) pain relievers intravenous fluids removal of spleen (thalassemia) erythropoietin b12- supplements
pruritus
itching
Parts of the urinary system
kidneys, ureters, urinary bladder, urethra
pernicious anemia
lack of mature erythrocytes caused by inability to absorb vitamin B12 into the bloodstream can be influenced by a deficiency in intrinsic factor from the stomach
what happens to the body when there is a decrease of RBCS
less O2 exchange and can lead to cyanosis and hypoxia
Reticulocyte count
measurement of the number of circulating reticulocytes, immature erythrocytes in a blood specimen
CBC
measures all blood cells, platelets, RBCs, WBCs
calcium acetate
phosphate binder Mineral and electrolyte replacement Control of hyperphosphatemia in end-stage renal disease without promoting aluminum absorption increasing calcium concentrations in the body to prevent bone demoralization and osteodystrophy Arrhythmias, hypercalcemia, constipation, diarrhea, vomiting Monitor for signs of toxicity And serum calcium
abuse
physical or emotional harm to someone
Cues of child abuse and neglect
multiple fractures/injuries(especially in various stages of healing) Surface of burn ("glove", "stocking") Emotional behavior of child Bruising before 6 months is suspicious Shaken Baby Syndrome (what does it look like?) Trauma to genitals malnutrition or failure to thrive - but must rule out other causes Inconsistency in the story and/or delay in treatment
Folic acid/folate
multivitamin/ supplement Antiemetics, Restoration and maintenance of normal hematopoiesis To prevent and treat megaloblastic and macrocytic anemias, Given during pregnancy for fetal development Rash, irritability, difficulty sleeping, malaise, confusion
adverse effects of iron supplements
nausea, heart burn, bloating, constipation, diarrhea Stool my be dark/ black (especially those with peptic ulcers and regional enteritis and ulcerative colitis teeth staining- liquid iron (drops in back of the throat) DO NOT give with Antacid (alter absorption of drugs) Avoid coffee
Normal appearance of urine
normally clear yellow or amber in color. Cloudiness may indicate the presence of bacteria, cells, or a high solute concentration. normally acidic, providing protection against bacterial survival. Normal urine does not contain glucose or blood cells and only occasionally contains traces of protein, usually in association with rigorous exercise.
iron defciency anemia
not enough iron and not intake of iron ex. meats, spinach, cereals
Metabolic alkalosis
occurs when there is an alteration in the level of HCO3 along with an increase in the pH of the blood. It can be the result when a client ingests too much antacid from blood transfusions or total parenteral nutrition. It can also occur if the client has prolonged vomiting or NG suction, takes thiazide diuretics, or has a metabolic disorder such as hypercortisolism or hyper aldosteronism. Arterial blood gases will reveal a pH that is higher than the normal reference range (7.35 - 7.45) and an HCO3 level that is higher than the normal reference range (35 - 45 mm Hg).
Metabolic acidosis
occurs when there is an alteration in the level of hydrogen ions or a reduction in the amount of bicarbonate available. It can be the result of diabetic ketoacidosis, starvation, hypoxia, renal or liver failure, dehydration, or diarrhea. Arterial blood gases will reveal a pH that is lower than the normal reference range (7.35 - 7.45) and a bicarbonate (HCO3) level that is lower than the normal reference range (21 - 28 mEq/mL).
Respiratory acidosis
occurs when there is retention of CO2 due to an impairment of respiratory function. result of respiratory depression (anesthesia or opioid administration) inadequate chest expansion, an obstruction of the airway, bronchoconstriction, or laryngeal edema; or from an inability of the lungs to adequately diffuse gases (O2 and CO2) (pneumonia, COPD, chest trauma, or pulmonary emboli.) Arterial blood gases will reveal a pH that is lower than the normal reference range (7.35 - 7.45) and a CO2 level that is higher than the normal reference range (35 - 45 mm Hg).
Cinacalcet
parathyroid hormone modulator Decreased bone turnover and fibrosis Decreases serum calcium Used for secondary hypoparathyroidism in CKD on dialysis Arrythmia, torsade's de pointes Hypotension's, QT interval prolongation, nausea, vomiting, seizures Monitor ECGs- QT interval periodically during therapy
Hematocrit
percentage of blood volume occupied by red blood cells
uremic frost
precipitation of renal urea and nitrogen waste products through sweat onto the skin
B-12 and folic are especially important for which group of people
pregnant women
Erythropoeisis
production of red blood cells
Loop of Henle-
section of the nephron tubule that conserves water and minimizes the volume of urine reabsorbs sodium and chloride
chelating agents
pull iron out of the cells and eliminates in the urine
Erythrocytes
red blood cells contain hemoglobin and help to transport o2 to the cells
hemolytic anemia
reduction in red cells due to excessive destruction more common in women
bone marrow aspiration biopsy
removal of living bone marrow tissue, usually taken from the sternum or iliac crest, for microscopic examination
invasion of privacy
revealing personal information about an individual without his or her consent
acute stress
short term stress
Which client statement demonstrates an understanding of cyanocobalamin (vitamin B_{12} prescribed for pernicious anemia? should have a vitamin B_{12} injection every month. take vitamin B_{12} supplements every morning with my breakfast. eat a diet high in green vegetables. will increase my intake of processed foods fortified with vitamin B_{12}
should have a vitamin B_{12} injection every month.
Nebulizers
small machine used to convert a drug solution into a mist. much finer than those produced by inhalers , hand-breath coordination is not a concern. Can be done through a face mask or through a mouthpiece held between the teeth. Nebulizers take several minutes to deliver the same amount of drug contained in one inhalation from an inhaler, but for some patients, a nebulizer may be more effective than an inhaler.
risk factors of asthma
smoking/secondhand smoke allergies dust
chronic stress
stress associated with long-term problems that are beyond a person's control
episodic stress
stress resulting from life experiences and situations that varies with those experiences Type A personalities
emphysema
structural changes- damage to alveoli sacs that stay inflated difficulty releasing air- lungs dont empty properly elastin is lost vital capacity is lower, dyspnea, barrel chest
instrinsic factor
substance that faciliates the absorption of vitamin B12 across the intestinal lining
COPD treatment
supplemental o2 bronchodilators inhaled steroids antibiotics not to exceed 2ml/min
Urinalysis
the examination of urine to determine the presence of abnormal elements Urinalysis includes evaluation of the color, turbidity, protein, pH, specific gravity, sediment, and supernatant
resilience
the personal strength that helps most people cope with stress and recover from adversity and even trauma
Stress
the process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging Not always bad
mental health
the state of being comfortable with yourself, with others, and with your surroundings Able to fulfill roles and live productively
bronchoscopy
the visual examination of the bronchi using a bronchoscope
why are children more predisposed to gas exchange complications?
underdeveloped immune system and lungs
False Imprisonment
unlawful restraint or restriction of a person's freedom of movement
Battery
unlawful touching of another person without consent Actual harm
mictruition
urinating
Theophylline (Aminophylline)
used for really bad asthma- used when not well controlled with normal preventative methods can cause toxicity- relax smooth muscle of bronchiole airway to prevent and treat wheezing, shortness of breath, and chest tightness caused by asthma, chronic bronchitis, emphysema, and other lung diseases.
Dry Powder Inhalers
used to deliver drugs in the form of a dry micronized powder directly to the lungs. DPIs are breath activated, making DPIs much easier to use. DPIs deliver more drug to the lungs Also, spacers are not used with DPIs.
Common food sources of iron
wheat Chex, fried clams, pork/beans, ( meat) lentils, spinach, beef chuck, garbanzo beans, tomato puree, turkey
Uremia
when the client develops symptoms from azotemia
Coarse Rales
- lower pitched, likely change with suctioning or coughing
Glomerulus-
A ball of capillaries surrounded by Bowman's capsule in the nephron and serving as the site of filtration in the vertebrate kidney.
asthma
A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, inflammation and wheezing. release of mucus, airway muscle constriction, swelling of bronchial membranes intermittent and reversible airflow obstruction of the bronchioles immune response- allergen enters the lungs and cause mediation of mast cells and a histamine and leukotriene response
CKD and Metabolic System Changes:acid base balance
Acid-base balance -As nephrons are lost, blood pH changes = metabolic acidosis -Kidney can't excrete hydrogen ions (acids) r/t ammonium and bicarbonate imbalances In CKD ammonium production is decreased and reabsorption of bicarbonate does not occur. Losing the base and must replace the base - Kussmaul respiration compensate for the increased blood hydrogen ions levels
Diuretics: pathophysiology
Action: Block the reabsorption of sodium & chloride Creates osmotic pressure that prevents reabsorption of water. Water and solutes are excreted. The amount of solute in the nephron becomes progressively smaller as filtrate flows from proximal tubule to collecting duct. Drugs that block solute reabsorption to the greatest degree produce greater diuresis. Example: furosemide acts on the loop of Henle and has greater diuresis than spironolactone acting on the distal convoluted tubule
When do we give antibiotics in relation to collecting a culture?
After receiving the sample
Why is peripheral perfusion important for accurate pulse ox?
Allows for an accurate reading and an idea of the perfusion reading
Beclomethasone
Anti-inflammatory (steroidal) (Inhaled) Prophylactic everyday use - decrease in frequency and severity of asthma attacks and improves symptoms observe for wheezing, coughing and rhinitis not for patients currently experiencing asthma attacks can effect growth in kids
Cyanocobalamin (vitamin b-12)
Antianemics Water soluble vitamins Corrects the effects and manifestations of pernicious anemia/ corrects Vitamin b12 deficiency * vitamin b-12 is necessary for the activation of Folic acid- without folic acid remains inactive - headaches, diarrhea, itching, pulm edema, hypokalemia, HF deficient: palor, neuropathy, red and inflamed tongue
Which clinical finding of an 8-year-old child with a history of asthma requires immediate intervention ? Barrel chest Audible wheezing Heart rate of 105 beats per minute Respiratory rate of 30 breaths per minute
Audible wheezing
Beta2-Adrenergic Agonists
Bronchodilator Mechanism of action: Relieving acute bronchospasm and preventing EIB. Activation of beta2 receptors in the smooth muscle of the lung, these drugs promote bronchodilation, relieving bronchospasm Improves airflow to the lungs 1st-line drugs as a component of an asthma management regimen. Also used COPD May be administered orally or by inhalation, and their effects may be brief or prolonged. Classifications Short-acting agents- albuterol Long-acting agents- salemetrol
Tiotropium
Bronchodilators Decreased incidence and severity of bronchospasm in COPD and asthma Acts as anticholinergic by selectively and reversibly inhibiting M3 receptors in smooth muscle of airways Tachycardia, rash, glaucoma, dry mouth, constipation, urinary difficulty, urinary retention
salmetrol
Bronchodilators, adrenergic Bronchodilation LONG ACTING Relaxation of airways smooth muscle Selective for beta2 pulmonary receptors palpitations, cramps, arrhythmias, headaches, nausea, vomiting, nervousness, restlessness, tremors long ACTING always combine with steriods
albuterol
Bronchodilators, adrenergic Relaxation of airways smooth muscle Selective for beta2 pulmonary receptors QUICK ACTING Chest pain, palpitations, angina, arrhythmias, hypertension, hyperglycemia, hypokalemia, nausea, vomiting, nervousness, restlessness, tremors, headache
Ipratropium
Bronchodilators, allergy, cold and cough remedies without systemic anticholinergic effects, decrease in rhinorrhea Inhibits cholinergic receptors in bronchial smooth muscle Hypotension, palpitations, blurred vision, sore throat, nasal dryness, irritation, nauseam dizziness, headache, nervousness, bronchospasm, cough
Rhonchi
Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways.
thorasentesis
Collecting pleural fluid by passing a needle to the plural cavity.
Opioid Induced Respiratory Failure (OIRF)
Common sentinel event - approx. ½ of all respiratory arrest patients have opioids in system High risk groups - COPD, HF, renal disease, obstructive sleep apnea, obesity, use of other meds, incisions impair breathing, older patients, long anesthesia time Reverse - Naloxone! (You'll hear it referred to also as "Narcan.")
Medications used to treat AKI
Fluid challenge- Administer IV fluids to promote kidney perfusion or replace fluids if client is dehydrated Diuretics (furosemide, mannitol, ethacrynic acid) To promote increased filtration of the blood by kidney Sodium polystyrene sulfonate (Kayexalate) Replaces sodium with potassium in the intestinal tract to promote potassium excretion Sorbitol- Induces bowel movement to promote excretion of excess potassium Sodium bicarbonate - To treat severe metabolic acidosis Phosphate-binding agents To treat hyperphosphatemia Normal phosphate is 2.8-4.5 mg/dL
ferrous sulfate
Iron Supplements Prevention of Iron Deficient Anemia (Enters blood stream and is transported to organs to increase iron stores) Dizziness, headaches, syncope, nausea, constipation, dark stools, Gi bleeding, vomiting, staining of teeth Use caution- peptic ulcers, ulcerative colitis, alcoholism, renal impairment, hepatic impairment. Increase in hemoglobin (may reach normal ranges after 1-2 months)
Which cause of anemia would the nurse recognize as the most common cause of anemia in 1 -year- olds? Thalassemia Lead poisoning Iron deficiency Sickle shape of blood cells
Iron deficiency
Pathophysiology-chronic kidney injury (CKI)
Progressive, irreversible disease 3 months or longer Results in end-stage kidney disease (ESKD) Development of azotemia & uremia Metallic taste, anorexia, N/V, muscle cramps, uremic frost on skin, fatigue & lethargy, hiccups, edema, dyspnea, paresthesias Renal changes: Abnormal urine production, F&E imbalances Metabolic abnormalities, BUN increases Urine output decreases, Extracellular volume overload (because the body can't excrete sodium) Fluid overload= edema, crackles, SOB and pleural effusion or pericardial effusion
Bronchodilators- BAM
Relaxes and opens the airways, or bronchi, in the lungs.(DILATION) Provide symptomatic relief but do not alter the underlying disease process (inflammation) Most patients who require a bronchodilator also use an inhaled glucocorticoid for long-term suppression of inflammation. Classification of bronchodilators: Beta2-Adrenergic Agonists( Inhaled short term and Inhaled long term) (albuterol) Anticholinergic Drugs (ipatropium) Methylxanthines (theophylline)
CKD and Metabolic System Changes: sodium
Serum Creatinine increases Urea is normally excreted by the kidneys, BUN may elevate Sodium -Early CKD= risk for hyponatremia r/t damaged nephrons inability to absorb sodium and sodium is lost on the urine -Later CKD= urine production decreases and sodium excretion is reduced; hypernatremia occurs with only modest increases in dietary sodium intake; leads to severe F&E disruption (hypertension and edema)
A pregnant client with iron- deficiency anemia is prescribed iron supplements daily. To help the client increase iron absorption, the nurse would suggest the client eat foods high in which substance ? Vitamin C Fat content Water content Vitamin B complex
Vitamin C
What allows for better absorption of iron in diet
Vitamin C
A child is prescribed fluticasone after an acute, asthma attack. Which instruction would the nurse give the family about the administration of his medication? Fluticasone needs to be taken with food or milk The medication is primarily used to treat acute asthma attacks The child should suck on hard candy to help relieve dry mouth Watch for white patches in the mouth and report to the healthcare provider
Watch for white patches in the mouth and report to the healthcare provider
Emphysema
a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness. -Loss of lung elasticity and hyperinflation of lung tissue. -Alveoli are destroyed (cigarette smoking triggers increased synthesis of proteases, which are enzymes that destroy and eliminate particulates inhaled in breathing), leading to decreased surface area for gas exchange, carbon dioxide retention, and respiratory acidosis -Pulmonary Function Study will show an increase in residual volume (air remains trapped in lungs) -Dyspnea on exertion (DOE)- interferes with ADLs -Minimal coughing with little or no sputum -Abnormal ratio of anteroposterior to lateral diameter (changes from 1:1.5 to 1:1) - common -thin & underweight -use of accessory muscles -Hypoxia with hypercapnia (too much CO2 in blood)
Folic Acid (Folate)
essential for DNA synthesis- without this cell division can not proceed must be converted to active form by b12 absorbed in small intestine and transported to liver and other tissues important for pregnant woman and prevention of neural tube defects pteroylglutamic acid - generic form
Why is iron important?
essential to function of hemoglobin and myoglobin iron in the body is regulated by intestinal absorption (most of the iron in the body stays in the body and is recycled)
Medications used to treat CKD
- Diuretics - Treat mild-to-severe CKD, but not used in ESKD after dialysis is started Furosemide or Bumetanide - Vitamins & Minerals- As replacements when on dialysis - Phosphate binders (take with meals, not with other drugs)(Calcium acetate, Calcium carbonate) - Non-calcium phosphate binders (doesn't disturb calcium levels) (Lanthanum carbonate,Sevelamer) - Sodium polystyrene sulfonate (Kayexalate) Replaces sodium with potassium in the intestinal tract to promote potassium excretion -Multivitamins & vitamin B supplements (Folic acid/folate,Cyanocobalamin (B12)) -Oral iron salts: ferrous sulfate, -Parenteral iron salts: Iron dextran (IV), Iron sucrose (IV) -Vitamin D: Calcitriol - Erythropoietin-Stimulating Agents Used to correct anemia by stimulating bone marrow to increase RBC production Epoetin alfa Darbepoetin alfa
labs for respiratory related issues
ABGs pulse ox sputum culture pulm function tests - spirometry chest x-ray allergy testing
Zafirlukast
Antiasthma tics (leukotriene antagonist) Bronchodilators Long term control agent in the management of asthma Decreases frequency of asthma attacks Mediate airway edema, smooth muscle constriction and altered cellular activity Decreases the inflammatory process Headache, agitation, aggression, anxiety depression, dizziness, abdominal pain, nausea, vomiting, dyspepsia, Churchstrost syndrome
cromolyn
Antiasthmatics allergy, cold and cough remedies (prophylaxis- not a bronchodilator) inhaled through nebulizer Decrease frequency and intensity of asthmatic episodes or allergic reactions Prevents the release of histamine and slow reacting substances of anaphylaxis from mast cells DO not take with caffeine cough, wheezing, bronchospasm safest of all
sodium polystyrene sulfonate (Kayexalate)
Antidote for hyperkalemia Electrolyte modifiers Reduction of serum potassium levels Exchanges sodium ions for potassium ions in the intestine s/s- Intestinal necrosis, hypocalcemia, hypokalemia, sodium retention, hypomagnesemia, constipation, fecal impaction Monitor for nausea, vomiting, anorexia
Mucomyst
Antidotes (for acetaminophen toxicity) Prevention or lessening of liver damage following acetaminophen overdose Lowers viscosity of mucous Decrease in the buildup of hepatotoxic metabolites in acetaminophen overdose, degrades mucus allowing better mobilization and expectoration Vasodilation, tachycardia, hypotension, rash, clamminess, puritus, urticaria, rhinorrhea, fluid overload, nausea, vomiting, drowsiness, bronchospasm
Cyanocobalamin (Vitamin B12)
Antiemetics Vitamins Corrects the effects and manifestations of pernicious anemia and corrects Vitamin b12 deficiency Headache, HF, diarrhea, itching, swelling of body, pulmonary edema, pain at IM site
CKD and Metabolic System Changes: calcium and phosphorus
Calcium and phosphorus (have reciprocal relationship) -Normally the kidney produces a hormone needed to activate vitamin D which enhances intestinal absorption of calcium - In CKD phosphorus excretion decreases and causes elevated phosphate levels (hyperphosphatemia); risk for bone and skeletal changes ( early osteoporosis) Parathyroid hormone (PTH) & calcium/phosphorus relationship -PTH controls phosphorus levels by causing tubular excretion of excess phosphorus -As plasma phosphorus levels increase (hyperphosphatemia), calcium levels decrease (hypocalcemia) -Chronic low calcium levels stimulate the parathyroid glands to release more PTH. results in calcium being released from storage areas in bones, leading to bone density loss. -CKD exacerbates low blood calcium levels because kidney cell damage also reduces production of active vitamin D which aids in calcium absorption -CKD induced low calcium and high phosphorus levels causes renal osteodystrophy= bone pain, bone density loss, and fractures -Crystals from excessive calcium or phosphorus can lodge in kidney, heart, lungs, blood vessels, joints, etc. Itching increases with calcium-phosphorus imbalances
CKD: Cardiac System Changes
Kidney and Heart have a reciprocal relationship - Hypertension (HTN) is common with CKD -HTN can be the result or cause of CKD (atherosclerosis & HTN damages the glomerular capillaries and leads to end-stage kidney disease (ESKD) -HTN can reduce perfusion to kidney( vaso constricted, could be due to plaques) -renin is released to increase blood flow- the production of angiotensin and aldosterone is triggered- angiotensin causes vasoconstriction and increased blood pressure -aldosterone stimulates reabsorption of sodium and water, increasing volume and raising blood pressure In CKD, this cycle results in severe hypertension (it's a perfusion problem) CKD elevates BP by fluid and sodium overload and dysfunction of the renin-angiotensin-aldosterone system (RAAS) - Hyperlipidemia r/t fat metabolism that increases triglycerides, total cholesterol, and low-density lipoprotein (LDL) levels - Increases risk for coronary artery disease and acute cardiac events - Heart failure (HF) r/t increased workload of the heart Jugular distention, peripheral edema, crackles Pericarditis r/t uremic toxins or infection Dysrhythmias r/t hyperkalemia (look for peaked T waves on ECG)
Bronchodilators: Methylxanthines
Theophylline - narrow therapeutic index ( can be toxic) Mechanism of action- Central nervous system (CNS) excitation Other actions: cardiac stimulation, vasodilation, and diuresis. Produces bronchodilation by relaxing smooth muscle of the bronchi ( WEAK) Prototype: Theophylline (continued on next slide) Principal bronchodilator medication in the treatment of asthma- long term The mechanism of bronchodilation is believed due to blockade of receptors for adenosine. Metabolized in the liver. Interactions- DO NOT GIVE WITH caffine, tabacco Aminophylline is a theophylline salt that is more soluble than theophylline itself. - available in formulations for IV dosing -Preferred over theophylline b/c of its high solubility Infusions should be done slowly( Rapid injection: severe hypotension & death)
How should liquid iron be taken?
Through a straw placed in the back of the mouth with a full glass of water *can stain teeth
renal osteodystrophy
a general term that refers to bone disease related to CKD caused by over- or underproduction of parathyroid hormone or by exposure to aluminum bone metabolism and structural damage caused by CKD
sickle cell anemia
a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape genetic unable to carry hemoglobin/ 02 to tissues can cause major pain- due to blockage and clogging in blood vessels
Creatinine
a natural substance produced by muscle and released into the blood at a relatively constant rate It is freely filtered at the glomerulus, but a small amount is secreted by the renal tubules, meaning creatinine clearance overestimates the GFR, but within tolerable limits
Angiotensin
a peptide hormone that constricts blood vessels, causes the retention of sodium and water, and produces thirst and a salt appetite
dissacociative identity disorder
a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Formerly called multiple personality disorder.
Respiratory alkalosis
occurs when there is an excessive loss of CO2 through hyperventilation, mechanical ventilation, fever, overdose of salicylates, or lesions to the central nervous system. Arterial blood gases will reveal a pH that is higher than the normal reference range (7.35 - 7.45) and a CO2 level that is lower than the normal reference range (35 - 45 mm Hg).
