Rasmussen - MDC III - Exam 2

never confirm/deny anything"tell me more about it

Therapeutic Communication Qs...

airborne- N95- negative pressure room

What precautions are we using for tuberculosis?(SATA?)

antimicrobials- isoniazid,- rifampin- pyrazinamide- ethambutol*they will have to take these "long-term" (6-9 mo.)*

Medications to treat tuberculosis

- no ETOH- medication compliance - stick with the doses, continue all the way through- f/u with doctor appointments

Patient Education: Long-term antibiotics(SATA?)

- sputum culture*PPD test is NOT for diagnosing, it does NOT mean active exposure*

How do you diagnose tuberculosis?

hepatotoxic- no ETOH- no drugs- eat a diet with quality protein; iron; vitamins A, B, C, and E; and abundant fresh produce- no other use of hepatotoxic medications

What do antimicrobials do to the body? And what patient education goes along with that?(SATA?)

asthma

__________ is a chronic intermittent airway obstruction caused by inflammation of the airway tissues that results in *bronchoconstriction*▪ Intermittent and *reversible airflow obstruction affecting airways only, not alveoli​​

complete airway obstructionintubation/tracheotomy....keep that airway patent - priority!

I think this is about status asthmaticus:A patient comes in with asthma...you listen to their lungs and they have lung sounds...then you lose lung sounds...what does that mean? What do we do next?

▪ pollution▪ dust▪ smoke▪ fire places▪ pet dander▪ household chemicals▪ bacteria▪ viruses▪ mold▪ exercise▪ weather changes from warm to cold▪ drugs: aspirin, NSAIDS, beta blockers

What can exacerbate asthma?"A good education question...avoid triggers!"(SATA?)

bronchodilators- beta2 agonists (SABAs) - albuterol, levalbuterol, terbutalinecorticosteroids- fluticasone- budesonide- mometasoneleukotriene modifiers- montelukast/Singular

Medications to treat asthma(SATA?)

5 min apartalbuterol (bronchodilator) firstrinse mouth after fluticasone (why? to avoid candida/thrush)

How do you take asthma medications? Ex: Spiriva and albuterol(SATA?)

improve gas exchange

Overall goal for Emphysema/COPD patients

Yes! Permanent damage to alveoli. Not reversible.

Are emphysema/COPD permanent?

CO2 builds up because the alveoli can't properly open for the CO2 to be expelled.

What happens to the patient's CO2 levels in COPD?

tripod posebarrel chestaccessory muscle useclubbingSOBcyanosisdyspnea

S/S: Emphysema/COPD(SATA?)

anxious - we have to decrease their anxiety; can't give them sedatives because that will decrease their respirations. So we to use relaxation techniques, etc.progressive relaxation, hypnosis therapy, and biofeedback (Ch 30)

How will emphysema/COPD patients be feeling? + patient education(SATA?)

▪ Respiratory infections▪ Wheezing▪ Dyspnea▪ Tachypnea▪ Sputum production - thick mucus▪ Chest congestion▪ Barrel chest▪ Distended abdomen▪ Crackles▪ Clubbing of the fingers and toes▪ Dry, nonproductive cough▪ Foul-smelling pale stool with high-fat content▪ Hematemesis▪ Poor growth▪ Limited exercise tolerance▪ Decreased pulmonary function

S/S: Cystic Fibrosis

sweat test (chloride)

How do you diagnose cystic fibrosis?

*osteoporosis - teach patients to have Ca intake*decreased immunitybuffalo humpthin skinweight gainhyperglycemiapeptic ulcer diseaseincreased potential for infectionadrenal insufficiency

Side effects of long-term steroid use

▪ Nutrition management▪ Positive expiratory pressure▪ Chest physiotherapy▪ Medications▪ Oxygen Therapy▪ Fluids - why? thins secretions...give as long as they don't have CHF▪ Lung Transplant - extends life by 1 to 15 years

Treatment: Cystic Fibrosis

Pulmonary fibrosis

_____________ is a common restrictive lung disease that is prevalent in the older adult. The onset is generally slow and results from loss of cellular regulation, which leads to prolonged inflammation of the lung tissue, causing scarring and fibrosis. *poor outcome...<5 yrs*▪ lungs become scarred, stiff, and thick, and the progressive damage isn't reversible.

Airway!Nursing care: Manage potential airway obstructions due to the presence of edema or a tumor.

What's our biggest concern with head and neck cancer?

▪ Weight loss▪ Dysphagia▪ Pain▪ Lump in the mouth, throat, or neck▪ Oral lesions that do not heal in 2 weeks▪ Persistent, unexplained oral bleeding▪ Numbness of the mouth, lips, or face▪ Changes in the fit of dentures▪ Persistent unilateral ear pain▪ Hoarseness or change in voice quality▪ Persistent or recurrent sore throat▪ SOB▪ oral leukoplakia▪ Color changes in mouth or tongue▪ Burning sensation when drinking citrus or hot liquids

S/S: Head and Neck Cancer(SATA?)

Radiation or surgery (laryngectomy), pain management with medications

How do you treat head and neck cancer?

skincare don't erase the markschanges in tastevoice SHOULD go back to normal if there's no surgeryVoice will improve 4-6 weeks post therapy & Rest voice during treatment and use alternative communication.

Patient education for radiation

▪ Manage potential airway obstructions due to the presence of edema or a tumor.▪ Aspiration precautions▪ Ventilation and oxygenation.▪ Monitor arterial blood gases▪ Assess respiratory rate and depth▪ Monitor pulse oximetry▪ Monitor for chemotherapy side effects: N/VIf the patient has had radiation▪ Consulting speech therapy to assist the patient with communication.▪ Manage sore throat by implementing pain management strategies (gargling with saline, sucking on ice, and use of mouthwash and throat sprays).▪ Instruct the patient to refrain from being in the sun and avoid shaving.▪ Teach the patient to wear protective clothing and gently clean skin with mild soap daily.Post-operative management includes:▪ Maintaining a patent airway by suctioning the patient.▪ Monitor patient for complications of surgery such as hemorrhage, airway obstruction, wound breakdown, and possible infection.▪ Implement nutritional support to meet the patient's needs. A feeding tube is generally inserted at the time of surgery to provide nutritional support since oral intake is not possible.▪ Consult speech and language pathologist to assist patient with communication needs.Patient and family teaching for diagnosis includes:▪ Education on performing tracheostomy care to include return demonstration.▪ Education on the administration of feeding to include return demonstration.▪ Education on signs and symptoms of infection (fever, chills, redness, drainage at sites) and when to follow up with the provider.

Nursing Care: Head and Neck Cancer

communicationdiet - PEG tube

Nursing Care: Patient has a tracheostomy tube

Educate the patient not to cough forcefully or strain for the first few days to prevent possible bleeding.

Post-Rhinoplasty patient education

sleep apnea

__________ is a condition in which the patient experiences cyclical patterns of breathing disruption for periods of 10 seconds that occurs at least five times in an hour due to upper airway obstruction.▪ These periods of apnea decrease gas exchange, which can lead to an acid-base imbalance.▪ Patients who suffer from this condition also suffer from excessive daytime sleepiness, inability to concentrate, and irritability.▪ The most common cause of the obstruction is the soft palate or tongue.

▪ Obesity▪ Large uvula▪ Short neck▪ Smoking▪ Enlarged tonsils or adenoids▪ Oropharyngeal edema

Who is at risk for sleep apnea?

▪ Noninvasive positive-pressure ventilation (NPPV)▪ Bi-level positive airway pressure (BiPAP)▪ Autotitrating positive airway pressure (APAP)▪ Nasal continuous positive airway pressure (CPAP)▪ Adenoidectomy▪ Uvulectomy▪ Uvulopalatopharyngoplasty (UPP)▪ Tracheostomy

Treatment for sleep apnea

hypoxia- heart disease- CVA- stroke

If you have sleep apnea and it's not treated properly what could happen? ("complication")

pneumococcal polysaccharide vaccine (PPSV 23), known as Pneumovax; and pneumococcal conjugate vaccine (PCV-13), known as Prevnar 13.

What 2 vaccinations do you need for pneumonia?

oxygen therapyincentive spirometerbronchodilatorssteroidsexpectorantsantibioticssepsis preventionfluids

Treatment for pneumonia

yes, if it's "viral" pneumonia. Tell patient to stay away from others. Take full course of antibiotics.

Is pneumonia contagious?

can't delegate what you EATEvaluateAssessTeach

a couple questions about delegation

Epistaxis

bleeding from the nose

pressurepinch noselean forward▪ Capillary cauterization▪ Silver nitrate▪ Electrocautery▪ Nasal packing▪ Epistaxis catheters▪ Manage bleeding by applying direct lateral pressure to the nose for 10 minutes and application of ice or cool compresses.▪ Nasal packing▪ Implement standard precautions.▪ Educate the patient to maintain an upright position, such as leaning forward to prevent aspiration.▪ Monitor blood pressure to prevent periods of hypertension, which could increase the chance of bleeding.▪ Instruct the patient not to blow his or her nose for 24 hours to prevent clot disruption.

How do you treat epistaxis?(SATA?)

dilate vessels...keeps them patent...allows for proper perfusion and no clot formationMedications (such as calcium channel blockers, endothelin-receptor agonist, natural and synthetic prostacyclin agents, and guanylate cyclase stimulators)

What's the overall goal for a patient with pulmonary hypertension?

▪ Dyspnea▪ Fever▪ Use of accessory muscles to breathe▪ Change in respiratory pattern▪ Clubbing▪ Weight loss▪ Wheezing▪ Persistent cough or change in cough▪ Chest pain, chest tightness▪ Shoulder, arm, or chest wall pain▪ Pleural friction rub▪ Recurring pleural effusion, pneumonia, bronchitis▪ Enlarged lymph nodes▪ Hemoptysis (blood-tinged sputum)▪ Fatigue▪ Hoarseness​Does NOT present like a respiratory infection...it's ...chronic....and hemoptysis is involved.

S/S: Lung Cancer(SATA?)

...

another question about lung cancer she thought was "too easy"...probably about smoking cessation

sleep study

How do you diagnose sleep apnea?

A. "You will only need one vaccine called Pneumovax."C. "If you have had the Prevnar vaccine, then you will not need the Pneumovax vaccine."D. "Since you are over 64 years old, only the flu vaccine is suggested.

QfromtextbookA nursing student is teaching a 72-year-old patient about the importance of the pneumonia vaccination. Which teaching requires intervention by the nurse? (Select all that apply.)A. "You will only need one vaccine called Pneumovax."B. "You will need two vaccines to prevent pneumonia."C. "If you have had the Prevnar vaccine, then you will not need the Pneumovax vaccine."D. "Since you are over 64 years old, only the flu vaccine is suggested."E. "You will receive the Prevnar vaccine about a year after the Pneumovax vaccine.

gas exchange

What is a priority when assessing a person with facial trauma?

stridor, SOB, dyspnea

S/S: Airway Obstruction

edema, asymmetry, pain, leakage of spinal fluid through the ears or nose (can be clear to pink-tinged)

S/S: Facial Trauma

▪ Bruising▪ Pain▪ Nasal deviation/malalignment▪ Crepitus▪ Blood or clear fluid draining from the nose▪ Impaired breathing*check for CSF*

S/S: Nasal Fractures

▪ Trauma▪ Hypertension▪ Leukemia▪ Inflammation▪ Tumor▪ Decreased humidity▪ Nose blowing/picking▪ Chronic cocaine use▪ Nasal procedure

Causes: Epistaxis

Blue BloatersAIRWAYS ONLY NOT alveoli.▪ Productive cough▪ Dyspnea▪ Tachypnea▪ Pursed-lip breathing▪ Cyanosis▪ Use of accessory muscles▪ Pedal edema▪ Weight gain▪ Jugular vein distention▪ Stridor▪ Fever▪ Rhonchi▪ Wheezing

S/S: Bronchitis

▪ cigarette smoking▪ Alpha1-antitrypsin deficiency

Causes: COPD

Hypoxia​Acidosis​ -> decreased O2 and increased CO2Respiratory Infection​ -> increased mucus production, inflammation, bronchospasmsHeart Failure​ -> cor pulmonaleDysrhythmiaRespiratory Failure​​

Complications of COPD

TRUE

T/F: Cystic Fibrosis - chlorine utilization deficiency can impact multiple organs.