Rasmussen College: MDC III/NUR2502 Exam 2 Focused Review_ LATEST 2021/2022,100% CORRECT

Rasmussen College: MDC III/NUR2502 Exam 2 Focused Review_ LATEST 2021/2022 • Neck cancer- s/s, nursing interventions, teaching regarding treatment • S/S: leukoplakia (white, patchy lesions), erythroplakia (red, velvety lesions), lumps in mouth/throat/neck, difficulty swallowing and chewing, foul breath, epistaxis (nose bleeds), oral lesion or sore throat that doesn’t heal in 2 wks, persistent/unilateral ear pain, persistent/unexplained oral bleeding, numbness of mouth/lips/face, jaw pain, change in fit of dentures, voice hoarseness, SOB, burning sensation when drinking citrus or hot liquids • Nursing interventions: fowlers or semi fowlers, monitor for hemorrhage after surgery, wound flap/reconstructive tissue care, prevent wound breakdown, admin opioid analgesics, feeding tube, teach how to minimize anxiety, monitor for resp. distress • Teaching about tx: o radiation s/e: dry mouth (increased risk for dental cavities, infections, bad breath), hoarseness of voice, skin irritation, difficulty swallowing, impaired taste; avoid exposing area to sun, heat/cold, abrasive actions (shaving) o laryngectomy or cordectomy: need feeding tube sort-term, alt. means of communication, self mgmt of airway, tracheostomy may be temp. or permanent, stoma care • Nasal fractures- s/s, treatments, nursing interventions, post-operative care and teachings • S/S: deviation, misaligned bridge, change in nasal breathing, crepitus on palpitation, bruising, pain, blood or clear drainage from nose (CSF may indicate skull fracture) • Tx: closed reduction (move bone back into place), rhinoplasty, nasoseptoplasty • Nursing interventions: semi-fowlers, maintain airway • Post-op care and teaching: observe for edema and bleeding, cool compress to reduce swelling, analgesics, change drip pad as needed, don’t sniff upward or blow nose, stool softeners to ease bowel mvmts so pt doesn’t strain, avoid aspirin and NSAIDs, let pt know edema and bruising is expected and can last for weeks, drink adequate fluids, use of humidifier • Rhinosinusitis- s/s, diagnosis, treatment • Sinus infection • S/S: nasal swelling, congestion, headache, facial pressure, pain, tenderness, low-grade fever, cough, purulent or bloody nasal drainage (everything is inflammed) • Diagnosis: CT scan, physical exam and if has s/s for 10 days (to make sure it's not a virus bc viruses last 7-10 days) OR is sick, gets a little better, and then s/s get worse • Tx: broad spectrum abx, analgesics, decongestants, intranasal steroid spray, steam humidification, hot/wet packs over sinuses, nasal saline irrigations, increased fluids • Differentiating CSF from nasal drainage • CSF has glucose and yellow halo when dried • COPD and oxygen • Be careful not to give too much O2 for too long, bc it can take away the hypoxic drive to breathe, expect them to have lower O2 sat and that’s okay 88-93% • Obstructive sleep apnea- s/s, treatment, nursing interventions • S/S: excessive daytime sleepiness, inability to concentrate, irritability • Tx: change sleep position, positive pressure ventilation (CPAP), surgical: adenoidectomy, uvulectomy, uvulopalatopharyngoplasty (removes excess tissue in throat) • Nursing interventions: encourage weight loss, smoking cessation, raise HOB when sleeping or lateral position • Non-invasive ventilation techniques • Uses positive pressure to keep alveoli open and improve gas exchange w/o intubation • CPAP and BiPAP o BiPAP has 2 pressure settings: the prescribed pressure for inhalation, and a lower pressure for exhalation; allows pt to get more air in and out of the lungs • Can deliver oxygen or room air • Epistaxis- treatment, nursing interventions • Nosebleed; posterior nasal bleeding is an emergency because we cant readily access the back of the nose • Tx: cauterization of affected capillaries, nose is packed • Nursing interventions: have pt lean forward and pinch bridge of nose, assess for resp. distress, humidification, O2, bedrest, abx, analgesics • Asthma- etiology, s/s, treatments, nursing interventions, education • Chronic, reversible airway obstruction resulting in inflammation and bronchoconstriction (affects airway only, not alveoli) • Etiology: general irritants, exercise, upper respiratory illness, aspirin/NSAIDs, GERD • S/S: audible wheeze, increased RR, increased cough, use of accessory muscles, “Barrel chest”, tachycardia, chest pain, color changes ▪ Difficulty talking, ▪ Nasal flaring ▪ Using inhaler and not getting better, 50% o Resp. Acidosis, decreased PaO2, increased PaCO2 during an attack • Tx: bronchodilators- albuterol (cause smooth muscle relaxation, no role in inflammation; give 5 min before other meds), anticholinergics- ipratropium/tiotropium (increases bronchodilation and decreases secretions), anti-inflammatories- corticosteroids/ leukotriene modifiers (only controller drugs, not for relief), Exercise, O2 therapy if O2 sats are low, mag sulfate o Drugs for asthma: ▪ Controlled therapy: inhaled corticoid steroid is drug of choice: • Considerations: rinse their mouth to avoid thrush, hyperglycemia, tachy, • If pt comes into the ER, has drug tx but HR is still high, do not give breathing tx o Give the medication some time, get hr down a bit • Bronchodilator should be given 5 mins before corticoid steroid o Steroids are not a priority drug ▪ O2 and breathing tx are reliever drugs • Steroids are controller drugs ▪ Do not give Beta blockers, NSAIDs, or Aspirin to asthmatic pt • • Nursing interventions: obtain a baseline PFT, improve air flow and gas exchange with exercise/activity, relieve symptoms, O2 therapy during an acute attack ▪ Tripod position ▪ Keep elevated • Education: Peak flow meter:Avoid asthma triggers by keeping a symptom diary, changing air filters, taking out carpet or curtains ▪ self-management, personal asthma action plan, assess peak expiratory flow (PEF) at least daily, avoid NSAIDs, aspirin, and beta blockers, use bronchodilator 30 min before exercise for EIB, avoid MSG in foods linked to asthma and migraines, exercise induced asthma is a different type of asthma ▪ How to use spacer: spacer allow us to ensure the pt is getting the ▪ Reducing stress and anxiety ▪ Hot water to destroy dust mites o Set meter to zero, standing position w/o support, take v deep breath, place meter in mouth and wrap lips tightly, blow breath out as hard and fast as you can, reset and perform 2 more times, the highest reading is the current peak flow rate o Green zone: 80% or more of personal best; no increase in drug therapy needed o Yellow zone: 50-80% of personal best; use prescribed reliever drug ▪ Use albuterol o Red zone: below 50% of personal best; severe resp. obstruction; use reliever drug and go to ER ▪ Use reliever drugs AND go to the ER • Dyspnea management in respiratory disorders • More towards resp. distress: diaphragmatic/abdominal breathing, pursed lip breathing, semi fowlers, exercise conditioning, decrease anxiety, pace themselves, O2 • Dyspnea management in lung cancer • More palliative: semi fowlers, O2, continuous morphine • Bronchitis vs. Emphysema • Bronchitis- inflammation of airway (bronchi and bronchioles), caused by chronic exposure to irritants (esp. cigarette smoke), productive cough, mucus occluding airways, rhonchi, weight gain d/t pulmonary HTN • Emphysema- loss of lung elasticity, air trapped in alveoli, barrel chest (hyperinflates lung), when diaphragm weakens d/t hyperinflated lung, more muscles need to be used to breathe which increases O2 need, more problems w hypoxia bc air is trapped, weight loss, wheezing or diminished breath sounds • Pneumonia- s/s, diagnosis, treatment, nursing interventions, education, vaccinations, reduction of risk • Excess fluid in lungs from inflammation r/t infectious organisms or inhalation of irritants • S/S: flushed cheeks, bright eyes, anxious expression (general appearance); chest pain, discomfort, myalgia, headache, chills, fever, cough, tachycardia, dyspnea, tachypnea, hemoptysis (coughing up blood), sputum production, crackles upon auscultation • Diagnosis: chest x-ray- most common • Tx: bronchodilators, steroids, mucinex, abx • Nursing interventions: improve gas exchange w/ O2 therapy and incentive spirometry; prevent airway obstruction w/ cough, deep breathing, increased fluid intake, meds; prevent sepsis w/ abx; prevent/manage emphysema w/ thoracentesis, chest tube, abx • Education: importance of meds and completing abx, when to notify provider (fever, chills, persistent cough, dyspnea, wheezing, hemoptysis, increased sputum production, chest discomfort, increasing fatigue returns or fails to go away), rest, increase activity gradually, avoid sources of infection like crowds, etc., adequate fluid intake, smoking cessation • Vaccinations: 65 and older or person with a chronic health problem to get pneumococcal vaccine; repeated 1-year later • Reduction of risk: pneumococcal vaccine, flu shot, smoking cessation, don’t drink alcohol, older than 65/chronic health prob/limited mobility is increased risk • COPD- s/s, treatment, nursing interventions, education • Includes emphysema and chronic bronchitis; tissue damage not reversible, increases in severity, eventually leads to resp. failure; characterized by dyspnea and bronchospasm • S/S: thin w/ decreased muscle mass, slow moving, tripod position, rapid/shallow breathing (SOB, dyspnea), barrel chest, cyanosis, delayed capillary refill, finger clubbing d/t prolonged decreased O2 sat, swelling of feet/ankles d/t R sided HF • Tx: inhaled corticosteroids (beclomethasone, fluticasone), expectorants, anticholinergics (ipratropium, tiotropium), beta adrenergics (albuterol, salmeterol), methylxanthines (theophylline), NSAIDs, lung reduction surgery (removal of the hyperinflated tissue) • Nursing interventions: place in semi-fowlers, O2 therapy, suctioning, vibratory positive pressure device to loosen mucus, nutrition to prevent weight loss • Education: breathing techniques like pursed lip breathing, relaxation therapy, teach effective coughing, manifestations of infection, importance of hydration to thin mucus, energy conservation, pulmonary rehab program for home care (teaches them effective coughing, bronchial hygiene, etc) • Energy conservation in lower respiratory disorders • Divide daily activities into smaller parts or see if it can be done differently or at a different time, teach planning and pacing of activities w rest periods in between, encourage pt to not work w arms raised bc it uses the accessory muscles, and the muscles are needed to assist in breathing, adjust work heights to reduce back strain and fatigue, keep arm motions smooth to prevent jerky motions that waste energy, use of adaptive tools for housework to reduce bending and reaching, have things within easy reach, don’t talk when engaged in other activities that require energy, avoid holding breath while performing any activity • Cystic fibrosis- s/s, diagnosis, treatment, interventions, education, ways to help clear mucus • Genetic, affects many organs, lethally impairs pulmonary fx, mucus plugs up glands causing atrophy and organ dysfunction • S/S: abdominal distension, GERD, rectal prolapse, foul-smelling stools, steatorrhea (have trouble digesting fat), malnourished, fat soluble vitamin deficiencies, thick mucus, chest congestion, decreased pulmonary fx, limited exercise tolerance, respiratory infections • Diagnosis: more prevalent in whites, sweat chloride test (measures chloride in sweat) • Tx: inhaled corticosteroids, bronchodilators (albuterol), expectorants, exacerbation therapy: O2 and abx, lung transplant (extends life by 1-15 yrs), rejection rate is high • Interventions: help them cope, allow them to talk about quality of life, address support system, pulmonary hygiene, chest physiotherapy • Education: weight maintenance, nutrition, pancreatic enzyme replacement (anytime they eat anything, they must take one), infection prevention, stay away from other CF pts • Ways to help clear mucus: fluids to thin, chest physiotherapy loosens mucus and helps w coughing, pulmonary hygiene includes procedures or exercises to clear airways of mucus such as breathing exercises, suctioning, spirometer, percussion, vibration, postural drainage • Respiratory medications • Bronchodilators o Beta adrenergics ▪ Albuterol (short-acting, for acute bronchospasm), salmeterol (long-acting, for long-term control of asthma), terbutaline (oral, long-term control) ▪ Precautions/interactions: don’t use in pts w/ tachydysrhythmias, caution in pts w/ DM/hyperthyroidism/heart disease/HTN, beta blockers reduce effects, MAOIs increase effects ▪ S/E: tachycardia, palpitations, tremors o Anticholinergics ▪ Ipratropium, tiotropium ▪ Uses: prevent bronchospasm, asthma r/t allergens, EIB, COPD ▪ Precautions/interactions: do not give to pts w/ peanut allergy, extreme caution in pts w/ narrow-angle glaucoma and BPH, do not use for tx of acute bronchospasm ▪ Nursing interventions: max effects may take up to 2 wks, shake inhaler well before admin, wait 5 mins btwn admin of other inhaled meds o Methylxanthines ▪ Theophylline (for long-term control of asthma) ▪ Precautions/interactions: don’t give to pts w/ PUD, caution in pts w/ DM/hyperthyroidism/HTN/heart disease/angina, phenobarbital and phenytoin decrease effects, caffeine/furosemide/cimetidine/ fluoroquinolones/acetaminophen falsely elevate therapeutic levels, do NOT mix IV form w/ other meds ▪ S/E: irritability, restlessness • Toxicity: tachycardia, tachypnea, seizures ▪ Nursing interventions: monitor therapeutic levels, avoid caffeine intake, monitor for signs of toxicity, smoking decreases effects, alcohol abuse increases effects ▪ Tx of toxicity: stop IV infusion, activated charcoal to decrease absorption of oral form, lidocaine for dysrhythmias, diazepam for seizures • Anti-inflammatories o Steroids ▪ Beclomethasone (inhaled), prednisone (oral), betamethasone (oral), fluticasone (inhaled) ▪ Used short-term for post-acute asthma attack, long-term for asthma prophylaxis and tx of chronic asthma ▪ Precautions/interactions: pts w/ DM may require higher doses, don’t stop abruptly ▪ S/E: insomnia, psychotic behavior, hyperglycemia, PUD, fluid retention, increased appetite, if taken long-term- osteoporosis ▪ Nursing interventions: admin meds w/ meals, do not take w/ NSAIDs, taper dose o Leukotrienes ▪ Montelukast, zafirlukast ▪ Used for long-term mgmt of asthma in adults and children, prevention of EIB ▪ Precautions: do not use for acute asthma attack, may increase levels of beta blockers ▪ S/E: elevated liver enzymes ▪ Take daily in the evening o Mast cell stabilizer ▪ Cromolyn • Antitussives o Suppress non-productive coughs o Hydrocodone, codeine o Expectorants ▪ Promote increased mucous secretion to increase cough production ▪ Guaifenesin o Mucolytics ▪ Enhance flow of secretions in the resp. tract ▪ Used for acute and chronic pulmonary d/o w/ copious secretions, CF ▪ Acetylcysteine (antidote for acetaminophen poisoning), hypertonic saline o Opioid antitussives have potential for abuse o S/E: drowsiness, dizziness, constipation, aspiration and bronchospasm risk w/ mucolytics • Decongestants and Antihistamines o Decongestants ▪ Reduce inflammation in nasal membranes ▪ Used for allergic rhinitis, sinusitis, common cold ▪ Pseudoephedrine, phenylephrine o Antihistamines ▪ Decrease allergic response ▪ Avoid alcohol intake ▪ Use products containing pseudoephedrine for no longer than 7 days o S/E: anticholinergic effects, drowsiness o Take at night • Influenza- s/s, nursing interventions, treatment, complications • S/S: severe headache, muscle aches, fever, chills, fatigue, weakness, anorexia (type B can be more stomach related w/ N/V and diarrhea) • Nursing interventions: advise pt to get the flu shot every year, teach pt how to prevent spread of infection • Tx: antivirals (tamiflu) effective if started w/in 24-48 hrs of symptoms, rest, increased fluid intake, saltwater gargles, antihistamines • Complications: pneumonia, death • Pulmonary hypertension- causes, s/s, treatment, complications • Causes: unknown, occurs w/o other lung disorders, can be genetic • S/S: dyspnea and fatigue (sometimes chest pain and light-headedness) • Tx: warfarin, calcium channel blockers (nifedipine, verapamil), digoxin (increases cardiac output), diuretics (so heart doesn’t have to work as hard), O2 therapy for uncomfortable dyspnea, lung transplant, heart transplant if cor pulmonale is present • Complications: R sided HF (cor pulmonale), w/o tx death can occur w/in 2 yrs • Respiratory failure as a complication of respiratory disorders • d/t inability to remove enough CO2 from the blood, causing it to build up, or when resp. system can’t take in enough O2 so severely low O2 levels in blood • causes of resp. failure: COPD, complicated pneumonia, CF, sleep apnea, excess fluid in the lungs • Lung cancer- s/s, nursing interventions, palliative care • Poor long-term survival bc can present as different resp. problems leading to late-stage diagnosis • S/S: labored/painful breathing, hemoptysis (coughing up blood), resp. distress, dyspnea, wheezing, cardiac tamponade d/t tumor pressing on heart (blood/fluid in pericardial space), dysrhythmias • Nursing interventions: maintain patent airway, warm and humidify O2, semi-fowlers, incentive spirometer every hour, may need chest tube (2cm water, should have gentle bubbling when connected to suction, ensure patency, ensure it doesn’t become dislodged as it can cause air to enter causing a pneumothorax, if it does, cover w sterile gauze immediately, gentle milking of line is okay), ambulate, encourage coughing and deep breathing • Palliative care: O2 therapy, bronchodilators, corticosteroids, mucolytics, radiation, thoracentesis to remove fluid, semi-fowler's, morphine and other analgesics, hospice care • Tuberculosis- s/s, diagnosis, treatment, education, nursing interventions • S/S: progressive fatigue, lethargy, nausea, anorexia, weight loss, irregular menses, low- grade fever, night sweats, cough, mucopurulent sputum, blood streaks • Diagnosis: nucleic acid amplification test (NAA)- most accurate and results in 2 hrs; sputum culture- confirms TB; tuberculin (Mantoux) test aka PPD test- given intradermally in forearm and read 48-72 hrs later, swelling/redness (induration) of 10mm or more in diameter is positive for exposure; blood analysis includes QuantiFERON-TB gold and T-SPOT TB, shows how pts immune system respond to TB • Tx: Isoniazid (avoid antacids, take on empty stomach), Rifampin (expect orange-reddish staining of skin and urine and other secretions to have reddish-orange tinge, reduces effectiveness of oral contraceptives, interacts w/ many meds), Pyrazinamide (increases uric acid production, photosensitivity), Ethambutol (report changes in vision, increases uric acid production) o All can be used for first 8 wks, but for the remaining 18 wks, pt takes isoniazid and rifampin either daily or 2x/wk • Education: avoid alcohol, adequate fluid intake, need strict adherence to meds, not considered contagious after 2-3 wks of tx and signs of improvement, cough or sneeze into tissue and dispose of it in plastic bags, wear a mask in public, eat small, freq. meals, resume activity slowly and get plenty of rest, pt to report signs of liver toxicity when taking meds • Nursing interventions: airborne precautions; promote airway clearance w/ deep breath before coughing, incentive spirometer, increase fluids; decrease drug resistant and infection spread w/ combination drug therapy and strict adherence, negative sputum culture means pt is no longer infectious; help pt manage anxiety, improve nutrition (quality protein, vit. a, b, c, e, fresh produce); directly observed therapy (DOT) may be indicated in some situations where healthcare professional watches pt swallow meds • Peritonsillar abscess- s/s, diagnosis, treatment, nursing interventions, education • Complication of tonsilitis; it spreads to surrounding tissue and causes abscess’ • S/S: pus behind tonsil causing one-sided swelling w/ deviation of the uvula, trismus (lockjaw), difficulty breathing, pain radiating to teeth or ear, muffled voice, difficulty swallowing, bad breath, swollen lymph nodes • Diagnosis: usually made based on s/s but needle aspiration and culture of pus is preferred, ultrasound • Tx: needle aspiration of abscess, abx • Education: stress importance of completing full course of abx, go to ER if signs of obstruction occur (drooling, stridor)