95 terms

adult health theory quiz one

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aspirin
drug that inhibits platelet aggregation
2 types of WBCS
agranulocytes and granulocytes
agranulocytes
lymphocytes and monocytes
granulocytes
neutrophils, eosinophils, basophils
thrombocytes
platelets
neutrophils
protect patients from infection
neutropenia
-decreased production or increased destruction of neutrophils (less than 2,000)
-absolute neutrophil count less than 1,000
-increased risk for infection
-note fever response decreased
anemia
-syndrome, not a disease (constellation of signs and symptoms but is always caused by something else)
-decreased hemoglobin, hematocrit, and RBC count
hypo proliferative anemia
-defect in production of RBCS
-caused by iron, vitamin B12, or folate deficiency, decreased erythropoietin production, cancer
erythropoietin
comes from kidney to stimulate BM to produce RBCs
hemolytic anemia
-excess destruction of RBCs
-caused by altered erythropoiesis, hyperslpenism, drug-induced or autoimmune processes, mechanical heart valves, SC anemia
hemorrhagic anemia
-blood loss
-trauma with acute bleeding
-chronic: GI losses, occult bleeding, heavy menstruation
symptoms of anemia
-fatigue, weakness, malaise, pallor/jaundice, cardiorespiratory signs, tongue changes, nail changes, angular cheilosis (dried and cracked mouth), PICA
hemoglobin and hematocrit
-hemoglobin: concentration of Hg in blood (only in RBCs); normal is 12-16
-hematocrit is percentage of RBCs in blood plasma; normal is 40-50%
reticulocyte count
-number of immature RBCs (nucleated RBCs that aren't mature yet)
-can get DNA because they still have nucleus
-high is good
RBCS have no nucleus true or false
true
RBC indices
MCV, MCH, MCHC
-gives you a lot of clues to what type of anemia it is (color, size, etc)
iron studies
center of hemoglobin molecule
-no iron means no Hg means no RBCs
vitamin B12 and folate deficiency
signs of lack of RBCs
diagnostic testing-bone marrow aspirate/biopsy
assesses quantity and quality of each blood cell type
medical management of anemia
-correct or control the cause
-transfusion of packed RBCs
-treatment specific to the type of anemia: dietary therapy, iron or vitamin supplementation (iron, folate, b12), transfusions, immunosuppressive therapy
nursing process assessment: patient with anemia
-health history and physical exam
-laboratory data
-presence of symptoms and impact of those symptoms on patient's life: fatigue, weakness, malaise, pain
-nutritional assessment (B12, iron, folate)
-medications (anti-coagulants)
-cardiac and GI assessment
-blood loss: menses, potential GI loss
-neurologic assessment (hypoxia worst case)
nursing diagnoses for patients with anemia
-risk for inadequate tissue perfusion
-altered tissue perfusion
-risk for injury
-risk for falls
-fatigue
-altered nutrition
nursing interventions for patients with anemia
-monitor O2 stats, vital signs
-given oxygen therapy
-do all the things you would do for falls
-get up slowly, no risk objects
transfusion therapy-PRBCs
-packed RBCs
-takes out the serum/plasma (don't want other's antibodies)
transfusion therapy-FFP
-fresh frozen plasma
-just plasma
-need clotting factors and things in plasma (not RBCs)
transfusion therapy-platelets
-people with prolonged thrombocytopenia
plasmapheresis
-put your blood and filter it through a system and then put it back in
-gets bad stuff out and goes back in healthy
-kind of like dialysis
-good for immunocompromised patients and myasthenia grave
what do you do if someone reacts to blood transfusion
always stop the transfusion
Febrile reaction to blood transfusion
WBC in the donor blood is causing a reaction
hemolytic reaction to blood transfusion
RBCs that you are putting in patient are breaking down and clumping
transfusion complications
-circulatory overload
-bacterial contamination
-transfusion-related acute lung injury
-delayed hemolytic reaction
-disease acquisition
-longer-term transfusion therapy
Hereditary Hemochromatosis
-autosomal recessive (most prevalent on Celtic population)
-over absorption of iron from GI tract
-treatment: therapeutic phlebotomy (taking blood out of a vein)
-iron deposition in organs can kill you (liver, skin, pancreas)
-Red Cross won't take blood from these patients
primary polycythemia
polycythemia vera
-proliferation of RBCs
-EPO shots, blood doping
secondary polycythemia
-excessive production of erythropoietin
-compensatory response to hypoxemia (COPD patients)
medical treatment of polycythemia
-treatment not needed if condition is mild
-treat underlying cause
-therapeutic phelebotomy
bleeding disorders
-failure of hemostatic mechanisms
-causes: trauma, platelet abnormality (number, form), coagulation factor abnormality (factor 8 deficiency)
-medical management: specific blood products
-nursing management: limit injury, assess for bleeding, bleeding precautions
thrombocytopenia
-150,000-450,000 is normal amounts
-low platelets in blood
bleeding disorders AVOID
-rectal temp
venipuncture/needles
-catheters
-aspirin et al
bleeding disorders USE
-prolonged direct pressure on sites
-stool softeners
-skin lubricants
-fall precautions
adult's typical body percentage that is water
60%
2 major fluid compartments
intracellular and extracellular
osmosis
when water moves across a semipermeable membrane from an area of low solute concentration to an area of high solute concentration
albumin
serum protein that exerts this force the keep fluid from escaping into the tissues
3 factors that increase serum osmolality
-severe dehydration
-diabetes insipidus
-hypernatremia
ADH
-secreted by posterior pituitary
-causes kidney to retain water
-increases blood volume
-decreases urine output and increases concentration
aldosterone
-secreted by adrenal cortex
-causes kidney to retain sodium
-increase blood volume
hypovolemia (fluid volume deficit)
-causes: vomiting, diarrhea, sweating, blood loss, loss of fluid/electrolytes
-symptoms: weight loss, decreased skin turgor, concentrated urine, decrease urine output, increased thirst, pale/clammy
-decreases BP
increases hematocrit
-increases urine specific gravity
hypervolemia (fluid volume excess)
-causes: kidney injury, heart failure, cirrhosis, corticosteroid excess, too much sodium
-symptoms: weight gain, edema, JVD, increased RR, increased urine output, SOB
-increases BP
-decreases hematocrit
-decreases urine specific gravity
concentration of sodium in normal saline
0.9%
concentration of sodium in 1/2 normal saline
0.45%
concentration of sodium in 1/4 normal saline
0.225%
isotonic saline solution
0.9%
electrolytes in Lactated ringer solution
Na, K, Ca, Cl
number of calories in a liter of D5W
170
D5W tonicity
isotonic
why can't potassium be given IV push
-to avoid replacing it too quickly
-would cause cardiac arrest
why is K dangerous for patients with impaired renal function
-already have decreased ability to excrete potassium
-too high affects heart
what is tetany and what electrolyte disturbances can it cause?
-increased neural excitability
-hypocalcemia and hypomagnesemia
trousseau sign
-BP cuff, 2-5 mins, carpal finger spasm
-sign of hypocalcemia and hypomagnesemia
Chvostek sign
twitch of muscles with you touch side of face
-sign of hypocalcemia and hypomagnesemia
hyponatremia
-below 135mEq/L
-causes: fluid overload, extreme temperatures, excessive sweating, aldosterone deficiency
-symptoms: excessive ADH activity, poor skin turgor, dry mucosa, headache, low BP, N/V
-effect on cell size: cell swells as water in pulled into cell from ECF
hypernatremia
-above 145mEq/L
-causes: fluid deprivation, poor thirst mechanism, high sodium diet, watery diarrhea
-symptoms: thirst, high body temp, swollen/dry tongue, lethargy, irritability, N/V, increased BP and pulse
-effect on cell size: cell shrinks as water is pulled out of cell into ECF
hypokalemia
-below 3.5mEq/L
-causes: diarrhea, vomiting, hyperaldosteonrism, alkalosis, starvation, diuretics
-symptoms: fatigue, N/V, polyuria, muscle weakness, low BP
-effect on T wave: flattened
hyperkalemia
-above 5mEq/L
-causes: Addison disease, burns, metabolic acidosis, kidney injury
-symptoms: muscle weakness, lethal arrhythmias, tachycardia, anxiety, dyspnea, cramps
-effect on T wave: peaked
where does trachea bifurcate
carina and left main bronchus
functions of respiratory system
-provide oxygen for tissue metabolism
-remove carbon dioxide
-acid-base balance (CO2 acid, HCO3 base)
-speech
-sense of smell
-fluid balance
-temperature control
normal blood pH
7.4
where does gas exchange take place
alveoli
ventilation (V)
movement of air in/out of the lungs
perfusion (Q)
blood flow in capillaries surrounding air sacs
V/Q should equal
1
hypoxia
-decrease in oxygen supply to the tissues and cells
-early signs/symptoms: increased activity, increased BP, P, R, anxiety, restlessness and agitation
-later symptoms: dyspnea, cyanosis, confusion, lethargy
atlectasis
-lower respiratory tract disorder
-collapsed lung
-usually due to blockage in bronchioles
-first step is to remove the cause of the obstruction
-opioids and sedatives decrease respiratory function
-hallmarks: tachypnea, dyspnea, hypoxemia
pneumonia
-lung inflammation caused by microorganisms
-need chest x ray to diagnosis
-most common cause of death of infectious disease
-risk factors: age, smoking, immunocompromised, diabetes, obesity
-symptoms: fever, cough, chills, loss of appetite, general weakness, increased tactile remits
aspiration pneumonia
-develops after inhalation of colonized oral or pharyngeal material
-people with feeding tubes are at risk
oxygen therapy
-used to relieve hypoxia
-goal to maintain O2 stat at 90% (pO2 at 60mmHg)
-to use the lowest fraction of inspired oxygen to have an acceptable blood oxygen level without causing harmful side effects
oxygen therapy: hazards and complications
-combustion: no smokin
-oxygen induced hypoventilation: CO2 narcosis, hypoxic drive, monitor RR and depth
-oxygen toxicity: greater than 50% for longer than 48 hours
-drying of mucous membranes: when greater than 4L/min (need to add humidity)
low flow oxygen
-patients also breathes in some unregulated amount of room air
-nasal cannula, simple face mask, partial rebreather mask, non-rebreather mask
nasal canula
-1-2L/min (23-30% O2)
-3-5L/min (30-40% O2)
-6L/min (42% O2)
simple task mask
-40-60% O2 at 6-8L/min
-skin care
-remove to eat
partial rebreather mask
-50-75% at 9-11L/min
-to the keep the reservoir bag inflated
non-rebreather mask
-80-100% at 12L/min
-one way valve
high flow oxygen
-controls percent of oxygen and room air taken in
-venti-mask
-tracheostomy collar
venti-mask
-delivers the most accurate oxygen concentration
-24-40% FiO2 with flow rate 4-8L/min
-high humidity
prevention of pneumonia
-pneumococcal vaccine (every 5 years, older than 65 and chronic disease)
-flu vaccine
-hand washing
-respiratory equipment hygiene
-appropriately treating underlying illnesses
-smoking cessation
-prevent aspiration
arterial blood gases (ABGs)
-best way to asses need for oxygen therapy (but invasive)
-drawing gases fro man arterial line in a critical care patient
diagnosis of pneumonia
-physical exam
-chest x ray
-blood cultures
-sputum cultures
chronic obstructive pulmonary disease (COPD)
-includes bronchitis and emphysema
-separate pathophysiologies, but many patients have both and some also have asthma
asthma
reversible airway inflammation and constriction
emphysema
-abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli
-decreased alveolar SA increases in "dead space"
-impaired oxygen diffusion
-hypoxemia results
cor pulmonale
-increased pulmonary artery pressure leading to right sided heart failure
-heart failure from a lung problem
chronic bronchitis
-disease of the airways
-cough and sputum production for at least 3 months in each of 2 consecutive years
-ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways
-alveoli become damaged, fibrous, and alveolar macrophage function diminishes
-patient more susceptible to respiratory infections
COPD general appearance
-thin, loss of muscle mass, barrel chest, bends forward, cyanosis, clubbing, rapid breathing, using accessory muscle
complications of COPD
-respiratory insufficiency
-respiratory failure
-pneumonia
-chronic atelectasis
-pneumothorax
-cor pulmonale