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Adult Health 2-exam 2 focused review

Terms in this set (80)

i. Ventilatory failure is when they cannot mechanically suck/pull in air into the lungs and cannot expire air on their own; patient cannot breathe on their own mechanically.
1. Pathologies that would cause ventilatory failure: unilateral sucking chest wound (one of the findings is deviation of the trachea- trachea is moving to one side); tension pneumothorax
2. One of the big causes of ventilatory failure is tension pneumothorax because they cannot inflate the affected, collapsed lung.
Other causes are diseases that affect the diaphragm (paralysis of the diaphragm), which prevents the patient from breathing in: multiple sclerosis, Guillain barre (starts from toes and ascend up), spinal cord injury (will cause diaphragmatic paralysis), brainstem stroke or brainstem bleed or injury to the brain causing ICP to go 1. up and the resultant swelling will lead to brain tissue to herniate and thus destroy the medulla, and opioid overdose.
What is the mechanism of ventilatory failure in an opioid overdose? Respiratory depression.
a. During an opioid overdose, patient is not breathing and ventilating adequately. Therefore, this patient has ventilatory failure AND oxygenation failure.
ii. Can have both oxygen and ventilatory failure at the same time à definitely need ventilator.
iii. Oxygenation failure occurs at the level of the alveoli; involves diseases that prevent person from oxygenating.
1. One of the primary problems is inflammation. You get inflammation with any infectious process like in pneumonia and COVID. In COVID, there was localized alveolar inflammation. What happens when you get localized inflammation? A release of histamine
With inflammation in any place in the body, whether systemic or localized, you will get a release of histamine.
a. Release of histamine leads to capillary leak, which then results to the alveoli filling up with fluid.
b. COPD has an inflammatory component with chronic bronchitis and especially emphysema.
Fluid buildup in the alveoli will impede oxygenation
1. kidney infection; inflammation of the kidney due to a bacterial infection.
a. Can be hospitalized, but not always. However, you can be one of the sickest people ever with pyelonephritis.
i. Intense flank pain (very specific to pyelonephritis)
ii. Very high temp: extremely febrile (some of the highest temps you will ever see as an RN in acute care are going to come from pyelonephritis and peritonitis)
b. Most likely caused by a UTI that migrated from the bladder.
c. Treatment/Interventions
i. Obtain blood culture x2. Why do you need to do 2 sets of blood cultures? One can be contaminated, so you have to get two different sites for samples. Why are you doing a culture? So you know what is the causative bacterial agent and which antibiotic to use against it.
ii. Also, why do you have to get your blood cultures x2 first? If you give the antibiotics first and then get the blood cultures, you're going to have a skewed result (similar to nitro and EKG)
iii. Hang the antibiotic drip as quickly as you can.
iv. To treat high temp: acetaminophen
1. Can treat the pain and temp at the same time by giving Percocet (contains a combination of acetaminophen and oxycodone) or Vicodin (contains acetaminophen and hydrocodone)
2. Do not give 2 tabs of Percocet or 2 tabs of Vicodin because that is a big hit of opioids and patient may not be able to tolerate it. Also, it could potentially stop the patient's breathing
3. Only give 1 tab of Percocet or 1 tab of Vicodin, and then give an additional Tylenol as needed.
ii. Can also send out urine culture too.
Can patient with pyelonephritis go sepsis? YES (this is an infectious process)
Peritonitis secondary to peritoneal dialysis
a. In peritoneal dialysis, there is a Tenckhoff catheter that goes into the peritoneum and it will administer the dialysate in a certain concentration. The dialysate dwells in there for a certain number of hours (determined by the prescription; ex: 3-4 hours). Afterwards, you release the clamp and it drains into a bag on the floor. The fluid that comes out into the bag is called effluent.
i. When it comes out, effluent looks like urine (despite it coming from the peritoneal cavity). The effluent should be clear. If it is not and it looks cloudy ---->infection. This is very serious! This indicates peritonitis, which can kill the patient in a very short amount of time.
b. Clinical findings: pain, rigid abdomen (because inflammation is starting), high elevated WBC count, very high temp (fever)
c. Peritonitis can turn into systemic inflammatory response system (SIRS) very quickly! (Remember: the 2 pathophysiological mechanisms in SIRS is widespread vasodilation and capillary leak à causing hemodynamic instability).
i. This can turn into sepsis: patient's BP tanks and ultimately, they die from MODS.
ii. Why is peritonitis so dangerous? There is a big surface area of infection. Whether patient goes into sepsis or not (whether infection has gone into the bloodstream or not), they will still get SIRS.
iii. Infection is causing inflammation in the gut.
1. You can have inflammation without infection ---------->Patient will have SIRS with or without systemic septicemia
Broad spectrum antibiotics is prescribed immediately, given IV piggyback