Nursing Study Guide Block 4 Final

Study Guide for the Final Exam Here are the rules please do not call me or email me questions somewhat the study guide. I will answer questions ab step forward the study guide during the brief review before the exam itself. You cannot memorize the answers to the questions and do well on the exam- the questions are meant to stimu latterly thinking, not to be answers. Please think up to review the chapters on shock and MODS as there are questions on this content. 1.There are some(prenominal) ABG questions remember these also include oxygen numbers so be prepared to determine oxygenation in addition to acid base PH 7. 35- 7. 45 PCO2 35-45 HCO3 22-26 O2 94-100 2. Review the care of the patient with pneumonia, including applicable nursing diagnoses and measureable come out of the closetcomes Restrictive respiratory disorder decreased lung expansion- low PaO2, decreased lung compliance, normal to low P/Q ration, shunt, respiratory alkalosis (blowing off co2, more bicarbonate) increase RR, TV smaller.SOB/cough, dyspnea=how many words can they say in one breath bosom pain, fatigue, wt. loss, lung crackles, care imp 30deg, fluids to clear secretions, tidal volumenormal breathing 500mL Nursing dx imp placeed gas exchange, in hard-hitting breathing pattern, acute pain Outcomes maintains adequate alveolar oxygen-carbon dioxide exchange, clears lungs of fluids and exudates. Demonstrates effective RR, rhythm, and depth of respirations. Reports control of pain following relief measures. . Review the treatment for TB (look in Lewis), including medications, length of treatment, evaluation of treatment plan, who is most likely to necessitate TB transmission, and side effects of the medications Medications aggressive TB treatment four drugs for 6 months, (INH, rifampin Rifadin, pyrazinamide PZA, and ethambutol) Newer rifamycins, rifubin, rifapentine, first line for special situations Length of treatment 6 months- 1 YearEvaluation of treatment plan resolution of the diseas e, normal pulmonary function, absence of any complication, no transmission of TB, Most likely to contract Asians have the highest TB rate, followed by Hawaiians and pacific islanders. African Americans are the highest rate inside the US. (45%) Higher rates of TB infections with patients with HIV infections Side effects of meds alcohol increases hepatotoxicity of INH, monitor colored function.PZA may not be included in initial phase (due to liver disease or pregnancy) 4. Review the care of a patient with lung surgery, including bosom tube management To keep lung inflated & Drain fluid from interpleural space How do you know if collapsed lung Blood gases, Chest X-ray, Vital signs, Color Air leaks bubbling in water chamber check your tubes for air leak & make sure theyre always free of kinks. Dont milk the chest tube (unless ordered).Continued bubbling = pneumothorax not resolved yet, Constant vigorous bubbling = air leak in system Should see tidaling if not attached to sucking 100 cc/hr. of drainage = call doc Determine if working correctly by Monitor output, pain, breath sounds, assess patient breathing, auscultate, ABG, pulse ox (SPO2), skin/mucous membrane coloring, and respiratory effort Chest tube pain is common- give pain meds 7/10 5.Review heart failure right-sided (acute and chronic), left- sided (acute and chronic), pulmonary edema, cardiomyopathy and management of the patients remember to review the hemodynamic changes (and values) associated with right and left sided failure RIGHT SIDED HF (FLUID RETENTION) Corpulmonale, systemic edema, neck vein distention, weight gain, fluid retention, Risk COPD, hypoxia (pulmonary HTN), ca social functions pulmonary vasoconstriction.CVP = increased PVR = increased SVR = increased wedge = increased contractility = decreased medication nitroglycerine to decrease venous return, fix preload LEFT SIDED HF (RESPIRATORY) DYSPNEA ON EXERTION, back up in lungs, pink frothy sputum, decreased O2 stat, increase RR. CVP = in creased PVR = increased SVR = increased wedge = increased contractility = decreased HEART FAILURE Usually starts out with one ventricle.Nitroglycerine, aspirin, O2, pericardial thump, Lasix, ACE, + inotrope, Class 4, transplant, symptomatic. ACUTE HF Dig, Lasix, ACE, ARBS, Betas, Calcium Channel, Nitro, and Aspirin, compensatory mechanism is ok. CHRONIC HF both ventricles can fail (left to right), Dig, Lasix, ACE, BETA, ARBS (if cough), calcium channel blocker, Primacore, compensatory mechanism makes it worse. 2 CLASSIFICATIONS OF HF 1. Systolic problems pushing volume out problem with too much afterload HTN. TX decrease SVR with dig, Lasix (diuretics), ACE. 2.Diastolic problem with filling and getting course in (Hypertrophic cardio) less room for blood TX Beta blockers to reduce contraction or calcium channel then ACE. If you give them DIG it will fine-tune them (will increase heart working too hard). PULMONARY EDEMA hallmark pink frothy sputum, unexpended- sided heart failure. Decreased albumin, decreased oncotic pressure, increased hydrostatic pressure. Dilated Left vent is dilated (stretched out of shape) decreasing the ejection fraction. Vent is overstretched from CHF or chronic hypertension.Diagnose with chest X-ray heart is BIG. TX Dig, Lasix, Ace. Arrhythmias will increase mortality rate HYPERTROPHIC L vent hypertrophy decreases the ability of the chamber to relax, decrease contractility (athlete, hereditary. ) TX BB, CCB Constricted/restricted normal size heart with decreased cardiac muscle compliance. Scarred= fibrosis, radiation, infection (rheumatic fever) control of volume overload is AGGRESSIVE Ace, Diuretic, Dobutamine, Nitroglycerin/Nitropresside, exercise restriction . Review patho and management of COPD, especially related to acute respiratory failure. COPD obstructive, exhalation problem, air flows in but then becomes trapped, teach pursed lipped breathing to improve FRC. Clinical manifestations increased lung expansion, normal to increa sed TLC, decreased forces expiratory volume, increased useful residual capacity, decreased vital capacity, increased CO2, O2 sat-80-100, PaO2- 60 Best mask to use is vent mask, most precise O2 is delivered.Barrel chest- chronic hyperinflation of torso Corpulmonale, expiratory time, reedy or rhonchi, A fib from chronic overuse of right ventricle TX beta agonist/beta stimulant=dilates airway (epinephrine, albuterol) Anticholinergic bronchodilators, corticosteroids, mucolytic=thin out secretions, Mucinex or SVN mucomist, pulmonary vasodilators not common, prostaglandin E2, supposed to dilate pulmonary vessels but BP can plummet too.Nitrous oxide can temporarily improve pulmonary HTN but doesnt improve outcomes Respiratory Failure ALOC- confusion, restless. Nasal flaring, increased HR, increased BP, increased RR, increased depth, PVCs, Pulmonary Embolism=blue very fast, otherwise cyanosis is a late sign 7. Review management of patients on ventilators, including process of weaning and recognition of weaning failure AC assist control doing all the breathing for the patient. Its providing Tidal volume and oxygen.For your unstable patient NO pressure support needed SIMV synchronized intermittent mandatory ventilation For weaning Makes it easier for patient to crap their own spontaneous breath. Tidal volume off and O2 on. Pressure support adjunct PEEP positive end expiratory pressure, make unnecessarys alveoli open by use of positive pressure. Increases FRC air left in after exhalation. ARDS patient. Little bit of positive pressure at the end of exhalation. Use with SIMV or AC. Keep between 5-10, and not over