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Medical-Surgical Nursing, 10th Ed., Lewis, Dirksen, Heitkemper & Bucher
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27 - Lower Respiratory Problems

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Medical-Surgical Nursing, 10th Ed., Lewis, Dirksen, Heitkemper & Bucher | Registered Nurse (RN) School Study Aid

27 - Lower Respiratory Problems
31 Picmonics to Learn | 55 mins
Pneumonia Assessment
Risk Factors
Older Adult
Immunocompromised
Long Term Care
Assessment
Shortness of Breath (SOB)
Hypoxemia
Cough and Sputum Production
Wheezing or Crackles
Fever
Pleuritic Pain
Diagnosis
Chest X-ray
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2 mins
Pneumonia Intervention
Interventions
Humidified Oxygen
Deep Breathing Exercises
Position of Comfort
Increase Fluid Intake
Manage Fever
Medications
Antibiotics
Mucolytics
Expectorants
Considerations
Pneumococcal Vaccine
Sepsis
Acute Respiratory Failure (ARF)
Prevention Education
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2 mins
Fluoroquinolones
End in "-floxacin"
Mechanism of Action
Bactericidal
Indications
Variety of Infections
Side Effects
GI Distress
Photosensitivity
Achilles Tendon Rupture
Contraindications
Pregnancy
Children
Myasthenia Gravis
Considerations
Avoid Milk Products or Antacids
Slow IV Infusion
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2 mins
Acyclovir (Zovirax)
Mechanism
Guanosine Analog
Inhibits Viral Replication
Thymidine Kinase Activation
Indications
Herpes Simplex Virus (HSV)
Varicella Zoster Virus (VZV)
Side Effects (Oral)
Headache
GI Distress
Side Effects (IV)
CNS Toxicity
Nephrotoxicity (Crystalline Nephropathy)
Considerations
Prevents Recurrent Episodes
Slow IV Infusion
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2 mins
Vancomycin
Mechanism of Action
Inhibits Bacterial Cell Wall Synthesis
Indications
Serious Gram-Positive Infections
Side Effects
Nephrotoxicity
Ototoxicity
Red Man Syndrome
Thrombophlebitis
Nursing Considerations
Culture Samples First
Infuse IV Over 60 Minutes
Take Around the Clock
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2 mins
Macrolides
End in "-thromycin"
Mechanism of Action
Bacteriostatic
Indications
Alternative for Penicillin Allergy
Respiratory Infections
Pneumonia
Side Effects
QT Prolongation and Sudden Death
C.Diff Overgrowth
GI Distress
Considerations
Slow IV Infusion
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2 mins
Tuberculosis Assessment
Etiology
Airborne Droplet
Assessment
3 Week Productive Cough
Night Sweats
Chest Pain
Fever
Weight Loss
Fatigue
Diagnosis
Chest X-Ray
Blood Tests
Mantoux Skin Test
3 Positive Sputum Tests
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1 min
Tuberculosis Intervention
Hospital Care
Airborne Isolation
Drug Therapy
Combination Drug Therapy (RIPE)
6-12 Months
Considerations
DOT
BCG Vaccination
Medication Education
3 Negative Sputum Specimens
Infection Control
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2 mins
Tuberculosis Skin Mantoux Test (PPD)
Delayed Hypersensitivity (Cell Mediated Response)
Intradermal Injection
Read 48-72 hours
Positive Results
≥ 5 mm Induration
Immunosuppressed
≥ 10 mm Induration
High Risk Patients
≥ 15 mm Induration
Considerations
Chest X-Ray
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3 mins
Isoniazid (INH)
Mechanism
Interferes with DNA Metabolism
Indications
Tuberculosis (TB)
Side Effects
Optic Neuritis
Nausea and Vomiting
Hepatotoxicity
Peripheral Neuropathy
Considerations
Vitamin B6 Prophylaxis
Monitor AST/ALT
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2 mins
Ethambutol (Myambutol)
Mechanisms
Inhibits RNA Synthesis
Bacteriostatic
Indications
Tuberculosis (TB)
Side Effects
Optic Neuritis
Red/Green Color Blindness
Gouty Arthritis
Consideration
Monitor Vision Acuity
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2 mins
Amphotericin B
Indications
Systemic Mycosis
Fungal Meningitis
Last Resort for Protozoan infections
Mechanism
Polyene
Binds Ergosterol
Forms Membrane Pores
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1 min
Azoles (Ketoconazole)
"-azole" suffix
Indications
Local and Less Serious Systemic Mycosis
Mechanism
Inhibits Ergosterol Synthesis
Inhibits P450
Side Effects
Liver Dysfunction
Inhibition of Testosterone Synthesis
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1 min
Lung Cancer Assessment
2nd Most Common Cancer
Assessment
Chronic Cough
Hoarseness
Abnormal Breath Sounds
Hemoptysis
Chest Pain
Anorexia or Weight Loss
Considerations
Symptoms Appear Late in Disease
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2 mins
Cisplatin (Platinol)
Mechanism
Alkylating Agent
Cross-Links DNA
Indications
Testicular Cancer
Ovarian Cancer
Side Effects
Nausea and Vomiting
Myelosuppression
Nephrotoxicity
Ototoxicity
Peripheral Neuropathy
Considerations
Antiemetics Before Administration
Aggressive Hydration
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3 mins
Pneumothorax
Mechanism
Air Enters Pleural Space
Assessment
Sudden Dyspnea
Absent or Restricted Movement on Affected Side
Decreased or Absent Breath Sounds on Affected Side
Chest Pain
Tracheal Deviation
Vital Sign Changes
Crepitus
Considerations
High Fowler's Position With Oxygen
Prepare For Chest Tube Placement
Educate High Risk Patients
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2 mins
Flail Chest
Cause/Mechanism
Trauma
Assessment
Shallow Respirations
Chest Pain
Paradoxical Chest Movement
Interventions
Mechanical Ventilation
Analgesics
Intercostal Nerve Blocks
Considerations
Surgical Rib Fixation
Monitor Pulmonary Contusion
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2 mins
Cardiac Tamponade
Mechanism
Fluid in the Pericardial Sac
Pericarditis
Decreased Cardiac Output
Signs/Symptoms
Beck's Triad
Hypotension
Jugular Venous Distention (JVD)
Distant Heart Sounds
Pulsus Paradoxus
Electrical Alternans
Treatment
Pericardiocentesis
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1 min
Chest Tubes: Management and Care
Confirm suction order
Assessment
Crepitus
Kinking
Shortness of Breath (SOB)
Infection
Excessive bubbling
Quick Interventions
If tube dislodges from patient, use petroleum gauze taped 3 ways
If drainage system is damaged, place disconnected drainage tube in sterile water
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1 min
Restrictive vs. Obstructive Lung Diseases
Restrictive Lung Disease
Decreased Lung Volume
FEV1/FVC Ratio Normal to Increased
Obstructive Lung Disease
Increased Lung Volume
Decreased FEV1/FVC Ratio
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2 mins
Pulmonary Embolism Causes
Causes
FAT BAT Mnemonic
Fat
Air
Deep Vein Thrombosis (DVT)
Bacteria
Amniotic Fluid
Tumor
Risk Factors
Hypercoagulable
Central Venous Lines
Immobilized
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1 min
Pulmonary Embolism Assessment
Assessment
Shortness of Breath (SOB)
Pleuritic Chest Pain
Tachypnea
Hemoptysis
Hypoxemia
Considerations
Sudden Death
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52 secs
Warfarin (Coumadin)
Mechanism of Action
Inhibits Clotting Factors
Indications
Atrial Fibrillation
Venous Thrombosis
Pulmonary Embolism
Assessment
PT/INR Levels
Observe for Bleeding
Contraindications
Pregnancy
Nursing Considerations
Vitamin K and Fresh Frozen Plasma
Prolonged Therapeutic Onset
Maintain Same Diet
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2 mins
Enoxaparin (Lovenox)
Mechanism of Action
Inhibits Clotting Factors
Factor Xa
Indications
Clot Formation Prevention
Side Effects
Heparin Induced Thrombocytopenia (HIT)
Bleeding
Considerations
Medication Education
Subcutaneous Injection
2 Inches from Umbilicus or Incisions
Antidote
Protamine Sulfate
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2 mins
Heparin (Unfractionated)
Mechanism of Action
Suppresses Coagulation
Indications
Deep Vein Thrombosis (DVT)
Pulmonary Embolism
Side Effects
Hemorrhage
Heparin-Induced Thrombocytopenia (HIT)
Considerations
Monitor aPTT
Preferred (Safe) During Pregnancy
Antidote
Protamine Sulfate
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2 mins
Alteplase
Mechanism
Tissue Plasminogen Activator
Indications
Thrombosis
Side Effects
Bleeding
Contraindications
Intracranial Hemorrhage
Internal Hemorrhaging
Considerations
Minimize Bleeding
Monitor for Shock
Antidote
Aminocaproic Acid
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2 mins
Heparin Induced Thrombocytopenia (HIT)
Pathophysiology
5-10 Days After Heparin Exposure
Heparin-Platelet Factor 4 Complex
Autoantibodies Form Against Complex
Heparin-Platelet Factor 4-Antibody Complex Binds Platelets
Platelet Aggregation
Procoagulant Release
Symptoms
Thrombocytopenia
Diagnosis
Serotonin Release Assay (SRA)
Treatment
Stop Heparin, Start Direct Thrombin Inhibitor
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2 mins
Cardiac Enzyme Evaluation: Troponin
Measures
Cardiac Muscle Injury
Time Ranges
Detection in Blood: 4 Hours
Peak: 24 - 36 Hours
Return to Normal: 5 - 14 Days
Considerations
Most Specific for Cardiac Muscle
Treat Aggressively
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2 mins
Calcium Channel Blockers (Verapamil and Diltiazem)
Mechanism of Action
Slows AV Conduction
Indications
Angina Pectoris
Arrhythmias
Essential Hypertension
Side Effects
Bradycardia
Hypotension
Constipation
Peripheral Edema
Gingival Hyperplasia
Nursing Consideration
Medication Education
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2 mins
Tacrolimus (Prograf) Overview
Mechanisms
Immunosuppressant
Inhibits Calcineurin, Decreasing IL-2
Indications
Transplant Rejection
Atopic Dermatitis
Considerations
Increased Lymphoma Risk
Avoid Grapefruit Juice
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1 min
Prednisone (Glucocorticoids)
Mechanism
Glucocorticoid
Indications
Inflammatory Conditions
Organ Transplant Rejection
Side Effects
Cataracts and Glaucoma
Cushing's Syndrome
Osteoporosis
Immunosuppression
Hyperglycemia
Ulcers
Considerations
Adrenal Insufficiency
Taper Gradually
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2 mins

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