Focus Review for Exam PDF

FOCUS REVIEW FOR EXAM BNP → BUN, Cr, Na, Cl, K, Ca, HCO/Bicarb, glucose The Lab Values Low number = FVE High Number = FVD BUN → 10 to 20 Hematocrit → 38 to 45% Creatinine → 0.6 to 1.2 Osmolality → 275 - 295 Specif...

FOCUS REVIEW FOR EXAM BNP → BUN, Cr, Na, Cl, K, Ca, HCO/Bicarb, glucose The Lab Values Low number = FVE High Number = FVD BUN → 10 to 20 Hematocrit → 38 to 45% Creatinine → 0.6 to 1.2 Osmolality → 275 - 295 Specific gravity → 1.003 to 1.030 WBC → 5,000 to 10,000 Glucose → 70 to 110 CVP - Increase = FVE hypervolemia - Decreased = FVD hypovolemia The Electrolytes Na → 135 to 145 K → 3.5 to 5.3 Ca → 9 to 11 Mg → 1.8 to 3 Phos → 2.5 to 4.5 Cl → 97 to 110 Medications (diuretics) - Loop Diuretics = Furosemide (Lasix) - Effects the ascending limb of the loop of Henle generic - Thiazide Diuretics = Hydrochlorothiazide (Hydrodiuril) brand - Inhibit sodium chloride reabsorption - Potassium-Sparing Diuretics (aldosterone antagonist) = Spironolactone (Aldactone) - Increase potassium reabsorption by preventing sodium reabsorption - Renagel → removal of phosphate - Kayexalate → removal of potassium Know the IV fluids / Know how fluids shift Extracellular(outside) intracellular(inside cell) Isotonic → enter cell evenly - 0.9 NS, LR Hypotonic → into cell From spaces > - into cell - 0.45% NaCl  - 0.225 NaCl Hypertonic → out of cell from cell- > Into spaces - D5NS, D5LR, 3% and 5% NaCl How body compensates ABGs Chemical = ADH , CO2 removal Respiratory = remove Hydrogen (Acid) Renal/Metabolic = hold onto bicarb (Base) Fluid Regulation - Thirst, Kidneys, ADH - Thirst = decrease blood volume, increased serum osmolality = water loss - Kidney = RAAS - ADH = release for pituitary to retain fluids RAAS Stimulus → angiotensin (from liver) → renin → angiotensin 1 → angiotensin 2 → renal excretion Cause → water/blood fluid in body decreases Effect → decrease BP, decrease blood flow Result → thrist factor increase, ADH hormone Insensible fluid loss —> sweating Diseases to know - ADH = antidiuretic hormone - SIADH = too much ADH, wet and wild, FLUIDS IN - DI = too little ADH, Dry and high, FLUIDS OUT IMPORTANT NOTES K+/Mg = Heart Hyponatremia W - Measure I & Os - - Daily weights > - - Labs to know - Fluid volume excess → CXR, Diuretics Altered renal function → No LASIX NG tube suction/vomit (Metabolic Base) = Lose H, K+, Na (more basic Diarrhea (metabolic acid) = Lose Bicarb (more acidic Hypovolemia vs hypovolemic shock Hypovolemia + organ dysfunction = hypovolemic shock S/S → rapid breathing, sweating, passing out, neuro, cold skin, weakness, fast pulse Heart rate = High, BP = low How to administer potassium Never IV push 2-3 hours Slow if pt states burn NEVER bolus Check K before and after Must be diluted Monitor IV site Infusion pump / not gravity flow neey A B 35 7 45 PH - : 7. , * Lungs CO2 : : 335 - 45 ABGs and their ranges How to do ABG problems Look at the pH for acid or baseKidney HCO3 : 12-123 : pH → acid 7.35 to 7.45 base HCO3 → acid 22 to 26 base PaCO2 issue = respiratory PaCO2 → base 35 to 45 acid HCO3 issue = Metabolic PaO2 → 80 - 100 mm HG Ignore PaO2 O2 stat = 94% or higher Fluid volume deficit vs Fluid volume overload SODIUM 135 TO 145 POTASSIUM 3.5 TO 5.3 MAGNESIUM 1.8 TO 3 CALCIUM 9 TO 11 E RESPIRATORY Things that affects rate, depth of breathing Bronchi + alveoli Bronchi carry = - Bronchi → carry oxygen - Alveoli → oxygen exchange Alveoli =exchange Aortic + Cortaid bodies → sensory organs used to monitor O2 and CO2 in body Chemoreceptors vs baroreceptors - Pons, Medulla oblongata - Chemoreceptor → sensitive to acidosis and produce vasoconstriction - Baroreceptor → pressure receptor that reacts to changes in blood pressure Pleural space → space between visceral and parietal that allows you to breathe without pain/friction Xaround the Lungs Aging → less effective cough, immobility It muscle strength) Lung compliance = distensibility of lung - Ability to swell with pressure - Flexibility of rib cage - Elasticity of lung tissue What is surfactant + purpose Surfactant stabilizes = alveoli Used to reduce surface tension to help alveoli to be more stable Prevent pain when breathing Effects of Zinc in the body Decrease of Zinc results in olfactory nerve damage or chronic inflammation - Zinc is a mineral used for smell Inspiration and expiration mechanisms Exhalation is longer !!! Inspiration → 1 to 1.5 seconds - Muscle used diaphragm and external intercostals - Diaphragm contracts + external muscles and moves down, allow air to go in Exhalation → 1.5 to 2 seconds - Muscle used Diaphragm abdominal muscles - Diaphragm relaxes + abdominal muscles and moves up, pushing air out Prevention - Lifestyle changes, Work effects - Flu shot - Avoid noxious/ toxic inhalants Assessment Lung sounds - Crackles = fluid → popping / bubbling sound - Wheezes = narrowing → musical sound - Stridor = med emergency → honking sound - Rhonchi = construction secretions → snoring sound Diagnostic + Labs to do Biopsy → taking piece of lung to send to lab for testing CXR + CT + MRI → imaging of lung to check for fluids VQ (ventilation + perfusion) → looks at air exchange vs perfusion PET scan → using dyes to visualize lungs Bronchoscopy → used to look directly at airway with a tube - Confirm gag reflex, done before ANY feeding - HUGE Aspiration risk - Pt needs to be sedated Peak flow monitoring → measures air flow out of the lung; pt is breathing out - Green 80% to 100% - Yellow 50% to 80% - Red under 50% Culture and sensitivity test - 2-3 deep breaths before coughing - Sterile container - Collect in AM BMP/CMP → blood test that measures proteins and enzymes in blood sample) CBC → blood test that looks at blood in body (Diff types of cells Found : in ABGs CRP/ESR → find inflammation in body by looking at C-protein Nursing responsibilities for respiratory system Nursing dx of respiratory system - Ineffective airway, Impaired gas exchange, Risk for falls What happens when a pt gets new onset of confusion - DO NOT IGNORE - Get O2 stat, pulse, call MD, document How to care aspiration risk - Remove food Traytry at first sign - NPO, Swallow eval Giving oxygen Breathing devices → O2 is flammable !!  - Cannula 1-6L - Simple mask 4-8L - Aerosol 8-10L Complications - Oxygen toxicity I should only be used for a short period of time if possible) - If used more than 48 hrs - Damage or kill cells - Can give antioxidants → E, C and beta-carotene - Oxygen is flammable !! - Reduce as needed → decreasing duration or concentration How to use a Nebulizer → usually used for asthma - Pre-nebulizer lung assessment - Connect hose to air compressor - Insert medication - Turn on machine - Place mouthpiece in pt’s mouth - Turn off machine → when mist stops !! produced using vaccines are Flu → 18-72 hrs after exposure eggs How the vaccine is made → MUST CHECK FOR EGG ALLERGY - Inject virus into chicken - - Extract from chicken egg - Inactivate viral Labs to do → CBC, culture CXR → to check for pneumonia Encourage fluids Colds → over 200 strains Infected way before you show s/s Direct contact Types of pneumonia → stuff (Fluids) in lungs Types of acquired pneumonia - CAP community acquired = - HAP hospital acquired - VAP ventilator acquired Legionnaire Disease → freshwater infection of lungs - Symptoms → Dry cough w/ bloody mucus, High fever/chills, weak/tired, , Muscle aches, Abdominal pain, anorexia, diarrhea Atypical Pneumonia → large group of people - Symptoms → dry nonproductive cough, headache/weakness, joint pain, systematic Viral Pneumonia → virus causing - Symptoms → dry cough w/ yellow mucus, cold/flu like symptoms Pneumocystis Pneumonia → decreased immune system - Symptoms → Dry cough NO mucus, Decreased cough/gag reflex, silent regurgitation, Tachy/SOB Aspiration Pneumonia → choking on self - Symptoms → chest pain, SOB, wheezing, constant cough, signs of aspiration When pt is aspirating → turn to side Sleep apnea → Stop of breathing during sleeping Causes → age, narrowing of airways, genetics/Hx Symptoms → loud snort, stop breathing for at least 10 seconds, daytime sleepiness - Increase risk for Type II DM, HTN, Cardiac arrest Treatment → CPAP machine Asthma Cause → genetic, triggers, etc Dx → Peak flow meaning Symptoms → wheezing coughing, SOB, Chest tightness Treatment → LOOK AT MEDS FOR ASTHMA - short-acting beta2-adrenergic agonist dilate bronchial passage - Corticosteroids decrease inflammation - IV hydration replaces calories + glycogen - Magnesium sulfate relaxes smooth muscles  COPD Cause - low level alpha 1 antitrypsin break down elasticity and shape of alveoli - Genetic testing → alpha1, antitrypsin - Alpha 1 antitrypsin inhibits neutrophil elastase activity in the lung and protects it from proteolytic damage Treatment - Hypoxic drive → 2 L at home - 90% O2 stat, never expect 100% - Exercise / walking = 3x a week - Position = tripod - - Nutrition = small frequent meals ( protein/calories ; Realistic goals for pt carbscarbs burn Hot Emphysema VS Bronchitis Emphysema * Barrel chest & Decreased breath sounds ⑧ Use of accessory muscles Bronchitis How they Dx - Productive cough x3 months in 2 yrs  Meds to know for upper respiratory infections Antbx Decongestants → decongest, mobilize fluids Mucolytics → anti mucus Antihistamines → allergic reactions Broad spectrum antibiotics - Macrolide - Penicillin - 2nd/3rd gen. cephalosporin - Fluoroquinolone Meds to know for asthma Bronchodilator → Beta adrenergic aka beta-2 agonists - Relaxes muscles around airway, dilates airway - Albuterol (Proventil), levalbuterol (Xopenex) Bronchodilator → Anticholinergics - Blocks acetylcholine - Ipratropium (Atrovent), tiotropium (Spiriva) Bronchodilator → Methylxanthines Relay/smooth - - Relaxes smooth muscles - Theophylline ↑ Corticosteroids → methylprednisolone, prednisolone, prednisone Devotion to know Be strong and courageous Joshua 1:9 → have I not commanded you to be strong and courageous blah blah afraid , nor be Do not be strong and of Good courage ? ; be Have I not commanded you Lord your God is with you whereever you go dismayed , For the - Joshua 1 9 :