Funds Exam 2 Topics PDF

Know how to differentiate the types of diuretics and how to recognize them, why one would be used over another, potassium levels, etc Diuretics (Potassium-Wasting and Potassium-Sparing) Types of Diuretics: Loop Diuretics: ○ Examples: Furosemide (Lasix), bumetanide. ○ Mec...

Know how to differentiate the types of diuretics and how to recognize them, why one would be used over another, potassium levels, etc Diuretics (Potassium-Wasting and Potassium-Sparing) Types of Diuretics: Loop Diuretics: ○ Examples: Furosemide (Lasix), bumetanide. ○ Mechanism: Act on the loop of Henle in the kidneys, inhibiting the reabsorption of sodium, chloride, and water. ○ Monitor for: Hypokalemia: Loop diuretics are potassium-wasting, meaning they cause the kidneys to lose potassium. Low potassium can cause muscle cramps, weakness, and arrhythmias. Dehydration: Excessive fluid loss. Ototoxicity: In high doses or rapid administration, loop diuretics can lead to hearing loss. ○ Side Effects: Hypokalemia, dehydration, hypotension, hyperuricemia (risk of gout), and ototoxicity. ○ Contraindications: Severe electrolyte imbalances, anuria, or severe renal failure. ○ Nursing Considerations: Monitor potassium levels closely, and replace potassium as needed through supplements or diet. Ensure clients consume high-potassium foods, such as bananas, oranges, and spinach. Thiazide Diuretics: ○ Examples: Hydrochlorothiazide (HCTZ), chlorthalidone. ○ Mechanism: Act on the distal convoluted tubule to inhibit sodium and water reabsorption. ○ Monitor for: Hypokalemia: Also potassium-wasting, leading to low potassium levels. Hyperglycemia: Can increase blood glucose, especially in diabetic patients. ○ Side Effects: Hypokalemia, hyperglycemia, hypercalcemia, hyperuricemia. ○ Contraindications: Severe renal impairment, known hypersensitivity. ○ Nursing Considerations: Monitor electrolytes, especially potassium and sodium. Encourage fluid intake and foods high in potassium, especially for patients with hypertension or those on other antihypertensives. Potassium-Sparing Diuretics: ○ Examples: Spironolactone, eplerenone. ○ Mechanism: Block the effects of aldosterone, causing the kidneys to excrete sodium and water but retain potassium. ○ Monitor for:  Hyperkalemia: Since these diuretics are potassium-sparing, they can lead to high potassium levels, which can cause arrhythmias. ○ Side Effects: Hyperkalemia, gynecomastia (with spironolactone), menstrual irregularities, impotence. ○ Contraindications: Hyperkalemia, severe renal failure, Addison’s disease. ○ Nursing Considerations: Avoid giving potassium supplements or instruct clients not to eat excessive high-potassium foods (e.g., bananas, oranges) when using potassium-sparing diuretics. High Potassium Foods: Bananas, oranges, spinach, potatoes, tomatoes, avocados, raisins, beans, and nuts. Hypertensive Drugs and Their Side Effects: ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors) Examples: Lisinopril, enalapril, captopril (end in "-pril"). Mechanism: Inhibit the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thus lowering blood pressure by reducing vasoconstriction and sodium retention. Side Effects: ○ Persistent dry cough: Due to accumulation of bradykinin. ○ Angioedema: Rare but life-threatening swelling of the face, lips, or throat. ○ Hyperkalemia: Due to decreased aldosterone. ○ Hypotension: Particularly after the first dose. Contraindications: Pregnancy, history of angioedema, severe renal impairment. Monitor: Blood pressure, potassium levels, renal function. Nursing Consideration: If a patient develops a persistent cough or signs of angioedema, the medication should be discontinued immediately. Beta Blockers: Examples: Metoprolol, atenolol (end in "-olol"). Mechanism: Block beta-adrenergic receptors, reducing heart rate and contractility, which lowers blood pressure. Side Effects: ○ Bradycardia: Low heart rate. ○ Fatigue: Due to reduced cardiac output. ○ Bronchospasm: Especially in patients with asthma or COPD. ○ Masking of Hypoglycemia: Beta blockers can hide signs of hypoglycemia in diabetic patients. Contraindications: Asthma, COPD, heart failure, bradycardia, certain heart blocks.  Nursing Considerations: Monitor heart rate and blood pressure before administering. Avoid giving to patients with a history of asthma or chronic obstructive pulmonary disease. Calcium Channel Blockers: Examples: Amlodipine, diltiazem (end in "-dipine"). Mechanism: Inhibit calcium influx into cardiac and smooth muscle cells, leading to vasodilation and reduced heart contractility. Side Effects: ○ Peripheral edema. ○ Bradycardia. ○ Headaches and dizziness. Contraindications: Severe hypotension, heart block, bradycardia. Monitor: Blood pressure, heart rate. Digoxin (Inotropic Agent) Mechanism of Action: Increases the force of myocardial contraction (positive inotropic effect) by increasing calcium availability, thereby improving cardiac output and controlling heart rate in atrial fibrillation. Therapeutic Range: 0.5-2.0 ng/mL. Toxicity Risk: Narrow therapeutic range, so close monitoring is required. Signs of Toxicity: Early signs include nausea, vomiting, anorexia, and visual disturbances (e.g., yellow-green halos). Advanced toxicity may cause bradycardia, arrhythmias. When to Hold: Hold digoxin if heart rate is less than 60 bpm or if there are signs of toxicity. Always check apical pulse before administration. Factors Affecting Absorption: Increased Absorption: Hypokalemia increases the risk of digoxin toxicity. Decreased Absorption: High-fiber meals can reduce absorption of digoxin. Antidote: Digoxin Immune Fab (Digibind) for severe digoxin toxicity. Heparin vs. Warfarin Heparin: Mechanism: Inactivates thrombin and factor Xa, preventing clot formation. Administration: Given subcutaneously or intravenously. Lab to Monitor: aPTT (Activated Partial Thromboplastin Time). ○ Therapeutic Range: aPTT should be 1.5 to 2.5 times the normal. Antidote: Protamine sulfate for heparin overdose. Nursing Considerations: Monitor for signs of bleeding, check aPTT regularly, and adjust dose accordingly. Warfarin: Mechanism: Inhibits vitamin K-dependent clotting factors, preventing clot formation. Administration: Oral. Lab to Monitor: PT/INR (Prothrombin Time/International Normalized Ratio). ○ Therapeutic Range: INR should be 2 to 3 for most indications. Antidote: Vitamin K for warfarin overdose. Nursing Considerations: Monitor PT/INR regularly, educate patients to avoid foods high in vitamin K (e.g., leafy greens), and avoid alcohol and certain antibiotics that can increase bleeding risk. Heparin (Subcutaneous Injection) vs. Warfarin in Pregnancy: Heparin: ○ Safe for pregnancy because it does not cross the placenta. ○ Administration: Given subcutaneously or intravenously. ○ Bleeding risk education: Use electric razors instead of traditional razors to prevent nicks and cuts. Use a soft toothbrush to minimize gum bleeding. Avoid taking NSAIDs and aspirin, as they increase bleeding risk. Monitor for any signs of excessive bleeding (e.g., blood in stool or urine, easy bruising). Warfarin: ○ NOT safe for pregnancy because it crosses the placenta and can cause fetal harm. ○ Requires frequent PT/INR monitoring to ensure appropriate anticoagulation.  ○ Bleeding risk education: Same as Heparin (soft toothbrush, electric razor, avoid NSAIDs/aspirin). Cardiac Definitions: Cardiac Output (CO): ○ Definition: The volume of blood ejected from the left ventricle per minute. ○ Formula: CO = Stroke Volume (SV) × Heart Rate (HR). ○ Normal Range: 4-8 L/min. Preload: ○ Definition: The amount of blood in the ventricles at the end of diastole, just before contraction. ○ Influences: Affected by venous return and fluid volume. ○ Clinical Context: Increased preload (e.g., heart failure) stretches the ventricles. Afterload: ○ Definition: The resistance the heart must overcome to eject blood into the arteries. ○ Influences: Affected by blood pressure and vascular resistance. ○ Clinical Context: Increased afterload (e.g., in hypertension) makes it harder for the heart to pump. Stroke Volume (SV): ○ Definition: The amount of blood ejected with each heartbeat. ○ Normal Range: 60-100 mL per beat. ○ Factors affecting: Contractility, preload, and afterload. Cardiac Biomarkers: BNP (B-type Natriuretic Peptide): ○ Function: Released by the ventricles in response to increased volume/stretching. ○ Clinical Use: Elevated levels indicate heart failure. ○ Normal Range: Less than 100 pg/mL. CRP (C-Reactive Protein): ○ Function: A marker of inflammation produced by the liver. ○ Clinical Use: Elevated levels can indicate systemic inflammation and increased risk for cardiovascular disease (e.g., atherosclerosis). ○ Normal Range: Less than 1 mg/L (low cardiovascular risk). Troponin: ○ Function: Proteins released when the heart muscle is damaged. ○ Clinical Use: Highly specific for myocardial infarction (heart attack). ○ Normal Range: Less than 0.04 ng/mL. Arteriosclerosis vs. Atherosclerosis: Arteriosclerosis: ○ Definition: Hardening or thickening of the arterial walls, generally associated with aging. ○ Cause: Loss of elasticity in the arteries. Atherosclerosis: ○ Definition: A type of arteriosclerosis characterized by the buildup of plaque (fat, cholesterol, and other substances) inside the arteries. ○ Cause: Can lead to blockage of arteries, increasing risk of heart attack and stroke. Peripheral Artery Disease (PAD) vs. Peripheral Vascular Disease (PVD): Peripheral Artery Disease (PAD): Cause: Atherosclerosis, which leads to narrowed arteries and reduced blood flow to the extremities. Symptoms: ○ Intermittent claudication: Pain in the legs during exercise, relieved by rest. ○ Cold, pale extremities. ○ Weak or absent pulses. ○ Ulcers: Painful, well-defined edges, typically on toes and pressure points. Nursing Considerations: Encourage ambulation as tolerated, promote smoking cessation, and monitor for signs of ischemia. Peripheral Vascular Disease (PVD): Cause: Damage to veins, often related to chronic venous insufficiency. Symptoms: ○ Edema: Especially in the lower extremities. ○ Varicose veins. ○ Venous stasis ulcers: Shallow, irregular, usually painless, often found on the ankles. ○ Brownish discoloration around the ankles due to hemosiderin deposits. Nursing Considerations: Encourage compression stockings, leg elevation, and skin care to prevent ulcers. Types of Aneurysms: Abdominal Aortic Aneurysm (AAA): ○ Description: A localized dilation of the abdominal aorta. ○ Symptoms: Often asymptomatic. Pulsating mass in the abdomen. Back pain or flank pain. Bruit heard on auscultation. ○ Nursing Considerations: Monitor for signs of rupture (severe back pain, hypotension, tachycardia). Thoracic Aortic Aneurysm (TAA): ○ Description: A dilation of the aorta in the chest cavity. ○ Symptoms: Chest pain or back pain. Shortness of breath, difficulty swallowing, or hoarseness if it compresses nearby structures. ○ Nursing Considerations: Monitor vital signs and ensure preparation for surgical intervention if necessary. Raynaud’s Phenomenon: Description: A condition where small arteries in the fingers and toes constrict in response to cold or stress, causing decreased blood flow. Symptoms: ○ Color changes: White (pallor) to blue (cyanosis) to red (reactive hyperemia) in the fingers or toes. ○ Pain or tingling in affected areas. Nursing Care: ○ Educate clients to avoid cold environments and wear warm gloves. ○ Encourage stress management techniques. ○ Calcium channel blockers (e.g., nifedipine) may be prescribed to reduce vasospasm. ○ Smoking cessation is critical as nicotine exacerbates vasoconstriction. Controlled Substances Requirements: When administering controlled substances, specific documentation and safety measures are required. These include: Patient's Name: Must be clearly identified. Medication Name and Amount: Exact dose given should be documented. Time Administered: The hour of administration must be recorded accurately.  Provider's Name: The name of the healthcare provider who prescribed the controlled substance. Nurse's Name: The name of the nurse administering the medication. Other Considerations: ○ Double-checking: Some facilities require two nurses to verify the administration of controlled substances, especially for high-risk medications. ○ Secure Storage: Controlled substances must be stored in locked compartments. ○ Tracking: Document each use carefully to ensure proper tracking of controlled substances. Schedule I Description: These substances have a high potential for abuse, no currently accepted medical use in the U.S., and a lack of accepted safety for use under medical supervision. Examples: ○ Heroin ○ LSD (Lysergic acid diethylamide) ○ Ecstasy (MDMA) ○ Marijuana (still classified as Schedule I federally, although legal for medical use in many states) Significance: These drugs are not prescribed by healthcare providers and are illegal for use. Schedule II Description: These substances have a high potential for abuse, which may lead to severe psychological or physical dependence. They have accepted medical uses but with strict regulations. Examples: ○ Morphine ○ Oxycodone (OxyContin) ○ Fentanyl ○ Methamphetamine ○ Hydrocodone (Vicodin) ○ Adderall (amphetamine/dextroamphetamine) ○ Cocaine (sometimes used as a local anesthetic) Significance: Schedule II drugs require a written prescription, and refills are not allowed. They are tightly regulated to prevent abuse. Schedule III  Description: These substances have a moderate to low potential for physical and psychological dependence. Their potential for abuse is lower than Schedule I or II drugs but higher than Schedule IV. Examples: ○ Codeine-containing medications (Tylenol with Codeine) ○ Anabolic steroids ○ Ketamine Significance: Schedule III drugs may be refilled up to five times within six months, but prescriptions still require regulation and oversight. Schedule IV Description: These substances have a low potential for abuse and a lower risk of dependence compared to Schedule III substances. Examples: ○ Alprazolam (Xanax) ○ Diazepam (Valium) ○ Lorazepam (Ativan) ○ Tramadol ○ Zolpidem (Ambien) Significance: These drugs can be refilled up to five times within six months and are often prescribed for anxiety, sleep disorders, and pain management. Schedule V Description: These substances have the lowest potential for abuse relative to Schedule IV substances and consist primarily of preparations containing limited quantities of certain narcotics. Examples: ○ Cough preparations containing less than 200 mg of codeine per 100 mL (Robitussin AC) ○ Loperamide (in higher doses) ○ Pregabalin (Lyrica) Significance: Schedule V drugs are typically used for antitussive, antidiarrheal, and analgesic purposes and can sometimes be obtained without a prescription in some states. Rights of Medication: There are six rights to ensure safe medication administration: 1. Right Patient: Verify the patient’s identity using two identifiers (e.g., name and date of birth).  2. Right Medication: Ensure the correct medication is being administered. 3. Right Dose: Verify that the dose is appropriate for the patient’s condition. 4. Right Time: Administer the medication at the right time (e.g., as prescribed, at the right intervals). 5. Right Route: Confirm the medication is given via the appropriate route (e.g., oral, IV, etc.). 6. Right Documentation: Document after administering the medication, not before, and include any relevant patient responses. Educating on Incentive Spirometer, Diaphragmatic Breathing, Deep Breathing, and Chest Physiotherapy: Incentive Spirometer: ○ Purpose: Helps prevent lung complications (e.g., pneumonia) after surgery or illness. ○ How to Use: Sit upright and exhale fully. Place the mouthpiece in the mouth and inhale deeply and slowly. Hold the breath for at least 3-5 seconds. Repeat 10 times per hour. ○ Goal: To expand the lungs and improve oxygen exchange. Diaphragmatic Breathing: ○ Purpose: Promotes full oxygen exchange and helps strengthen the diaphragm. ○ How to Perform: Place one hand on the chest and the other on the abdomen. Inhale deeply through the nose, allowing the abdomen to rise more than the chest. Exhale slowly through the mouth. Repeat for several minutes. Deep Breathing: ○ Purpose: Improves oxygenation and helps with lung expansion. ○ How to Perform: Sit or lie in a comfortable position. Take a slow, deep breath in through the nose, filling the lungs. Hold the breath for a few seconds. Exhale fully through the mouth. Chest Physiotherapy (CPT): ○ Purpose: Mobilizes secretions in patients with excessive mucus. ○ Techniques: Includes percussion (clapping), vibration, and postural drainage. ○ Performed By: Respiratory therapists or trained nurses. ○ Instructions: Patients may be positioned to allow secretions to drain from the lungs. Could be questions about which delivery method would be appropriate for random patient scenarios Oxygen Delivery Methods: Nasal Cannula: ○ Flow Rate: 1-6 L/min. ○ FiO2: 24-44%. ○ Use: For mild to moderate oxygen needs. Simple Face Mask: ○ Flow Rate: 5-8 L/min. ○ FiO2: 40-60%. ○ Use: For moderate oxygen needs. Venturi Mask: ○ Flow Rate: 4-12 L/min. ○ FiO2: 24-50% (depending on the selected setting). ○ Use: Precise oxygen delivery; often used in patients with COPD to prevent over-oxygenation. Non-rebreather Mask: ○ Flow Rate: 10-15 L/min. ○ FiO2: Up to 90-100%. ○ Use: For patients needing high concentrations of oxygen, often in emergency situations. Respiratory Medications: Short-Acting Bronchodilators (SABAs): ○ Examples: Albuterol, Levalbuterol. ○ Mechanism: Quickly relax the muscles around the airways to allow easier breathing. ○ Use: For acute asthma attacks or immediate relief. ○ Side Effects: Tachycardia, palpitations, tremors, headache. Long-Acting Bronchodilators (LABAs): ○ Examples: Salmeterol, Formoterol. ○ Mechanism: Provide extended bronchodilation for long-term control. ○ Use: Not for acute attacks, used in conjunction with inhaled corticosteroids for chronic asthma. ○ Side Effects: Headache, throat irritation, muscle cramps. Anticholinergics: Purpose: Block acetylcholine receptors in the lungs, reducing bronchoconstriction and drying up secretions. Examples: Ipratropium (short-acting), Tiotropium (long-acting). Side Effects: Dry mouth, cough, blurred vision, urinary retention. Encourage: ○ Fluids: To help with dry mouth. ○ Hard candies or lozenges: To relieve dry mouth. Caution: Use carefully in patients with glaucoma or urinary retention. Corticosteroids Mechanism of Action: Corticosteroids mimic cortisol, a hormone produced by the adrenal glands, and are used to reduce inflammation, suppress the immune system, and manage autoimmune conditions. Side Effects: ○ Delayed Wound Healing: Corticosteroids impair collagen production and slow the inflammatory response, which is crucial for the wound-healing process. ○ Lower Immune Response: By suppressing the immune system, corticosteroids make the body more susceptible to infections. ○ Hyperglycemia: Corticosteroids increase glucose production in the liver and decrease glucose utilization in tissues, leading to elevated blood sugar levels. ○ Soft Bones (Osteoporosis): Long-term use can lead to decreased calcium absorption and bone loss, increasing the risk of fractures. ○ Other Side Effects: Mood changes, weight gain, increased appetite, and fluid retention. Theophylline Mechanism of Action: A bronchodilator used in asthma and COPD to relax the muscles in the lungs and improve breathing. Important Considerations: ○ Avoid Caffeine: Both theophylline and caffeine are stimulants, and caffeine can increase the risk of side effects like nervousness, insomnia, and tachycardia. ○ Monitor Levels: Theophylline has a narrow therapeutic range, so blood levels need to be monitored to avoid toxicity (normal range: 10-20 mcg/mL). ○ Signs of Toxicity: Nausea, vomiting, tremors, restlessness, seizures. I'm sure there will be a question to drag and drop the correct parts of a med order or a question along these lines so memorize this. Parts of a Medication Order Components: 1. Patient Name: Full name of the patient receiving the medication. 2. Date/Time of Order: When the prescription was written to ensure timely administration. 3. Drug Name: Exact name of the medication to avoid errors. 4. Dosage: Amount of medication to be administered. 5. Route: How the medication is to be given (oral, IV, subcutaneous, etc.). 6. Frequency: How often the medication should be administered (e.g., every 4 hours, daily). 7. Signature of Provider: The ordering physician or prescriber’s signature for validation. Types of Medication Orders Standing Orders: Prewritten orders for routine treatments (e.g., a daily multivitamin) or in specific circumstances (e.g., insulin coverage for high blood sugar). PRN Orders: "As needed" orders. Medications administered only when the patient requires it (e.g., pain medications). Stat Orders: Medications that need to be administered immediately, typically in emergency situations. Peak, Trough, and Half-Life Peak: The highest concentration of a drug in the bloodstream after administration. For certain drugs, like antibiotics, it's important to monitor to ensure therapeutic effectiveness without causing toxicity. ○ Example: Drawing blood to check peak levels 30 minutes after the drug is administered. Trough: The lowest concentration of a drug in the bloodstream, usually measured just before the next dose. It ensures the drug stays within the therapeutic range and prevents subtherapeutic levels. ○ Example: Drawing blood to check trough levels just before the next scheduled dose. Half-Life: The time it takes for half of the drug to be eliminated from the body. Drugs with a long half-life stay in the system longer, while drugs with a short half-life require more frequent dosing. ○ Example: Drugs with a short half-life like metoprolol need more frequent dosing compared to drugs with a long half-life like amiodarone. Key Points for Exam Preparation  Monitor for Corticosteroid Side Effects: Hyperglycemia, infection risk, and delayed healing. Know Components of a Medication Order: Including verifying provider signature. Understand Types of Orders: Standing for routine, PRN for as-needed, stat for immediate. Caffeine and Theophylline Interaction: Avoid combining due to overstimulation. Monitoring Peak and Trough: Ensures safe and effective drug levels in the body. Pharmacokinetics Routes of Administration and Speed of Absorption: ○ IV (Intravenous): Fastest route since the drug is delivered directly into the bloodstream. It bypasses absorption entirely. ○ IM (Intramuscular): Fairly quick as the medication is absorbed into the bloodstream through the muscle tissue. Faster than subcutaneous but slower than IV. ○ Subcutaneous (SubQ): Slower than IM and IV because the drug is absorbed into the bloodstream through fatty tissue. ○ Oral (PO): Slower due to passage through the digestive system. Influenced by factors such as food, pH levels, and gastric motility. ○ Topical: Absorption through the skin or mucous membranes (e.g., creams, eye drops) is slower and localized unless the drug is formulated for systemic effects (e.g., patches). ○ Sublingual/Buccal: Medications placed under the tongue or in the cheek bypass the digestive system and are absorbed directly into the bloodstream. Faster than oral. Factors Influencing Absorption: ○ Food: Some medications are absorbed better on an empty stomach (e.g., certain antibiotics), while others may require food to prevent stomach irritation (e.g., NSAIDs). ○ Antacids: Can interfere with the absorption of some drugs by altering stomach acidity. ○ Gastric Motility: Decreases with age, which can delay absorption of oral medications in older adults. ○ Blood Flow: Adequate circulation is necessary for the medication to be distributed to target tissues. Decreased blood flow in shock or hypothermia slows absorption. Topical Medications  Types of Topical Medications: ○ Creams, Ointments, and Lotions: Applied to the skin for localized effects. ○ Eye Drops (Ophthalmic): Delivered to the eye surface for treating conditions like infections or glaucoma. ○ Ear Drops (Otic): Administered into the ear canal. ○ Nasal Sprays: Used for decongestants or allergy treatments. ○ Patches: Medicated patches (e.g., nicotine, fentanyl) are absorbed through the skin into the bloodstream for systemic effects. ○ Suppositories: Inserted into the rectum or vagina for local or systemic effects. Injection Angles Intramuscular (IM): Insert at a 90-degree angle. Common injection sites include the deltoid, vastus lateralis, and gluteal muscles. Subcutaneous (SubQ): Insert at a 45-degree angle, or 90 degrees if there’s more subcutaneous tissue. Common sites are the abdomen, thigh, and upper arm. Intradermal (ID): Insert at a 10-15 degree angle, typically used for allergy or tuberculosis testing. The inner forearm is the most common site. Intravenous (IV): Insert at a 25-degree angle directly into a vein. There could be questions on differentiating normal vs abnormal sounds Normal Breath Sounds Vesicular Sounds: ○ Description: Soft, low-pitched sounds heard over most of the lung fields. These sounds are longer during inspiration than expiration. ○ Why They Are Present: These are the expected sounds of air moving through the small bronchioles and alveoli. They indicate normal lung function. ○ What It Indicates: Normal breathing and air exchange in healthy lungs. Bronchial Sounds: ○ Description: Loud, high-pitched sounds heard over the trachea and larynx, with a longer expiration phase. ○ Why They Are Present: Air is moving through larger airways like the trachea, where the airflow is faster and more turbulent. ○ What It Indicates: Normally heard only over the trachea. If heard in peripheral lung fields, it could indicate lung consolidation (e.g., pneumonia). Bronchovesicular Sounds: ○ Description: Medium-pitched sounds heard over the major bronchi, with equal duration of inspiration and expiration. ○ Why They Are Present: This sound occurs where airways branch into smaller bronchi, such as near the sternum or between the scapulae. ○ What It Indicates: Normal lung function. If heard in areas where vesicular sounds should be, it might indicate lung disease. Abnormal (Adventitious) Breath Sounds Crackles (Rales): ○ Description: Fine crackling or popping sounds heard during inspiration, particularly at the end of inspiration. They can be classified as fine or coarse crackles depending on the intensity and pitch. ○ Why They Occur: Crackles are caused by the sudden opening of small airways or alveoli that were collapsed, or by the movement of air through secretions or fluid in the lungs. ○ Conditions Associated: Pulmonary Edema: Excess fluid in the lungs due to heart failure causes crackles, particularly in the lower lobes. Pneumonia: Inflammation and infection in the alveoli can cause fluid build-up, leading to crackles. Fibrosis: Scar tissue in the lungs makes it harder for the alveoli to expand properly, resulting in crackles. ○ Where It’s Heard: Typically in the bases of the lungs in conditions like heart failure or pneumonia. Wheezing: ○ Description: High-pitched whistling sounds, typically heard during expiration but can also be heard during inspiration in severe cases. ○ Why It Occurs: Wheezing occurs when airways become narrowed or constricted, making it harder for air to pass through. ○ Conditions Associated: Asthma: Narrowing of the airways due to bronchospasm and inflammation causes wheezing. Chronic Obstructive Pulmonary Disease (COPD): In chronic bronchitis or emphysema, airway narrowing leads to wheezing. Allergic Reactions: In severe allergic responses, airway constriction can lead to wheezing. ○ Where It’s Heard: Typically throughout the lung fields but especially in areas with significant airway constriction. Stridor: ○ Description: Loud, high-pitched sound heard primarily during inspiration. It is usually louder than wheezing and can be heard without a stethoscope. ○ Why It Occurs: Stridor occurs when there is an upper airway obstruction or narrowing at the level of the trachea or larynx. ○ Conditions Associated: Croup: Inflammation of the larynx and trachea in children, often caused by a viral infection. Foreign Body Aspiration: If something is lodged in the trachea or upper airway, stridor may occur. Epiglottitis: Inflammation of the epiglottis, a medical emergency that causes upper airway obstruction.  ○ Where It’s Heard: Over the upper airway, especially around the neck and trachea. Rhonchi: ○ Description: Low-pitched, snoring-like sounds heard during both inspiration and expiration, often louder during expiration. ○ Why It Occurs: Rhonchi are caused by secretions or mucus obstructing the larger airways. ○ Conditions Associated: Chronic Bronchitis: Mucus build-up in the larger airways leads to rhonchi. Pneumonia: Secretions in the bronchi from infection can also cause rhonchi. Cystic Fibrosis: Thick, sticky mucus blocks the airways and results in rhonchi. ○ Where It’s Heard: Over the larger airways, like the bronchi, often clearing after coughing. Pleural Friction Rub: ○ Description: A harsh, grating sound heard during inspiration and expiration, similar to the sound of leather rubbing together. ○ Why It Occurs: It occurs when the pleura (the lining of the lungs) becomes inflamed and rubs against the chest wall, losing its lubricating fluid. ○ Conditions Associated: Pleuritis: Inflammation of the pleura due to infection, trauma, or autoimmune diseases. Pulmonary Embolism: A blood clot in the lung can cause inflammation of the pleura. ○ Where It’s Heard: Typically heard over areas of the lungs close to the chest wall where the pleura is inflamed. Decreased or Absent Breath Sounds Decreased Breath Sounds: ○ Description: Lower than normal sound intensity, possibly due to a lack of airflow. ○ Why It Occurs: Can occur due to partial obstruction of airflow, decreased lung expansion, or a mass in the chest. ○ Conditions Associated: Pneumothorax: Air trapped in the pleural space causes the lung to collapse, resulting in decreased breath sounds. Pleural Effusion: Fluid build-up in the pleural space dampens sound transmission. COPD: Hyperinflation of the lungs can cause decreased breath sounds. ○ Where It’s Heard: Over the affected area where airflow is limited. Absent Breath Sounds:  ○ Description: No breath sounds heard at all, indicating a complete lack of airflow to a particular area of the lung. ○ Why It Occurs: Results from complete obstruction or absence of lung tissue in the area. ○ Conditions Associated: Severe Pneumothorax: Complete collapse of the lung may lead to absent breath sounds. Large Pleural Effusion: A large amount of fluid compressing the lung can prevent airflow entirely. ○ Where It’s Heard: Over areas with no lung tissue expansion or airflow. She will include delegation questions so just remember to review what can and can’t be delegated Delegation Delegation Guidelines: ○ RN Responsibilities: Assessment, planning, teaching, evaluation, and clinical judgment (e.g., unstable patients, initial assessments). ○ LPN Responsibilities: Basic care, administration of oral medications, assisting with care plans, reinforcing teaching, and monitoring stable patients. ○ Unlicensed Assistive Personnel (UAP): Non-invasive tasks such as bathing, ambulating, feeding, and vital signs for stable patients. Key Considerations: ○ Five Rights of Delegation: 1. Right Task: Can this task be delegated? 2. Right Circumstance: Is the patient stable? 3. Right Person: Is the delegatee qualified? 4. Right Direction/Communication: Are instructions clear? 5. Right Supervision: Is follow-up provided?