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 about the study hightail it. I give answer questions about the study guide during the brief review before the exam itself. You cannot memorize the answers to the questions and do rise on the exam- the questions are meant to stimulate issueking, not to be answers. Please mobilise to review the chapters on shock and MODS as there are questions on this content. 1.There are several ABG questions remember these also include oxygen numbers so be prepared to determine oxygenation in addition to acetous base PH 7. 35- 7. 45 PCO2 35-45 HCO3 22-26 O2 94-100 2. review article the care of the patient with pneumonia, including relevant nursing diagnoses and measureable outcomes Restrictive respiratory disorder diminish lung expansion- low PaO2, fall lung compliance, normal to low P/Q ration, shunt, respiratory alkalosis (blowing off co2, more bicarbonate) summation RR, TV smaller.SOB/cough, dyspnea=how many words can they say in one breath chest upset, fatigue, wt. loss, lung crackles, care HOB 30deg, fluids to clear secretions, tidal volumenormal breathing 500mL Nursing dx imp tuneed gas exchange, inefficacious breathing pattern, acute pain Outcomes maintains adequate alveolar oxygen-carbon dioxide exchange, clears lungs of fluids and exudates. Demonst calculates effective RR, rhythm, and shrewdness of respirations. Reports control of pain following relief measures. . Review the manipulation for TB (look in Lewis), including medications, length of treatment, evaluation of treatment plan, who is most likely to produce TB infection, and side set up of the medications Medications aggressive TB treatment cardinal drugs for 6 months, (INH, rifampin Rifadin, pyrazinamide PZA, and etham justol) Newer rifamycins, rifubin, rifapentine, first line for special situations Length of treatment 6 months- 1 YearEvaluation of treatment plan resolution of the disease, normal p ulmonic function, absence of any complication, no transmission of TB, Most likely to fuck off 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 liver function.PZA may not be include in initial phase (due to liver disease or pregnancy) 4. Review the care of a patient with lung surgery, including chest thermionic valve management To obligate lung inflated & Drain fluid from interpleural space How do you know if collapsed lung caudex gases, Chest X-ray, Vital signs, Color Air leaks bubbling in irrigate ho procedure 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 t o sucking 100cc/hr. of drainage = call doc Determine if working correctly by Monitor output, pain, breath sounds, assess patient breathing, auscultate, ABG, pulse ox (SPO2), scrape/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, myocardiopathy and management of the patients remember to review the hemodynamic changes (and values) associated with right and left sided failure counterbalance SIDED HF (FLUID RETENTION) Corpulmonale, systemic edema, neck vein distention, weight gain, fluid retention, seek COPD, hypoxia (pulmonary HTN), causes pulmonary vasoconstriction.CVP = increase PVR = increase SVR = change magnitude wedge = change magnitude contractility = change magnitude medication nitroglycerine to decrease venous return, fix preload LEFT SIDED HF (RESPIRATORY) DYSPNEA ON EXERTION, back up in lungs, pink bubbling sputum, d ecreased O2 stat, increase RR. CVP = increased PVR = increased SVR = increased wedge = increased contractility = decreased HEART FAILURE Usually starts out with one heart 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 to a fault much afterload HTN. TX decrease SVR with dig, Lasix (diuretics), ACE. 2.Diastolic problem with filling and getting cable in (Hypertrophic cardio) less room for blood TX Beta blockers to reduce concretion or calcium channel then ACE. If you give them DIG it will kill them (will increase heart working too hard). PULMONARY oedema hallmark pink frothy sputum, Left- sided heart failure. Decreased albumin, decreased oncotic pressure, increased hydrostatic pressure. Dilated Left vent is dilated (stretched out of shape) decreasing the ejection fraction. publicize 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 rob is AGGRESSIVE Ace, Diuretic, Dobutamine, Nitroglycerin/Nitropresside, exercise restriction . Review patho and management of COPD, curiously 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 increased TLC, decreased forces expiratory volume, increased functional difference 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, respire 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 rattling fast, otherwise cyanosis is a late sign 7. Review management of p atients on ventilators, including process of weaning and recognition of weaning failure AC facilitate control doing all the breathing for the patient. Its providing Tidal volume and oxygen.For your insecure patient NO pressure support needed SIMV synchronized sporadic mandatory ventilation For weaning Makes it easier for patient to take their own automatic breath. Tidal volume off and O2 on. Pressure support adjunct cheep collateral end expiratory pressure, observes alveoli open by use of positive pressure. Increases FRC air left in after exhalation. ARDS patient. Little mo of positive pressure at the end of exhalation. Use with SIMV or AC. Keep between 5-10, and not over