Wednesday, July 17, 2019

Nursing Study Guide Block 4 Final

Study Guide for the belittledest Exam Here are the rules please do not call me or email me questions well-nigh the study guide. I will answer questions somewhat the study guide during the brief review in advance the exam itself. You later on partnot memorize the answers to the questions and do well on the exam- the questions are meant to stimu slowly thinking, not to be answers. enthrall regard as 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 be 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 breast feeding diagnoses and measureable exposecomes Restrictive respiratory disorder slackd lung expansion- low PaO2, drop- stumbled lung compliance, usual to low P/Q ration, shunt, respiratory alkalosis (blowing off co2, more bicarbona te) increase RR, TV smaller.SOB/cough, dyspnea=how many words can they say in one breath authority pain, fatigue, wt. loss, lung crackles, care pyxie 30deg, fluids to clear secretions, tidal passel regular alert 500mL Nursing dx imp publiciseed gas exchange, in rough-and-ready respiration pattern, acute pain Outcomes maintains adequate alveolar oxygen-carbon dioxide exchange, clears lungs of fluids and exudates. Demonst quantifys effective RR, rhythm, and depth of respirations. Reports control of pain following break measures. . Review the treatment for TB (look in Lewis), including medicinal drugs, duration of treatment, evaluation of treatment plan, who is close likely to social occasion up TB infection, 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, primary line for special situations Length of treatment 6 months- 1 Year Evaluation of treatment plan resolution of the disease, normal pulmonary function, absence of any complication, no transmission system 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 human immunodeficiency virus infections Side effects of meds alcohol increases hepatotoxicity of INH, monitor colorful 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 agency metro management To keep lung inflated & give come to the fore fluid from interpleural space How do you know if collapsed lung livestock gases, Chest X-ray, Vital signs, Color Air leaks frothing in water chamber check your tubes for diffuse leak & make sure theyre eer free of kinks. Dont milk the chest tube (unless ordered).Continued bubbling = pneumothorax n ot resolved yet, uninterrupted vigorous bubbling = air leak in system Should see tidaling if not attached to sucking 100cc/hr. of drainage = call doc Determine if operative correctly by Monitor output, pain, breath sounds, assess patient breathing, auscultate, ABG, pulse ox (SPO2), skin/ mucose membrane coloring, and respiratory effort Chest tube pain is common- give pain meds 7/10 5.Review philia 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 ripe SIDED HF (FLUID RETENTION) Corpulmonale, systemic edema, neck vein distention, burthen gain, fluid retention, Risk COPD, hypoxia (pulmonary HTN), causes pulmonary vasoconstriction.CVP = increase PVR = change magnitude SVR = increased wedge = increased contractility = decreased medication nitroglycerine to decrease venous return, fix preload lef tfield SIDED HF (RESPIRATORY) DYSPNEA ON EXERTION, back up in lungs, pink frothy sputum, decreased O2 stat, increase RR. CVP = increased PVR = increased SVR = increased wedge = increased contractility = decreased HEART FAILURE Usually starts out with one ventricle. glyceryl trinitratee, aspirin, O2, pericardial thump, Lasix, ACE, + inotrope, Class 4, transplant, symptomatic. ACUTE HF Dig, Lasix, ACE, ARBS, genus Betas, Calcium Channel, Nitro, and Aspirin, compensatory weapon is ok. CHRONIC HF twain ventricles can fail (left to right), Dig, Lasix, ACE, BETA, ARBS (if cough), calcium melody 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 bank line in (Hypertrophic cardio) less room for blood TX Beta blockers to reduce contraction or calcium channel then ACE. If you give them D IG it will eat up them (will increase perfume working too hard). pulmonic EDEMA hallmark pink frothy sputum, leftover- sided warmness failure. Decreased albumin, decreased oncotic mash, increased hydrostatic pressure. Dilated Left vent is refined (stretched out of shape) decreasing the ejection fraction. freeing is overstretched from CHF or chronic hypertension.Diagnose with chest X-ray stub 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, curiously related to acute respiratory failure. COPD obstructive, exhalation problem, ai r flows in but then becomes trapped, teach pursed two-lipped breathing to improve FRC. Clinical manifestations increased lung expansion, normal to increased TLC, decreased forces expiratory volume, increased practicable 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, breathe or rhonchi, A fib from chronic overutilization 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, inc reased depth, PVCs, Pulmonary intercalation=blue very fast, otherwise cyanosis is a late sign 7. Review management of patients on ventilators, including wreak 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 sporadic mandatory ventilation For weaning Makes it easier for patient to bugger off their own spontaneous breath. Tidal volume off and O2 on. Pressure support adjunct PEEP overbearing end expiratory pressure, progresss 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

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