Fluids and Electrolytes
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Questions and Answers

Which fluid compartment contains the largest amount of the body's water?

  • Interstitial Fluid
  • Extracellular Fluid (ECF)
  • Intravascular Fluid
  • Intracellular Fluid (ICF) (correct)

What is the primary cation found in the intracellular fluid (ICF)?

  • Sodium (Na⁺)
  • Chloride (Cl⁻)
  • Potassium (K⁺) (correct)
  • Calcium (Ca²⁺)

Which of the following is an example of transcellular fluid?

  • Intracellular Fluid
  • Plasma
  • Cerebrospinal Fluid (correct)
  • Interstitial Fluid

What is the term for the movement of fluid from the intravascular space into the interstitial space, where it is not readily available for use?

<p>Third spacing (D)</p> Signup and view all the answers

A patient with a sodium level of 120 mEq/L is likely experiencing which condition?

<p>Hyponatremia (D)</p> Signup and view all the answers

Which intravenous solution type pulls fluid out of cells and into the blood vessels?

<p>Hypertonic (D)</p> Signup and view all the answers

Which of the following would be a typical sign or symptom of hypokalemia?

<p>Muscle weakness (A)</p> Signup and view all the answers

What is the primary problem in polycythemia vera?

<p>Overproduction of red blood cells (A)</p> Signup and view all the answers

A common symptom of polycythemia vera is:

<p>Itching after a hot shower (C)</p> Signup and view all the answers

What is a common treatment for polycythemia vera?

<p>Phlebotomy (B)</p> Signup and view all the answers

Stable angina is typically triggered by:

<p>Physical exertion (C)</p> Signup and view all the answers

What is the primary cause of stable angina?

<p>Narrowed coronary arteries (B)</p> Signup and view all the answers

What is considered the most accurate measure of a patient's fluid balance?

<p>Daily Weights (A)</p> Signup and view all the answers

What physical assessment finding may indicate fluid overload?

<p>Crackles in the lungs (D)</p> Signup and view all the answers

Which of the following puts older adults at a higher risk of dehydration?

<p>Decreased thirst perception (B)</p> Signup and view all the answers

The respiratory system compensates for altered arterial blood gases by adjusting which of the parameters?

<p>CO₂ levels (D)</p> Signup and view all the answers

What causes crackles (rales) lung sounds?

<p>Popping sounds due to fluid in alveoli (C)</p> Signup and view all the answers

Which of these conditions is a leading risk factor for developing chronic kidney disease?

<p>Diabetes mellitus (C)</p> Signup and view all the answers

What is the primary mechanism of hemodialysis?

<p>Filtering blood through a machine (B)</p> Signup and view all the answers

Which dialysis type is typically performed by a patient at home?

<p>Peritoneal Dialysis (B)</p> Signup and view all the answers

What is a common side effect that can occur during hemodialysis?

<p>Muscle cramps (C)</p> Signup and view all the answers

What is a common symptom of peritonitis in peritoneal dialysis?

<p>Cloudy dialysate (B)</p> Signup and view all the answers

What is the GFR range in Stage 2 chronic kidney disease?

<p>60-89 mL/min (C)</p> Signup and view all the answers

Which bodily system is affected by pulmonary edema due to renal failure?

<p>Respiratory (C)</p> Signup and view all the answers

What hematologic issue can arise from renal failure?

<p>Anemia (B)</p> Signup and view all the answers

Which of the following is a symptom of the moderate stage of chronic kidney disease?

<p>Fluid retention (D)</p> Signup and view all the answers

What electrolyte imbalance increases the risk for cardiac arrest in renal failure?

<p>Hyperkalemia (A)</p> Signup and view all the answers

Which type of dialysate is typically used for diabetic patients?

<p>Icodextrin-based solution (C)</p> Signup and view all the answers

Which medication is used as a phosphate binder for dialysis patients?

<p>Sevelamer (A)</p> Signup and view all the answers

What should be monitored at the AV fistula site?

<p>Bruit/thrill (D)</p> Signup and view all the answers

What type of technique should be implemented during peritoneal dialysis?

<p>Aseptic technique (A)</p> Signup and view all the answers

Which of the following is often an early sign of pneumonia in older adults?

<p>Confusion (B)</p> Signup and view all the answers

What is a common early symptom of pneumonia in older adults, often appearing before respiratory symptoms?

<p>Weakness and fatigue (D)</p> Signup and view all the answers

Which of the following complications of pneumonia involves fluid buildup in the pleural space?

<p>Pleural effusion (B)</p> Signup and view all the answers

What diagnostic test is commonly used to identify lung infiltrates in patients with pneumonia?

<p>Chest X-ray (A)</p> Signup and view all the answers

Which of the following blood test results would you expect to see in a patient with pneumonia?

<p>Increased WBCs (C)</p> Signup and view all the answers

What complication following a bronchoscopy is indicated by coughing up blood?

<p>Hemoptysis (A)</p> Signup and view all the answers

Following a bronchoscopy, which nursing intervention is most important to perform before resuming oral intake?

<p>Assessing gag reflex (B)</p> Signup and view all the answers

Which of the following is a common treatment for hypoxia in patients with pneumonia?

<p>ограничено по време Oxygen therapy (D)</p> Signup and view all the answers

Which of the following medications is often prescribed to loosen mucus and make it easier to cough up?

<p>Expectorants (A)</p> Signup and view all the answers

What is an important patient education point regarding antibiotic use for pneumonia?

<p>Take the full course of antibiotics (A)</p> Signup and view all the answers

Which of the following is the most accurate way to measure a patient's fluid balance?

<p>Daily weights (B)</p> Signup and view all the answers

What is the primary reason older adults are at higher risk for dehydration?

<p>Decreased thirst perception (C)</p> Signup and view all the answers

Which system compensates the fastest for altered arterial blood gases?

<p>Respiratory system (B)</p> Signup and view all the answers

Which of the following is a leading risk factor for developing chronic kidney disease?

<p>Diabetes mellitus (B)</p> Signup and view all the answers

How does hemodialysis remove waste and excess fluid from the body?

<p>By filtering the blood through a machine (D)</p> Signup and view all the answers

A patient undergoing hemodialysis reports muscle cramps. Which of the following is a potential cause?

<p>Rapid fluid and electrolyte shifts (B)</p> Signup and view all the answers

What causes the blood to thicken in polycythemia vera?

<p>Overproduction of red blood cells (C)</p> Signup and view all the answers

A patient with polycythemia vera is at increased risk for which of the following?

<p>Clotting (C)</p> Signup and view all the answers

What is a common symptom of vasospastic angina?

<p>Chest pain that occurs at rest, often at night (C)</p> Signup and view all the answers

Epinephrine, norepinephrine, and dopamine are examples of:

<p>Catecholamines (A)</p> Signup and view all the answers

Which psychological effect is commonly seen in dialysis patients due to significant lifestyle changes?

<p>Depression and anxiety (A)</p> Signup and view all the answers

What early sign of asthma is often characterized by a whistling sound when breathing?

<p>Wheezing (B)</p> Signup and view all the answers

Which of the following is a key nursing action in managing a patient experiencing an asthma exacerbation?

<p>Administering bronchodilators (B)</p> Signup and view all the answers

What should asthma patients be taught to avoid to prevent asthma exacerbations?

<p>Allergens, smoke, and stress (A)</p> Signup and view all the answers

Which quick-relief medication should an asthmatic patient always carry with them?

<p>Albuterol (C)</p> Signup and view all the answers

Which medication is commonly administered via nebulizer or MDI for asthma emergencies?

<p>Albuterol (D)</p> Signup and view all the answers

Which type of medication is used to treat the inflammation associated with asthma?

<p>Inhaled Corticosteriods (A)</p> Signup and view all the answers

What is indicated by a 'silent chest' during an asthma attack?

<p>Severe airway obstruction (A)</p> Signup and view all the answers

During status asthmaticus, which of the following symptoms indicates respiratory distress?

<p>Use of accessory muscles (B)</p> Signup and view all the answers

What is the first step in the process of tuberculosis (TB) infection?

<p>Mycobacterium tuberculosis is inhaled. (C)</p> Signup and view all the answers

Which of the following is a risk factor for developing tuberculosis (TB)?

<p>Weakened immune system (D)</p> Signup and view all the answers

What is the primary body system affected by Mycobacterium tuberculosis?

<p>Respiratory system (B)</p> Signup and view all the answers

How does tuberculosis (TB) primarily spread from one person to another?

<p>Through airborne transmission (D)</p> Signup and view all the answers

Which of the following is a common sign or symptom of tuberculosis (TB)?

<p>Persistent cough (B)</p> Signup and view all the answers

What type of isolation precaution is required for patients diagnosed with tuberculosis (TB)?

<p>Airborne precautions (D)</p> Signup and view all the answers

Which diagnostic test indicates exposure to tuberculosis (TB) but does not confirm active disease?

<p>Mantoux (PPD) skin test (A)</p> Signup and view all the answers

What is the purpose of sputum culture in diagnosing TB?

<p>Confirm active TB (D)</p> Signup and view all the answers

Which medication used to treat TB can cause optic neuritis (vision problems)?

<p>Ethambutol (D)</p> Signup and view all the answers

What should a patient diagnosed with tuberculosis (TB) be educated on?

<p>Take all medications for the full duration (A)</p> Signup and view all the answers

What is a common early sign of pneumonia in older adults?

<p>Confusion (C)</p> Signup and view all the answers

Which of the following is a risk factor for developing pneumonia?

<p>COPD (C)</p> Signup and view all the answers

What might a chest X-ray reveal in a patient with pneumonia?

<p>Lung infiltrates (B)</p> Signup and view all the answers

What is a potential complication of bronchoscopy?

<p>Bleeding (C)</p> Signup and view all the answers

Which of the following is a nursing diagnosis related to pneumonia?

<p>Ineffective airway clearance (C)</p> Signup and view all the answers

What intervention should a nurse perform before resuming oral intake after a bronchoscopy?

<p>Assess gag reflex (A)</p> Signup and view all the answers

What is a common treatment for pneumonia-related hypoxemia?

<p>Oxygen therapy (D)</p> Signup and view all the answers

Which medication is often prescribed to help loosen mucus in patients with pneumonia?

<p>Expectorant (C)</p> Signup and view all the answers

Which of the following is important for the nurse to teach the patient about antibiotics?

<p>Finish the full course of antibiotics (D)</p> Signup and view all the answers

What position is best for a patient with pneumonia to help improve their breathing?

<p>High-Fowler's (C)</p> Signup and view all the answers

Flashcards

Intracellular Fluid (ICF)

Fluid inside cells; 2/3 of body water. High in K⁺ and Mg²⁺.

Extracellular Fluid (ECF)

Fluid outside cells; 1/3 of body water. Includes interstitial, intravascular (plasma), and transcellular fluid.

Third Spacing

Fluid moves from intravascular space to interstitial/transcellular spaces, becoming unusable.

Hyponatremia Symptoms

Low sodium level (<135 mEq/L) can causes Thirst, dry mucosa, irritability, restlessness.

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Hypokalemia Symptoms

Low potassium level (<3.5 mEq/L) can cause ECG changes (peaked T waves), muscle cramps, bradycardia.

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Isotonic Solutions

Stays in the intravascular space. Used for dehydration, blood loss, and fluid resuscitation.

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Hypertonic Solutions

Pulls fluid out of cells into blood vessels. Used for cerebral edema and severe hyponatremia.

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Daily Weights

Most accurate measure of fluid balance.

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Intake and Output (I&O)

Measures fluid intake (IV/oral) vs. output (urine, stool, vomit).

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Skin Turgor

Checks for dehydration (poor turgor = dehydration).

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Lung Sounds: Crackles

Crackles may indicate fluid overload.

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Urine Specific Gravity

Low in fluid overload, high in dehydration.

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Respiratory compensation

Minutes to hours, adjusts CO₂ levels.

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Vesicular

Normal breath sounds, soft, heard over lung fields.

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Crackles (Rales)

Popping sounds, caused by fluid in alveoli (seen in pneumonia, CHF).

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Rhonchi

Coarse, low-pitched wheezing, caused by secretions in large airways (seen in COPD, bronchitis).

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CKD Stage 1

GFR > 90 mL/min with kidney damage but normal function.

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CKD Stage 2

GFR 60-89 mL/min with mild loss of function.

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CKD Stage 3

GFR 30-59 mL/min; moderate loss, increased symptoms (fatigue, fluid retention).

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CKD Stage 4

GFR 15-29 mL/min; severe kidney damage, preparation for dialysis.

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CKD Stage 5 (ESRD)

GFR < 15 mL/min; requires dialysis or kidney transplant.

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Hyperkalemia in CRF

High potassium levels leading to risk for cardiac arrest.

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Hyponatremia in CRF

Low sodium levels leading to fluid retention, confusion.

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Calcium & Phosphate in CRF

Low calcium & high phosphate leading to bone disease.

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Dextrose Dialysate

Used to pull excess fluid from the blood in peritoneal dialysis.

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Sevelamer (Renagel)

Phosphate binder, taken with meals to prevent hyperphosphatemia.

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Polycythemia Vera

Bone marrow overproduces red blood cells, leading to thickened blood and increased clotting risk.

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Stable Angina

Chest pain due to the heart needing more oxygen, often caused by narrowed coronary arteries. Relieved by rest or nitroglycerin.

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Vasospastic Angina

Spasm of coronary artery temporarily reduces blood flow. Occurs at rest, often at night.

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Pre-Infarction Angina

Worsening unstable angina that signals an impending heart attack (MI). Severe, persistent chest pain not relieved by rest or meds.

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Catecholamines

Stress hormones, including epinephrine, norepinephrine, and dopamine.

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Pleural Effusion

Buildup of fluid in the pleural space.

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Sepsis (Pneumonia Complication)

Infection spreading into the bloodstream.

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Lung Abscess

Pockets of pus forming within lung tissue.

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Lung Infiltrates

Fluid buildup in the lungs, seen on chest X-ray.

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Ineffective Airway Clearance

Increased mucus buildup, hindering effective breathing.

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Impaired Gas Exchange

Compromised oxygen and carbon dioxide exchange in the lungs.

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Post-Bronchoscopy Monitoring

Monitor for stridor or dyspnea.

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Guaifenesin (Mucinex)

Loosens mucus, making it easier to cough up.

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Antibiotic Course Completion

Finish the full course of medication prescribed.

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Prevent Atelectasis

Coughing, deep breathing, incentive spirometry

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Dehydration risk in older adults?

Decreased thirst sensation, reduced kidney function, medication.

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Kidney function: Older adults

Alters the ability to concentrate urine, leading to imbalances.

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Fastest ABG compensation?

Adjusts CO₂ levels in response to pH changes.

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Hemodialysis (HD)

Filters blood using a machine, requiring vascular access.

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Peritoneal Dialysis (PD)

Uses peritoneal membrane in abdomen for waste removal at home.

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Hemodialysis side-effects

Hypotension, muscle cramps, fatigue, anemia, infection risk.

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Major risk with peritoneal dialysis

Infection of the peritoneum, mainly due to catheter use

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Dialysis: Psych Effects

Feelings of sadness and worry that can occur due to big changes dialysis brings.

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Dialysis: Body Image

Negative self-perception related to physical changes from dialysis treatment (AV fistula/catheter).

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Dialysis: Financial Burden

High medical bills/ impact from the inability to work that can cause emotional distress.

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Early Asthma Signs

Wheezing, shortness of breath, chest tightness, coughing (especially at night).

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Asthma: Nursing Actions

Assess, Administer bronchodilators (Albuterol), Corticosteroids, Oxygen, Teach trigger avoidance, Monitor.

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Asthma: Peak Flow

How well air moves out of the lungs to see if medicine adjustments are neeeded.

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Asthma: Rescue Inhaler

Albuterol provides quick relief during asthma attacks.

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Asthma: Anti-Inflammatory

Medication (Fluticasone/Prednisone) to reduce inflammation.

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Status Asthmaticus

Severe asthma attack unresponsive to treatment, with symptoms worsening.

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Aspirin in Polycythemia Vera

Reduced platelet count ( Thins blood, reducing clot risk.

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Hydroxyurea

Medication used to suppress bone marrow's excessive RBC production in polycythemia vera.

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Phlebotomy (for PV)

Regular removal of blood to reduce its thickness in polycythemia vera.

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Thrombocytopenia

Low platelet count, increasing the risk of bleeding.

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Hypertensive Crisis

Extremely high blood pressure (> 180/120 mmHg) with organ damage risk; requires immediate treatment.

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Chronic Conditions & Lungs

COPD, diabetes, and heart disease weaken lung defenses.

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Smoking, Alcohol & Pneumonia

Smoking and alcohol damages lung tissue, increasing pneumonia risk.

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Pneumonia in Older Adults

Confusion, weakness, and lack of fever are early signs in older adults.

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Pneumonia Diagnostics

Chest X-rays identify fluid, sputum cultures identify bacteria, CBC shows elevated WBC's, ABGs identify oxygenation levels.

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Bronchoscopy: Bleeding

Monitor for hemoptysis.

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Pneumonia: Oxygen Therapy

Oxygen therapy addresses hypoxia.

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Pneumonia: IV Fluids

IV fluids prevent dehydration.

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Azithromycin for Pneumonia

Azithromycin (Zithromax) is a common first-line treatment for CAP.

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Pneumonia: Cough & Deep Breathe

Coughing and deep breathing prevent atelectasis.

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Pneumococcal Vaccine

Vaccination helps protect against pneumococcal pneumonia.

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TB Infection Process

Infection caused by inhaling Mycobacterium tuberculosis, leading to multiplication in the lungs, immune response, and potential spread.

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TB Risk Factors

Weakened immunity, close contact with infected individuals, malnutrition, substance abuse, and smoking.

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Body Systems Affected by TB

Primarily affects the lungs (Pulmonary TB) but can also affect bones, kidneys, brain, and lymph nodes (Extrapulmonary TB).

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TB Transmission Method

Airborne transmission through coughs, sneezes, or speaking, allowing bacteria to remain suspended in the air.

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TB Signs and Symptoms

Persistent cough, night sweats, weight loss, fatigue, fever, chills, and hemoptysis (in advanced cases).

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TB Isolation Precautions

Airborne precautions, including a negative pressure room and N95 respirator or PAPR mask.

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TB Diagnostic Tests

Mantoux (PPD) skin test, Chest X-ray, Sputum Culture (AFB), and Interferon-Gamma Release Assay (IGRA).

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First-Line TB Medications

Rifampin (RIF), Isoniazid (INH), Pyrazinamide (PZA), and Ethambutol (EMB).

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Rifampin (RIF) side effect

Turns urine & body fluids orange.

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TB Patient Education

Medications must be taken for the full duration (6-12 months), alcohol should be avoided, and good hygiene & cough etiquette should be practiced.

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Study Notes

Chronic Kidney Disease (CKD) Complications and Care

  • Main risk factors for CKD include diabetes mellitus, hypertension, and heart disease
  • Renal failure affects multiple systems:
  • Cardiovascular system complications are hypertension, heart failure, and pericarditis due to fluid overload
  • Respiratory problems involve pulmonary edema and Kussmaul respirations
  • Hematologic issues includes anemia
  • Neurological problems are confusion, neuropathy, and seizures (due to uremic toxins)
  • Patients experience Gastrointestinal issues, namely nausea, vomiting, and metallic taste (uremia)
  • Skeletal problems involves osteodystrophy (low calcium, high phosphate)
  • Early stages (1-3) of Chronic Kidney Diease shows no major symptoms, just mild proteinuria
  • Moderate stage (3-4) involves fatigue, fluid retention, hypertension, and electrolyte imbalance
  • End-stage (5) symptoms are severe uremia, itching, confusion, seizures, edema, and anemia
  • Hyperkalemia (↑ potassium) leads to risk for cardiac arrest
  • Hyponatremia (↓ sodium) leads to fluid retention and confusion
  • Hypocalcemia (↓ calcium) & Hyperphosphatemia (↑ phosphate) causes bone disease
  • Metabolic acidosis occurs with decreased bicarbonate
  • Dextrose-based dialysate pulls excess fluid from the blood
  • Icodextrin-based solution is intended for diabetic patients

Medications for Chronic Kidney Disease

  • Sevelamer (Renagel) acts as a phosphate binder and should be taken with meals
  • Calcium Acetate (PhosLo) also binds phosphate but increases calcium levels

Hemodialysis and Peritoneal Dialysis Nursing Implications

  • Hemodialysis implications include blood pressure monitoring, checking AV fistula for bruit/thrill, and hold anti-hypertensive medications
  • Peritoneal Dialysis implications include assessing peritonitis, strict aseptic technique, and checking for hernias

Psychological effects of dialysis

  • Depression and Anxiety can occur due to lifestyle changes
  • Body image issues for AV fistula, catheter
  • Financial burden is a high cost due to missed work

Asthma

  • Early signs of asthma are wheezing, shortness of breath, chest tightness, and coughing
  • Asthma progressive symptoms are increased respiratory rate, accessory muscle use, and prolonged expiratory phase
  • Nursing Management includes monitoring the patient's respiratory system, give medications, teach to avoid triggers, encourage proper breathing
  • Always carry a rescue inhaler such as albuterol
  • Patients should avoid smoke, dust, and strong smells
  • Using inhalers correctly is important

Medications for Asthma

  • Albuterol, via nebulizer or metered-dose inhaler has bronchodilatory effects
  • inhaled Corticosteroids includes Fluticasone and Budesonide

Status Asthmaticus

  • Breathlessness at rest, inability to speak, increased RR, and silent chest occur during an asthma attack
  • Treatment includes Albuterol and Steroids
  • Albuterol should be used during an attack
  • Salmeterol should be used daily
  • Anticholinergic drugs prevent bronchoconstriction, examples includes Ipratropium

Bronchitis/Emphysema (COPD)

  • COPD inhibits the body from exhaling CO2
  • Chronic low 02 levels occur
  • Air trapping and hyperinflation is emphysema
  • Coarse, low-pitches wheezing, caused by buildup occurs
  • Increase dyspnea that occurs overtime

Required Equipment for COPD

  • Nasal Cannula prevents oxygen toxicity
  • Venturi Mask to ensure precise oxygen delivery
  • Air pollution exposure can worsen

Tuberculosis (TB)

  • TB can spread and affect bones, kidneys, brain, and lymph nodes
  • TB needs to be isolated
  • N95 or N99 are required when helping TB patients
  • Mantoux test is performed for TB, a positive results indicates to get a chest x-ray performed
  • Rifampin treatemnt

Anemia

  • Anemia may lead to weakness and decrease in oxygen in the body
  • Iron-Rich foods should be consumed
  • Anemia can lead to neurological issues
  • Sickle cell anemia is a genetic complications
  • Thrombocytopenia is low platelet count, which increases risk for patients with leukemia
  • Atypical symptoms for women with angina: jaw pain

Peripheral Artery Disease (PAD)

  • It is important to get blood flow to extremities to help narrow the arteries and treat PVD, which is caused by by atherosclerosis

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