Exam 1 Fluid and Electrolytes PDF - Nursing

Exam 1 Fluid and Electrolytes - 1.Explain intra, extra, and intercellular fluid compartments (Explain body fluid compartments) The body's fluid compartments are divided into intracellular fluid (ICF) and extracellular fluid (ECF). Intracellular fluid is the fluid contained within cells, comprisi...

Exam 1 Fluid and Electrolytes - 1.Explain intra, extra, and intercellular fluid compartments (Explain body fluid compartments) The body's fluid compartments are divided into intracellular fluid (ICF) and extracellular fluid (ECF). Intracellular fluid is the fluid contained within cells, comprising about two-thirds of total body water. It contains solutes like electrolytes and glucose. Extracellular fluid is the fluid outside of cells, making up about one-third of total body water. ECF is further divided into: 1) Interstitial fluid - the fluid between cells and surrounding them, but not inside blood vessels. 2) Intravascular fluid - the fluid inside blood vessels, also called blood plasma. 3) Transcellular fluids - fluids contained in epithelial-lined cavities like cerebrospinal, synovial, pleural, and peritoneal fluids. The distribution and composition of these fluid compartments is carefully regulated to maintain proper cellular function, transport nutrients, remove wastes, and provide the optimal internal environment. 2. Explain third spacing Third spacing refers to the abnormal shift of fluid from the intravascular space into the interstitial space or body cavities. This can occur in certain medical conditions like ascites, pleural effusions, intestinal obstructions, and severe burns. Although the total body fluid remains the same, the fluid becomes trapped or "third spaced" outside of the vascular system. This leads to a relative decrease in intravascular volume, which can result in hypovolemic shock if severe enough. Clinically, third spacing presents as edema or fluid accumulation in areas like the abdomen or extremities. 3.Explain the range and the abnormal signs and symptoms: Sodium, Calcium, Potassium, Magnesium, Bicarbonate, and Albumin -Sodium (Normal range: 135-145 mEq/L) Hyponatremia (145 mEq/L): Extreme thirst, confusion, muscle twitches, seizures -Calcium (Normal range: 8.5-10.2 mg/dL) Hypocalcemia (10.2 mg/dL): Nausea, vomiting, confusion, kidney stones -Potassium (Normal range: 3.5-5.0 mEq/L) Hypokalemia (5.0 mEq/L): Muscle paralysis, peaked T-waves on ECG, arrhythmias -Magnesium (Normal range: 1.8-2.4 mg/dL) Hypomagnesemia (2.4 mg/dL): Nausea, vomiting, lethargy, respiratory depression -Bicarbonate (Normal range: 22-28 mEq/L) Low levels: Metabolic acidosis - nausea, fatigue, Kussmaul respirations High levels: Metabolic alkalosis - confusion, arrhythmias, muscle twitching -Albumin (Normal range: 3.5-5.0 g/dL) Hypoalbuminemia (5.0 g/dL): Dehydration, rarely symptomatic 4.Explain the actions of isotonic, hypertonic, and hypotonic solutions. -Isotonic solutions have the same osmotic pressure as blood plasma and cells. They cause no fluid shift between compartments. Examples are 0.9% normal saline and 5% dextrose in water(D5W), and LR -Hypertonic solutions have higher osmotic pressure than blood plasma and cells. They pull water out of cells, causing cellular dehydration and shrinkage. Examples are 3-5% saline solution, D10W, D5 in 0.9% NS, DD5 in 0.45% NS, D5 in LR -Hypotonic solutions have lower osmotic pressure than blood plasma and cells. They cause water to move into cells, leading to cellular swelling and potentially rupture if severe. Examples are 0.45% saline and LR 5.Explain when a doctor would order hypertonic, isotonic, and hypotonic. (When would hypertonic, isotonic, and hypotonic be used as a treatment) Isotonic solutions like 0.9% normal saline are used to replace fluid losses and maintain intravascular volume without disrupting the fluid balance between compartments. Hypertonic solutions like 3% saline are used to treat severe hyponatremia (low sodium levels) by raising the sodium concentration in the extracellular fluid and pulling water out of cells. However, they must be administered cautiously to avoid complications. Hypotonic solutions like 0.45% saline are used to treat hypernatremia (high sodium levels) by diluting the extracellular fluid and allowing water to move into cells. They may also be used for fluid replacement in patients with elevated sodium levels. 6.Define colloids, and crystalloids (when would the doctor order them as a treatment) Colloid - albumin - hyper-oncotic - expands the plasma volume by about four times its volume. -Crystalloids are aqueous solutions of electrolytes or other water-soluble molecules. They are used to replace fluid losses, maintain fluid balance, and deliver medications. Examples include normal saline, Ringer's lactate, and dextrose solutions. Crystalloids are given for fluid resuscitation in conditions like dehydration, hypovolemia, and shock. -Colloids contain larger insoluble molecules like proteins or starches suspended in a crystalloid solution. They are used when plasma volume expansion is needed, such as in hypovolemic shock, burns, or during surgery. Examples are albumin, dextran, and hydroxyethyl starches. Colloids pull fluid into the vascular space from the interstitial space due to their higher oncotic pressure. Explain what this means: Colloid - albumin - hyper-oncotic - expands the plasma volume by about four times its volume. -This statement means that when albumin, which is a colloid solution, is administered intravenously, it has a higher oncotic (osmotic) pressure than blood plasma. This hyper-oncotic property causes fluid from the interstitial spaces to be pulled into the vascular space, effectively expanding the plasma volume by approximately 4 times the volume of albumin infused. Albumin is used to expand intravascular volume in conditions like hypovolemic shock or burns when plasma volume replacement is needed. 7.Explain how albumin can increase blood pressure, pulmonary edema, and urination. -Albumin can increase blood pressure by expanding the plasma volume when administered intravenously. The increased blood volume leads to increased venous return to the heart, increasing cardiac output and blood pressure. -Albumin administration can potentially cause pulmonary edema if too much fluid enters the pulmonary vasculature, increasing hydrostatic pressure and leading to fluid leakage into the lung interstitium and alveoli. -Albumin draws fluid from the interstitial spaces into the vascular space due to its oncotic properties. This fluid shift can increase renal perfusion and glomerular filtration rate, resulting in increased urination as the kidneys excrete the excess fluid. ​ 8.Explain the signs and symptoms of fluid volume deficit. -- Thirst and dry mucous membranes - Decreased skin turgor and dry skin - Sunken eyeballs - Orthostatic hypotension (dizziness upon standing) - Oliguria (decreased urine output) - Tachycardia (rapid heart rate) - Fatigue and weakness - Headache - Muscle cramps - Concentrated urine with high specific gravity - Elevated BUN and hematocrit levels - Weight loss -Severe cases can progress to hypovolemic shock with cool, clammy skin, altered mental status, oliguria or anuria, and hypotension. Prompt fluid replacement is crucial to prevent complications. 9.Explain the signs and symptoms of fluid volume excess. -- Weight gain - Edema (swelling) in the legs, feet, hands - Distended neck veins - Shortness of breath - Crackles or wheezing in the lungs - Jugular venous distension - Ascites (fluid accumulation in the abdomen) - Increased blood pressure - Decreased hematocrit and plasma protein levels - Oliguria (decreased urine output) -In severe cases, fluid can accumulate in the lungs causing pulmonary edema with pink, frothy sputum and severe shortness of breath. Fluid overload can also lead to congestive heart failure if the heart cannot handle the increased volume. Prompt treatment with diuretics and fluid restriction is necessary 10.Define edema and identify the types of edema. -Edema is the accumulation of excessive fluid in the interstitial spaces between cells or body tissues. The main types of edema are: -Localized edema - Swelling confined to a specific area, often due to injury, inflammation or obstruction. -Generalized edema - Widespread swelling throughout the body, often seen in conditions like heart, liver or kidney disease. (called anasarca) -Pitting edema - Edema that leaves an indentation or pit after pressing on the swollen area with a finger. -Non-pitting edema - Firm swelling that does not indent with pressure, seen in conditions like lymphedema. -Peripheral edema - Swelling in the extremities like legs, ankles and feet due to fluid accumulation. -Pulmonary edema - Fluid buildup in the lungs, causing breathing difficulties. -Cerebral edema - Excess fluid in the brain tissue, potentially life-threatening. -Edema can also be classified based on the underlying cause, such as cardiogenic, renal, or lymphatic edema. 11.Explain the different types of hormonal regulators. -Hormones regulate fluid intake through various mechanisms: - ADH stored in posterior pituitary gland, release in response to changes in blood osmolarity -Aldosterone released by adrenal cortex, great NA conserver -RAA system to combat hypovolemia -Antidiuretic hormone (ADH) stored in and released from the posterior pituitary gland in response to changes in blood osmolarity. ADH increases water reabsorption by the kidneys. - Aldosterone released by the adrenal cortex acts as a potent sodium conserver, causing the kidneys to reabsorb more sodium and water. - The renin-angiotensin-aldosterone (RAA) system combats hypovolemia and low blood pressure by increasing sodium and water retention through angiotensin II and aldosterone effects. -Atrial natriuretic peptide (ANP) released by the heart. ANP promotes excretion of sodium and water by the kidneys, helping to reduce blood volume and blood pressure. -So the key hormonal regulators are antidiuretic hormone (ADH), aldosterone, the renin-angiotensin-aldosterone system, and atrial natriuretic peptide. 12.Explain which organs release the hormonal regulators (how they work in the body) -Hypothalamus - Produces antidiuretic hormone (ADH) which is stored and released from the posterior pituitary gland. ADH increases water reabsorption by the kidneys. -Kidneys - Specialized cells in the kidneys release renin, which initiates the renin-angiotensin-aldosterone system (RAAS). Renin converts angiotensinogen to angiotensin I, which is further converted to angiotensin II. Angiotensin II stimulates aldosterone release. -Adrenal Cortex - Releases aldosterone in response to angiotensin II. Aldosterone causes the kidneys to reabsorb more sodium and water, increasing blood volume. -Heart Atria - Releases atrial natriuretic peptide (ANP) which counters RAAS by promoting excretion of sodium and water by the kidneys, reducing blood volume. -The integration of these hormones from different organs allows for precise regulation of body fluid levels and blood pressure homeostasis. 13.Explain fluid and electrolyte diagnostic test evaluation. – Serum electrolytes – Serum hematocrit – Hemoglobin – BUN – Creatinine – Renal function test – Liver function test -Serum electrolyte tests - Measure sodium, potassium, chloride, bicarbonate levels. Compare to normal ranges to detect imbalances. -Serum hematocrit measures the percentage of red blood cells and can indicate dehydration or overhydration. -Hemoglobin is a protein in red blood cells that carries oxygen. Low levels suggest anemia or fluid imbalance. -BUN (blood urea nitrogen) is a waste product filtered by the kidneys. Elevated levels indicate dehydration or kidney dysfunction. -Creatinine is another waste product eliminated by the kidneys. Rising levels signal impaired kidney function. -Renal function tests like BUN, creatinine, and GFR assess how well the kidneys are filtering wastes and maintaining fluid balance. -Liver function tests like bilirubin, albumin, and clotting factors evaluate the liver's role in fluid regulation and protein production. -Serum osmolality - Measures total solute concentration. Indicates fluid balance. -Urinalysis - Checks for abnormal substances like protein or glucose that can alter fluid balance. -Arterial blood gases - Assess acid-base status, which impacts fluid and electrolyte regulation. Evaluation: -Assessment and monitoring -Medication -Diet -Fluids -Patient and family education 14.Explain the medications that can cause electrolyte disturbances. -Diuretics can cause metabolic alkalosis and hypokalemia (low potassium) or hyperkalemia (high potassium) depending on the type of diuretic. -Steroids like prednisone can lead to metabolic alkalosis. -Potassium supplements may cause gastrointestinal upset, ulcers, or diarrhea if taken in excess. -Respiratory depressants that decrease respiratory rate and depth can result in respiratory acidosis. -Antibiotics: nephrotoxicity, and certain antibiotics like vancomycin can cause hyperkalemia, while others like zosyn (piperacillin/tazobactam) may lead to hypernatremia. -Calcium carbonate antacids can cause mild metabolic alkalosis with nausea and vomiting. -Magnesium hydroxide (milk of magnesia) laxatives can deplete potassium levels, causing hypokalemia. -Stimulant laxatives like dulcolax can disturb fluid and electrolyte balance if overused. 15.Diuretics, steroids, calcium carbonate, laxatives (Lasix, prednisone, Tums, Kayexalate) -Medication classification, actions, side effects, nursing diagnosis, interventions, and patient teaching for Diuretics, steroids, calcium carbonate, laxatives (Lasix, prednisone, Tums, Kayexalate) -Diuretics (Lasix/furosemide): Classification: Loop diuretic Action: Increases excretion of sodium, chloride, and water by inhibiting reabsorption in kidney tubules Side effects: Hypokalemia, hyponatremia, dehydration, metabolic alkalosis Nursing diagnosis: Risk for electrolyte imbalance, Deficient fluid volume Interventions: Monitor intake/output, weight, electrolytes. Encourage fluid/electrolyte replacement. Patient teaching: Weigh daily, report excessive thirst/urination. Take potassium supplements as prescribed. -Steroids (Prednisone): Classification: Glucocorticoid Action: Anti-inflammatory, immunosuppressive Side effects: Fluid retention, hypokalemia, hyperglycemia, osteoporosis Nursing diagnosis: Risk for electrolyte imbalance, Impaired glucose tolerance Interventions: Monitor weight, blood glucose, potassium levels. Administer potassium supplements if ordered. Patient teaching: Report swelling, muscle weakness, increased thirst/urination. Follow dietary instructions. -Calcium carbonate (Tums): Classification: Antacid Action: Neutralizes stomach acid Side effects: Constipation, metabolic alkalosis, hypercalcemia Nursing diagnosis: Risk for electrolyte imbalance, Constipation Interventions: Monitor bowel movements, encourage fluids. Check calcium levels. Patient teaching: Take with food/milk to minimize constipation. Report nausea, vomiting, loss of appetite. -Laxatives (Kayexalate): Classification: Sodium polystyrene sulfonate Action: Binds potassium in intestines for elimination Side effects: Hypokalemia, constipation, intestinal impaction Nursing diagnosis: Risk for electrolyte imbalance, Constipation Interventions: Monitor potassium levels, bowel movements. Encourage fluids. Patient teaching: Take with plenty of water/fluids. Report severe constipation, abdominal pain. 16.Explain the nurse's assessment related to abnormal electrolyte laboratory values. -Assessment – Respiratory – Circulatory – Integumentary Monitor Intake and Output Monitor daily weight Monitor Laboratory Test – Hypo or hypervolemia – Hematocrit – BUN – Creatinine – Urine Specific gravity – Serum sodium – Serum osmolality Imbalance Assessment Medication Cellular regulation Cognition Communication Perfusion Thermoregulation Elimination Bed position – Semi Fowlers Monitor fluid intake: Diet –– Fluid restriction –– NPO –– Intake of Sodium Input –– Fluids –– Food Output –– Urine –– Stool –– Sweat Input = Output Acidosis and Alkalosis- 17.Explain the causes of acidosis and alkalosis. -Acidosis can be caused by: Metabolic causes: - Diabetic ketoacidosis - Lactic acidosis due to poor perfusion - Renal failure leading to acid retention - Ingestion of acidic substances Respiratory causes: - Hypoventilation and carbon dioxide retention Alkalosis can be caused by: Metabolic causes: - Vomiting and loss of hydrochloric acid - Diuretic use - Hypokalemia - Excessive bicarbonate intake Respiratory causes: - Hyperventilation and excessive carbon dioxide loss 18.Identify all the signs and symptoms of acidosis. -Headache, lethargy, confusion, coma, Kussmaul respirations (rapid, deep breathing) , Anorexia, nausea, vomiting, diarrhea, abdominal discomfort , Dysrhythmias, hypotension, Muscle weakness, cramping, Fatigue, restlessness 19.Identify all the signs and symptoms of alkalosis. -Dizziness, headache, confusion, seizures, tetany (muscle twitching/cramping), Shallow, slow breathing, Arrhythmias, hypotension, Nausea, vomiting, Muscle cramps, weakness, hyperreflexia, Paresthesias (numbness/tingling around mouth and extremities) 20.Explain how to calculate and interpret the following types of arterial blood gases: Compensated for acidosis and alkalosis Uncompensated acidosis and alkalosis Partially compensated acidosis and alkalosis Complete compensated acidosis and alkalosis -Compensated acidosis: pH is low (7.45), PaCO2 is high, HCO3 is high. The respiratory system has compensated for the metabolic alkalosis by raising PaCO2. 🔹 pH is NORMAL (between 7.35-7.45) 🔹 PaCO₂ and HCO₃⁻ are BOTH abnormal, -Partially compensated acidosis: pH is low but higher than uncompensated, PaCO2 is low but 🔹 higher than compensated, HCO3 is low. Partial respiratory compensation. 🔹 pH is abnormal Both PaCO₂ and HCO₃⁻ are abnormal -Partially compensated alkalosis: pH is high but lower than uncompensated, PaCO2 is high but 🔹 lower than compensated, HCO3 is high. Partial respiratory compensation. 🔹 pH is abnormal Both PaCO₂ and HCO₃⁻ are abnormal -Uncompensated acidosis: pH is low ( 7.45) Only one system (respiratory or metabolic) is abnormal -Uncompensated alkalosis: pH is high (>7.45), PaCO2 is low, HCO3 is high. There is no compensation. 🔹 -HCO3- NORMAL RANGE 🔹 pH is abnormal (acidic < 7.35 or alkaline > 7.45) Only one system (respiratory or metabolic) is abnormal 21.Explain the reasons a patient can experience fluid and electrolyte imbalance. -Excessive fluid losses: Vomiting, diarrhea, high output fistulas or drains, excessive sweating, burns, or polyuria can lead to dehydration and electrolyte deficits. -Inadequate fluid intake: Poor oral intake due to nausea, dysphagia, altered mental status, or limited access to fluids. -Kidney disease: Impaired ability to regulate fluid and electrolyte levels. -Endocrine disorders: Conditions like diabetes insipidus, SIADH, Addison's disease, etc. disrupt fluid/electrolyte homeostasis. -Medications: Diuretics, chemotherapy, steroids, and others can cause fluid/electrolyte shifts. -Severe injuries or illnesses: Major trauma, pancreatitis, sepsis increase fluid/electrolyte needs. -Gastrointestinal losses: Vomiting, diarrhea, fistulas, or ostomy drainage. -Liver disease: Impairs regulation of fluid balance and protein production 22.Explain the nurse's procedures for determining a patient's fluid balance. 1. Measure and record accurate intake and output (I&O) - this includes oral, IV, tube feeding intake, as well as urine output, vomiting, diarrhea, and drainage from tubes/wounds. 2. Weigh the patient daily at the same time using the same scale and clothing. Compare weights day-to-day to detect fluid gains/losses. 3. Assess skin turgor, mucous membranes, and capillary refill for signs of dehydration. 4. Monitor vital signs like blood pressure, pulse, and respiratory rate which can indicate fluid shifts. 5. Review laboratory values like serum electrolytes, BUN, creatinine, and osmolality for imbalances, ABG’s 6. Inspect for edema which may signify fluid overload. 7. Collaborate with the healthcare team and patient/family to ensure accurate I&O recording. 23.Explain the fluid and electrolyte balance of the older adult health outcomes. -Older adults are at increased risk for fluid and electrolyte imbalances due to physiologic changes that occur with aging. Potential health outcomes include: -Dehydration - Decreased thirst perception, limited mobility, cognitive impairment, and medications like diuretics increase dehydration risk. Dehydration can lead to confusion, constipation, acute kidney injury, and increased risk of falls. Hypernatremia - Impaired kidney function and hormonal regulation make it difficult to conserve water and dilute sodium. Hypernatremia can cause neurological symptoms like lethargy and seizures. Hypokalemia - Diuretic use, poor dietary intake, and gastrointestinal losses contribute to low potassium levels. Hypokalemia increases arrhythmia risk and can cause muscle weakness. Fluid overload - Conditions like heart failure, liver disease, and kidney disease impair fluid regulation. Fluid overload can manifest as peripheral edema, pulmonary edema, and exacerbate underlying conditions. Careful monitoring of intake/output, daily weights, vital signs, and lab values is crucial to detect and prevent fluid and electrolyte disturbances in the older adult population. Early intervention can help avoid serious complications. 24.Explain the reason an older adult can develop a fluid deficit and fluid volume excess -Older adults can develop fluid deficits due to decreased thirst perception, reduced kidney function impairing water conservation, insensible fluid losses, and inadequate fluid intake. Factors like immobility, cognitive impairment, and medication side effects contribute to dehydration risk. -Fluid volume excess can occur in older adults with conditions like heart failure, liver disease, or kidney disease that impair the body's ability to regulate fluid balance. Sodium and water retention leads to edema formation. Careful monitoring of intake, output, weight changes, and clinical signs is crucial to detect and manage fluid imbalances promptly 25.Explain which system compensates the fastest for altered arterial blood gases. The RESPIRATORY SYSTEM compensates the fastest for altered arterial blood gases. Changes in the rate and depth of breathing can rapidly adjust the partial pressure of carbon dioxide (PaCO2) to compensate for acid-base disturbances. -The kidneys take longer to compensate by retaining or excreting more bicarbonate to regulate the pH. So the respiratory system provides the initial, faster compensation for acidosis or alkalosis before the slower renal compensation occurs. 26. Explain the different types of lung sounds: vesicular, crackles (Rales), Rhonchi. Vesicular (Normal) ✅ Soft, low-pitched, rustling sounds Heard over most lung areas Normal breath sounds -Vesicular breath sounds are the normal soft, breezy sounds heard over lung fields during inhalation and exhalation. They indicate air is moving freely through the airways. -Crackles (Rales) (Fluid) 💦 Popping, crackling sounds (like rice crispy cereal) Caused by fluid in the lungs (e.g., pneumonia, heart failure) Heard more during inspiration -Crackles (rales) are discontinuous, non-musical, interrupted sounds that can be fine or coarse. Fine crackles sound like hair rubbing together, while coarse crackles are louder, lower-pitched popping sounds. Crackles indicate airway secretions or abnormal opening of small airways. -Rhonchi (Mucus) 🛑 Low-pitched, snoring or gurgling sounds Caused by mucus or secretions in larger airways Clears with coughing (common in bronchitis) -Rhonchi are continuous, low-pitched, snoring or wheezing sounds caused by air moving through obstructed or compressed larger airways. Rhonchi can clear with coughing but often indicate mucus plugging or bronchospasm. 27.Explain the cause and intervention for pneumothorax, tension thorax, and hemothorax. -Pneumothorax is caused by air entering the pleural space due to a rupture in the lung (visceral pleura) or chest wall (parietal pleura). Intervention involves inserting a chest tube to remove the air and re-expand the lung. -Tension pneumothorax occurs when air enters the pleural space but cannot escape, increasing pressure and shifting the mediastinum. Emergent decompression with needle thoracostomy or chest tube is required. -Hemothorax is bleeding into the pleural space, often from chest trauma or surgery. A chest tube is inserted to drain the blood and re-expand the lung. Blood products may be needed for significant bleeding. 28.Explain the first signs and symptoms of asthma Wheezing Dyspnea Coughing Increased sputum Increased respiratory rate -SOB -Chest Tightness -rapid breathing, -elevated heart rate -nasal flaring 29.Explain the nursing management of asthma - Assessing respiratory status, including lung sounds, breathing pattern, oxygen saturation, and peak flow readings. - Administering prescribed bronchodilators like albuterol and corticosteroids to reduce inflammation and open airways. - Teaching proper inhaler technique and having the patient demonstrate back. - Developing an asthma action plan with the patient for self-management of symptoms and medication adjustments. - Educating on avoiding triggers like smoke, dust, pet dander, and managing stress/anxiety that can exacerbate asthma. - Encouraging breathing exercises, incentive spirometry use, and adequate hydration. - Monitoring for complications like respiratory failure needing oxygen, IV medications, or ventilator support. - Providing emotional support and connecting to resources like the Asthma and Allergy Foundation. Medical Management – Diagnosis History Pulmonary function tests Chest x-ray Pulse oximetry Arterial blood gases Medical Management – Treatment Assessment (respiratory status)- including lung sounds, breathing pattern, oxygen saturation, and peak flow readings. Monitoring-for complications like respiratory failure needing oxygen, IV medications, or ventilator support. Control of environmental factors  Pharmacological treatment -Non-Pharmacological: - Encouraging breathing exercises, incentive spirometry use, and adequate hydration. Teaching proper inhaler technique and having the patient demonstrate back Education- avoiding triggers like smoke, dust, pet dander, and managing stress/anxiety that can exacerbate asthma. -Providing emotional support and connecting to resources like the Asthma and Allergy Foundation. Medical Management – Medications Anti-inflammatories Bronchodilators- like albuterol and corticosteroids Anticholinergics Nursing Management – Assessment and analysis -Vital signs -Oxygen saturation -Arterial blood gas -Breath sounds - Level of consciousness - Ability to speak in full sentences -Cough -Use of accessory muscles -Position - Dyspnea - Previous intubation 30.Explain nursing education for a person diagnosed with asthma -Self-Management Education: Teach the patient to monitor respiratory status, recognize symptoms, and adjust medications based on an asthma action plan tailored to their personal triggers and responses. Instruct on tracking symptoms, peak flow monitoring, and keeping a diary. Medication -Teaching: Educate on proper inhaler technique for bronchodilators and corticosteroids. Have the patient demonstrate back. Explain when and how to adjust dosing per their action plan. Trigger -Avoidance: Identify and help the patient avoid exposure to allergens, irritants, viral infections, stress, and other personal asthma triggers. Recommend environmental control measures. L -Lifestyle Guidance: Encourage regular exercise and activity while providing strategies to prevent exercise-induced symptoms. Promote overall healthy behaviors. 31.Explain which medication an asthmatic patient should have with them all the time. -A short-acting beta-agonist (SABA) like albuterol -An asthmatic patient should always carry a quick-relief or "rescue" bronchodilator medication with them, typically a short-acting beta-agonist (SABA) like albuterol. SABAs act rapidly to relax and open the airways during an asthma attack or when symptoms worsen. Having this medication on hand at all times allows the patient to promptly treat breathing difficulties before they potentially escalate to a medical emergency. 32.Identify which medication is used to treat inflammation by an asthmatic patient -Inhaled corticosteroids (ICS) are the most effective anti-inflammatory medications for treating asthma. Examples given include high-potency ICS like fluticasone, budesonide, and mometasone. -These reduce airway inflammation by decreasing production of inflammatory chemicals. The materials also mention combination inhalers containing an ICS plus a bronchodilator like Breo Ellipta (fluticasone/vilanterol) 33.Explain the signs and symptoms of Status Asthmaticus Breathlessness at rest, unable to speak in full sentences Respiratory rate > 30 breaths/minute -Unresponsive to typical rescue treatment with bronchodilators Bronchospasm, inflammation, increased mucus or mucus plugging Chest tightness, wheezing, dry cough, shortness of breath, severe respiratory distress Use of accessory muscles for breathing Distended neck veins Pulsus paradoxus (drop in systolic BP >10 mmHg on inspiration) Decreasing oxygen saturation levels Silent chest with no audible air movement (ominous sign) Rising PaCO2 levels, potential respiratory acidosis 34.Explain the different types of medications to treat asthma (Classification, side effects patient teaching):Steroid-Prednisone, Bronchodilators-Albuterol, Anticholinergic drugs-Ipratropium Inhalant, Long-acting muscarinic antagonists- Tiotropium, Xanthine- Theophylline -Prednisone (Steroid): Classification - Corticosteroid, reduces airway inflammation. Side effects - Weight gain, fluid retention, mood changes, increased blood sugar. Patient teaching - Take with food, do not stop abruptly, watch for signs of infection. -Albuterol (Bronchodilator): Classification - Short-acting beta-agonist, relaxes airway muscles. Side effects - Tremors, rapid heartbeat, headache. Patient teaching - Use before exercise, do not exceed recommended doses. -Ipratropium Inhalant (Anticholinergic): Classification - Blocks acetylcholine effects, dilates airways. Side effects - Dry mouth, constipation, urinary retention. Patient teaching - Use with bronchodilator for better effect, rinse mouth after use. -Tiotropium (Long-acting muscarinic antagonist): Classification - Bronchodilator, longer duration. Side effects - Dry mouth, constipation, blurred vision. Patient teaching - Do not use for acute symptoms, rinse mouth after use. -Theophylline (Xanthine): Classification - Bronchodilator, anti-inflammatory. Side effects - Nausea, vomiting, insomnia, seizures with high levels. Patient teaching - Have levels monitored, avoid certain foods/drugs. 35.Explain the oxygenation complications of an older adult with COPD -Hypoxemia -Hypercapnia -Respiratory failure -Pulmonary hypertension -Polycythemia -Hypoxemia: Inadequate oxygenation of arterial blood due to ventilation-perfusion mismatching and impaired gas exchange. This can lead to tissue hypoxia. -Hypercapnia: Elevated carbon dioxide levels from hypoventilation and air trapping. Can progress to respiratory acidosis if severe. -Respiratory failure: The inability to maintain adequate gas exchange. May require ventilatory support like noninvasive ventilation or intubation. Pulmonary hypertension: Increased blood pressure in the pulmonary arteries from chronic hypoxemia and destruction of lung vasculature. Strains the right ventricle. Polycythemia: Increased red blood cell production to compensate for chronic hypoxemia. Increases blood viscosity and clotting risk. 36.Explain which type of oxygenation equipment delivers oxygen to an emphysema patient. -Compressed gas oxygen tanks or cylinders are commonly used. Larger stationary tanks like the H cylinder can serve as the main source, while smaller portable E tanks allow mobility. -Liquid oxygen stored in an insulated portable container is another option. It lasts longer than compressed gas but is more expensive. -Oxygen concentrators are machines that extract oxygen from room air, delivering over 90% oxygen concentration. They can be stationary or portable models. -Concentrators increase mobility and independence compared to tank setups. However, patients should have backup oxygen sources in case of power outages. -CPAP, Oxygen (nasal cannula etc.) 37.COPD risk Factors: Risk Factors for COPD: 80-90% of COPD cases exposure to tobacco smoke Smoking (active or passive) Occupational exposure Elderly and children : Elderly (Pneumonia, immune system, physiological changes, fluids, nutrition, medications, infections) Diseases (HIV) Air pollution Genetic abnormalities, including a deficiency of alpha1-antitrypsin enzyme -Tobacco smoke exposure - Cigarette smoking is the primary risk factor. Secondhand smoke and other forms of tobacco smoke also increase risk. -Occupational exposures - Inhaling dust, chemicals, and particulate matter from certain jobs like mining, construction, etc. can damage the lungs over time. -Indoor/outdoor air pollution - Exposure to biomass fuels from cooking/heating fires as well as outdoor air pollutants are risk factors. -Genetics - A genetic disorder called alpha-1 antitrypsin deficiency increases COPD susceptibility. -Age - COPD is more prevalent in older adults over age 65. -Respiratory infections - Respiratory illnesses like tuberculosis may contribute to COPD development. -Diseases: (HIV) 38.Explain the 3 primary signs and symptoms of COPD 1. Cough 2. Sputum 3. Dyspnea on exertion (DOE) *a) Severe dyspnea- Activity *b) Weight loss 39.Define the terms(words) located on the PowerPoint 1️⃣ Pleuritis – Inflammation of the lining around the lungs (pleura), causing chest pain when breathing. 2️⃣ Cyanosis – Bluish skin or lips due to low oxygen levels in the blood. 3️⃣ Pleuritic Pain – Sharp chest pain that gets worse with deep breathing or coughing (due to pleuritis). 4️⃣ Hemoptysis – Coughing up blood from the lungs. 5️⃣ Pleural Effusion – Fluid buildup between the lungs and chest wall. 6️⃣ Atelectasis – Collapsed lung or part of the lung, preventing proper air exchange. 7️⃣ Lung Abscess – Pocket of pus in the lung due to infection. 8️⃣ Empyema – Pus buildup in the pleural space (between the lungs and chest wall), often from infection. 9️⃣ Thoracentesis – Procedure to remove fluid from the pleural space with a needle. 🔟 Dyspnea – Shortness of breath or difficulty breathing. 40.Explain the thoracentesis used as a treatment -Thoracentesis Definition: Procedure to remove excess fluid accumulated in pleural space -Treatment for: Pneumonia Tuberculosis Pleurisy Pleural -Empyema (pus) Thoracentesis is a procedure performed to remove excess fluid buildup (pleural effusion) from the pleural space between the lungs and chest wall. It can be used as a diagnostic tool to obtain a sample of the fluid for analysis, as well as a therapeutic treatment to relieve symptoms like shortness of breath in conditions like congestive heart failure, pneumonia, or cancer. The procedure involves inserting a needle into the pleural space and aspirating the fluid. It is typically done at the bedside under sterile conditions, with the patient sitting upright and leaning slightly forward. Ultrasound guidance may be used to locate the fluid collection. Only a limited amount of fluid, usually around 1000 mL, is removed at one time to prevent complications like re-expansion pulmonary edema. After the procedure, the patient is monitored for potential complications like pneumothorax, subcutaneous emphysema, or bleeding/infection at the insertion site. Thoracentesis can provide significant relief of respiratory symptoms caused by large pleural effusions. 41.Explain the complications of thoracentesis --Complications: *Pneumothorax (3-30%) *Hemopneumothorax *Hemorrhage, bleeding *Hypotension related to vasovagal response *Pulmonary edema related to lung re expansion *Spleen or liver puncture *Air embolism *Introduction of infection 42.Explain the signs and symptoms of chronic bronchitis and emphysema -Chronic Bronchitis Symptoms: Chronic, productive cough Purulent sputum Hemoptysis Mild dyspnea initiallyCyanosis (due to hypoxemia) Peripheral edema (due to cor pulmonale) Crackles, wheezes Prolonged expiration Obese -Chronic Bronchitis Complications: Secondary polycythemia vera due to hypoxemia Pulmonary hypertension due to reactive vasoconstriction from hypoxemia Cor pulmonale from chronic pulmonary hypertension -Emphysema Symptoms: Dyspnea Minimal cough Increased minute ventilation Pink skin, Pursed-lip breathing Accessory muscle use Cachexia Hyperinflation, barrel chest Decreased breath sounds Tachypnea -Emphysema Complications: Pneumothorax due to bullae Weight loss due to work of breathing 43.Explain the signs and symptoms of Cor Pulmonale Hypoxia and hypoxemia Increasing dyspnea Fatigue Enlarged and tender liver Warm, cyanotic hands and feet, with bounding pulses Cyanotic lips Distended neck veins Right ventricular enlargement (hypertrophy) Visible pulsations below the sternum GI disturbances such as nausea or anorexia Dependent edema Metabolic and respiratory acidosis Pulmonary hypertension 44.Explain the following related to Chronic Bronchitis and Emphysema: Laboratory findings, Diagnostic results, Medications (same as asthma but add azithromycin), Nursing Interventions Laboratory Findings: - Increased white blood cell count during exacerbations - Arterial blood gases may show hypoxemia and hypercapnia - Sputum cultures to identify bacterial infections Sputum Gram Stain Sputum culture and sensitivity -Complete blood count -Serology testing Diagnostic Results: -HIstory -Physical assessment -spirometry: Forced Vital Capacity, FEV1 -Fibroptic Bronchoscopy - Chest X-ray to assess lung hyperinflation - Pulmonary function tests to measure airflow limitation - CT scan or MRI to evaluate lung structure and complications - Electrocardiogram to check for cor pulmonale Medications: - Bronchodilators (beta-2-adrenergic agonists, anticholinergics) - Inhaled corticosteroids/glucocorticoids - Phosphodiesterase inhibitors (theophylline) - Leukotriene modifiers - Mucolytics - Antibiotics like azithromycin Nursing Interventions: - Encourage smoking cessation and avoidance of environmental irritants - Teach proper inhaler and nebulizer techniques - Promote breathing exercises, incentive spirometry, pursed lip - Recommend pulmonary rehabilitation program - Provide supplemental oxygen as needed - Administer medications as prescribed- Inhaled glucocorticoids, inhaled bronchodilators, antibiotics - Monitor for signs of respiratory failure - Educate on energy conservation techniques, exacerbation recognition -CPAP -positioning -provide small, frequent meals -vaccine prophylaxis -Patient Education - Explain the chronic nature of COPD and need for lifelong management - Reinforce importance of medication adherence and proper inhaler use - Advise on avoiding triggers like smoke, dust, and air pollution - Recommend regular exercise and pulmonary rehab participation - Encourage smoking cessation and support available - Discuss nutritional needs and maintaining ideal weight - Provide information on oxygen therapy if prescribed - Explain signs/symptoms requiring medical attention -Azithromycin Classification, side effects patient teaching):Azithromycin (Zithromax) is a semisynthetic macrolide antibiotic. -Common side effects include nausea, vomiting, diarrhea, and abdominal pain. -Patient teaching should include: - Take with or without food as directed - Complete the full prescribed course even if feeling better - Do not skip doses or double up on missed doses - May interact with antacids, calcium supplements, iron products - separate dosing - Watch for signs of allergic reaction like rash, wheezing, swelling - Notify provider about diarrhea that is severe or doesn't resolve - Disclose use of herbal products or dietary supplements 45.Be able to identify the different signs and symptoms of pneumonia, bronchitis, emphysema, and Asthma Asthma S&S: -dyspnea -wheezing - Chest tightness -SOB, respiratory distresss Coughing Increased sputum  Increased respiratory rate -rapid breathing, -elevated heart rate -nasal flaring Pneumonia S&S: - Fever, chills - Cough (productive or dry) - Malaise, fatigue - Pleuritic chest pain - Dyspnea, hemoptysis -Chronic Bronchitis S&S: Chronic, productive cough Purulent sputum Hemoptysis Mild dyspnea initiallyCyanosis (due to hypoxemia) Peripheral edema (due to cor pulmonale) Crackles, wheezes Prolonged expiration Obese -Emphysema S&S: Dyspnea Minimal cough Increased minute ventilation Pink skin, Pursed-lip breathing Accessory muscle use Cachexia Hyperinflation, barrel chest Decreased breath sounds Tachypnea 46.Explain the causes of sleep apnea (remember to read your book) -Dysfunction in central nervous system control over ventilation, poor circulation and oxygenation, and airway obstruction. -Results in Hypoxia & Hypercapnia -The most common cause of obstructive sleep apnea (OSA) is upper airway obstruction by the soft palate or tongue -Structural risk factors for OSA include soft tissue and craniofacial dimensions, obesity, a deviated septum, nasal polyps, narrow lower jaw, or enlarged tonsils. Genetic factors also play a role, Sleep apnea can occur as a result of several different pathologic mechanisms, including dysfunction in central nervous system control over ventilation, poor circulation and oxygenation, and airway obstruction. This discussion focuses on the sleep apnea from obstructive causes. Obstructive sleep apnea (OSA) is a sleep-related disorder defined by partial or complete collapse of the airway, interrupting ventilation and resulting in hypoxia or hypercapnia and lack of sleep. The most common cause of obstructive sleep apnea (OSA) is upper airway obstruction by the soft palate or tongue. During sleep, the head and neck muscles relax, allowing the tongue, soft palate, and neck structures to be displaced. As a result, the upper airway is obstructed, but neural control of chest movement is unimpaired. Structural risk factors for OSA include soft tissue and craniofacial dimensions, obesity, a deviated septum, nasal polyps, narrow lower jaw, or enlarged tonsils. Genetic factors also play a role, though more research is needed to fully understand the genetic influences on OSA 47.What are the causes of airway obstruction from sleep apnea? Obstructive sleep apnea (OSA) is a sleep-related disorder defined by partial or complete collapse of the airway, interrupting ventilation and resulting in hypoxia and lack of sleep. OSAS results from partial or total airway obstruction recurring during sleep with apneic episodes that last 10 seconds or longer. OSAS is characterized by intermittent hypoxia (low levels of oxygen in the tissue, affecting gas exchange). The most common cause of airway obstruction in obstructive sleep apnea is the relaxation of muscles in the throat during sleep, allowing the tongue and soft palate to collapse and block the airway Upper airways narrow or collapse > increased resistance to airflow Sleep > muscle tone relaxes > normal work of breathing unable to overcome increased resistance > airway collapse Periods of apnea > no tidal volume or air movement Hypoxemia and hypercapnia 48.What are the nursing interventions to prevent airway obstruction? -Use of an oral appliance, called maxillomandibular advancement, -Noninvasive positive-pressure ventilation (NPPV) via continuous positive airway pressure (CPAP) -BIPAP - Administer medications as ordered -Diagnostic testing -Weight management -Surgical Management *Trachosstemy *Tonsillectomy *Adenoidectomy *Uvulopalatopharyngoplasty * Septoplasty * Nasal polypectomy (fixing of deviated septum) *uvulectomy * Tongue reduction *Epiglottoplasty *Bariatric surgery *Implanted stimulators *Modified uvulopalatopharyngoplasty (modUPPP) 49.What are the signs and symptoms of airway obstruction? -fatigue, -daytime sleepiness, insomnia -decreased libidddo -nocturia -SOB -dry mouth -headaches, -nighttime waking with gasping or choking sensation, -difficulty concentrating -depression -irritability -memory problems -Loud snoring -Snorting -Gasping during sleep -Recurrent waking during sleep -Choking -Hypoxia -Hypercapnia 50. What position does the nurse place the patient to prevent airway obstruction for sleep apnea? -Teach the patient to elevate the head of the bed and use a side or prone position for sleep. Use pillows to prevent a supine position. 51. What is the difference between continuous positive airway pressure (CPAP) and bilevel positive airway (BiPAP) machine -CPAP delivers a continuous, set positive airway pressure throughout the breathing cycle. -BiPAP delivers two different pressures - a higher inspiratory positive airway pressure during inhalation and a lower expiratory positive airway pressure during exhalation. The alternating pressures with BiPAP can improve tidal volume, reduce respiratory rate, and relieve shortness of breath more effectively than CPAP for some patients. 52.Explain nursing intervention when applying CPAP or BiPAP to the patient -ensure the mask fits snugly and tight over the nose and/or mouth to maintain an effective seal. -Explain the purpose and sensations to expect. -Have the patient practice breathing through the mask before turning on the airflow. -Start at the lowest effective pressure setting and gradually increase if needed. -Monitor for air leaks, skin irritation, and anxiety. -Provide reassurance and allow breaks as tolerated. -Check oxygen saturation levels. -Ensure the tubing is free of kinks or condensation. -Adjust head of bed and positioning for comfort. -Encourage the patient to use the therapy as prescribed. 53. Explain patient education related to the care of CPAP or BiPAP. -Provide self-management education on appropriate equipment maintenance. - Instruct the patient on keeping the compressor, mask, and tubing system clean to prevent infection and maintain tissue integrity. -Teach proper cleaning methods using manufacturer-recommended agents. -Advise against sharing equipment. -With humidification, explain the need to use distilled water and monitor for fungal growth. -Educate on recognizing signs of skin irritation or air leaks that require mask adjustment. -Emphasize the importance of consistent, nightly use as prescribed for effective sleep apnea management. -Encourage the patient to bring their home CPAP/BiPAP equipment when hospitalized and ensure proper setup. 54. Explain the process of infection caused by tuberculosis. Tuberculosis is transmitted via aerosolization. When a person with active TB coughs, laughs, sneezes, whistles, or sings, infected respiratory droplets become airborne and may be inhaled by others. Not all TB infections actually develop into active TB. This is because the normal protection of immunity prevents full development of TB in the healthy person The bacillus multiplies freely when it reaches a susceptible site (bronchi or alveoli). An inflammation and exudative response occurs, causing pneumonitis. With the development of acquired immunity to TB, further growth of bacilli is controlled in most cases. The lesions usually resolve and leave little or no residual bacilli. Only a small percentage of adults infected with the bacillus ever develop active TB. Cell-mediated immunity against TB develops 2 to 10 weeks after initial infection and is manifested by a positive reaction to a tuberculin test. The primary infection may be so small that it does not appear on a chest x-ray. Initial infection is seen more often in the upper lobes of the lung. The local lymph nodes are infected and enlarged. An asymptomatic period usually follows the primary infection and can last for years or decades before clinical symptoms develop. This is called latent TB. An infected person is not contagious to others until symptoms of the disease occur. Secondary TB is a reactivation of the disease in a previously infected person. It is more likely to occur when immunity is reduced, especially among older adults, those with chronic diseases, and those with HIV disease. Tuberculosis is caused by the bacteria Mycobacterium tuberculosis. When a person with active TB coughs, sneezes, or talks, they expel infectious droplets containing the bacteria into the air. If another person inhales these droplets, the TB bacteria can settle in their lungs and cause an infection. In most cases, the body is able to fight off the bacteria through the immune system's inflammatory response. This results in a latent TB infection where the bacteria remain dormant without causing symptoms. However, if the immune system is weakened, the latent infection can progress to active TB disease. Once in the lungs, the TB bacteria are engulfed by macrophages, but can evade destruction and multiply inside these immune cells. This triggers the formation of granulomas - nodular lesions surrounded by inflammatory cells that attempt to wall off the infection. The granulomas develop areas of necrosis or caseation in the center. If the immune response fails to contain the bacteria, active TB develops, damaging lung tissue and enabling further spread of the infection 55. What are the risk factors for TB? – Homeless and incarcerated populations – Immunocompromise –Individuals with weakened immune systems, such as those with HIV/AIDSor other immunocompromising conditions, are at higher risk of developing active TB from a latent infection. -Risk factors for tuberculosis (TB) include emigration from high-prevalence countries, transmission in crowded institutional settings, homelessness, substance abuse, and lack of access to screening and medical care. -Close contacts of patients with multidrug-resistant TB (MDR-TB) or extensively drug-resistant TB (XDR-TB) are also at increased risk. 56.What is the main body system Mycobacterium bacterial effects? -The upper lobes of the lungs are the most common site of initial infection and damage from tuberculosis. -The main body system affected by Mycobacterium tuberculosis bacteria is the respiratory system, particularly the lungs. -Tuberculosis is characterized by granulomas forming in the lung tissue as the immune system attempts to contain the infection. 57.Explain how TB spreads to another person. -Tuberculosis spreads from person to person through the air. When someone with active TB coughs, sneezes, speaks or sings, they expel infectious droplet nuclei containing Mycobacterium tuberculosis bacteria into the air. -These tiny particles can remain suspended in the air for several hours. If another person inhales these droplet nuclei, they can become infected with TB. Close, prolonged contact with an individual with active TB increases the risk of transmission occurring 58.What are the signs and symptoms of TB? -progressive fatigue, lethargy, -nausea, -anorexia, Unexplained weight loss -low-grade fever, chills -Symptoms may have been present for weeks or months. -Night sweats may occur with the fever. -A cough with mucopurulent sputum, often streaked with blood -Chest tightness and a dull, aching chest pain may also occur with the cough. -Primary tuberculosis *Asymptomatic and not infectious – Symptomatic TB infection: *Fatigue, weight loss, night sweats, cough, rust colored or blood-streaked sputum, dyspnea, orthopnea, rales, -Symptomatic Military TB *Headaches, neck stiffness, drowsiness *Pericarditis 59.Which type of isolation precaution is used when a nurse cares for a patient diagnosed with TB? -Airborne Precautions are used when caring for a patient diagnosed with tuberculosis (TB). -This involves placing the patient in a negative air pressure room and using a fitted N95 respirator mask when entering the room. 60.What are the diagnostic tests for TB? -There are two types of tests available for infection with tuberculosis—skin testing and blood testing. -Tuberculin skin test ( Mantoux and Acid-fast bacilli smear and culture) - -Interferon-Gamma Release Assays (IGRAs) - Blood tests that detect immune response to TB bacteria, such as QuantiFERON-TB Gold Plus and T-SPOT.TB. -Chest X-ray - Used to look for abnormalities in the lungs, but cannot distinguish active from inactive TB alone. -Sputum culture - Confirms active TB by detecting the presence of Mycobacterium tuberculosis bacteria in the sputum sample. Results take up to 4 weeks. -The Xpert MTB/RIF Ultra test can rapidly detect TB bacteria as well as resistance to the drug rifampin from sputum samples 60. Which type of medication is used to treat TB? Isoniazid Rifampin Traditional treatment regimens are 6 to 9 months in duration and include isoniazid, rifampin, pyrazinamide, and ethambutol. 61.Explain patient education to a patient diagnosed with TB. -teaching about infection prevention and what to expect about disease monitoring and participating in activities. -Teach the patient to cover the mouth and nose with a tissue when coughing or sneezing, to place used tissues in plastic bags, to wear a mask when in contact with crowds, and to use social distancing until the drugs suppress infection. -Airborne Precautions are unnecessary in the home setting because family members have already been exposed; however, all members of the household need to undergo TB testing. -Tell the patient that sputum specimens are needed about every 4 weeks once drug therapy is initiated. When the results of three consecutive sputum cultures are negative, the patient is no longer infectious (contagious) and may return to former activities. -Remind the patient to avoid exposure to any inhalation irritants because these can cause further lung damage. – Skin/blood testing – Medication Home – No Airborne precaution – Family testing – Proper hygiene – Prevention – Wear mask in public places – Support systems 62. What are the different ways a person can develop pneumonia? -infectious pneumonia develops when a patient’s immunity (immunocompromised) cannot overcome the invading organisms. -Organisms from the environment (especially after natural disasters), invasive devices, equipment and supplies, or other people can invade the body. -. Pneumonia can be caused by any organism, including bacteria, viruses, mycoplasmas, fungi, rickettsiae, protozoa, and helminths (worms). -The most common bacterial cause is Streptococcus pneumoniae (pneumococcus).The most common viral causes are influenza A, influenza B, and COVID-19. -Noninfectious causes of pneumonia include the inhalation of toxic gases, chemical fumes, and smoke,dust, and the aspiration of water, food, fluid (including saliva), and vomitus. -Infectious pneumonia can be categorized as community-acquired pneumonia (CAP)(spread thru coughing sneezing, or contaminated surfaces) or as nosocomial pneumonia, which includes hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). -Hematogenous spread - Bacteria or other infectious agents spreading through the bloodstream from another site of infection. -Aspiration - Inhaling food, liquid, or oral secretions into the lungs, which can introduce bacteria and irritate the lungs. 2. Inhalation - Breathing in airborne viruses, bacteria, or fungi that infect the lungs. 3. Hematogenous spread - Bacteria or other infectious agents spreading through the bloodstream from another site of infection. 4. Compromised immune system - People with weakened immunity are more susceptible to respiratory infections leading to pneumonia. 5. Hospitalization - Ventilator-associated pneumonia can occur in patients on breathing machines or with frequent suctioning. 6. Community exposure - Viruses and bacteria that cause pneumonia can spread through coughing, sneezing, or contaminated surfaces. Caused by: Infectious Viral or bacterial organisms, parasites, fungi mycoplasma, protozoa Non-infectious Aspiration Noxious substances Inhalation Dust 63. What are the different types of pneumonia categories? -1. Community-Acquired Pneumonia (CAP) - Pneumonia contracted outside of a healthcare setting. 2. Hospital-Acquired Pneumonia (HAP) - Pneumonia that develops at least 48 hours after hospital admission. -&Health care-associated 3. Ventilator-Associated Pneumonia (VAP) - A type of HAP that occurs in patients on mechanical ventilation. 4. Aspiration Pneumonia - Caused by inhaling food, liquid, or gastric contents into the lungs. 5. Viral Pneumonia - Caused by viruses like influenza, respiratory syncytial virus, or COVID-19. 6. Bacterial Pneumonia - Caused by bacteria like Streptococcus pneumoniae, Haemophilus influenzae, or Pseudomonas aeruginosa. 7. Atypical Pneumonia - Caused by atypical bacteria like Mycoplasma pneumoniae or Chlamydia pneumoniae. 8. Fungal Pneumonia - Caused by fungi like Pneumocystis jirovecii in immunocompromised patients. 64. What are the 3 main risk factors for developing pneumonia? 1.Age - Both the very young (under 2 years old) and the elderly (over 65) have higher risks due to weaker immune systems. 2. Chronic illnesses - Conditions like heart or lung disease, diabetes, cancer, and disorders that impair coughing/swallowing raise pneumonia risk. 3. Impaired immunity - People with weakened immune systems from HIV/AIDS, organ transplants, chemotherapy, or long-term steroid use are more susceptible -Respiratory infection Cigarette Smoking Air pollution -Hospitalization -limited mobility 65.Explain the older adult's first signs and symptoms of pneumonia -weakness, fatigue (which can lead to falls) -Fever and cough may be absent, but hypoxemia is often present. -The most common symptom of pneumonia in the older adult patient is a change in cognition, with acute confusion from hypoxia. -The WBC count may not be elevated until the infection is severe. - Confusion, lethargy or delirium - Decreased appetite and functional decline - Tachycardia (rapid heart rate) - Tachypnea (rapid breathing) - Only a slight elevation in body temperature within normal limits 66.What are the complications of developing pneumonia? - Respiratory failure or Acute Respiratory disstresss - Sepsis - Acute respiratory distress syndrome (ARDS) - - Lung abscess - Pleural effusion - Bacteremia - Empyema - Atelectasis –Bronchiolitis Obliterans -Hypotension and shock especially in gram negative bacterial disease,espicially in elderly -percarditis 67. What are the diagnostic tests for pneumonia? Pneumonia-Medical Management Laboratory test- CBC, WBC, SPUTUM Chest X-ray Pulse oximeter Arterial Blood Gas- PACO2, BUN, CR, LACTATE Thoracentesis - CT scan of the chest - Bronchoscopy - Pleural fluid analysis 68. What are the complications of a patient receiving bronchoscopy -– Hypoxia – Laryngospasm – Bronchospasm – Subcutaneous emphysema, – Cardiac stress - Bleeding from biopsy sites or trauma to airway structures - Pneumothorax (collapsed lung) from airway injury - Respiratory distress or respiratory failure requiring intubation - Arrhythmias or low blood pressure from sedation - Infection, fever, or pneumonia after the procedure - Nausea, vomiting, or sore throat from the procedure 69.What are nursing diagnoses related to pneumonia? – Impaired Gas Exchange – Ineffective Airway Clearance – Impaired Nutritional Status – Self-Care Deficit - Decreased gas exchange due to decreased diffusion at the alveolar-capillary membrane -Potential for airway obstruction due to inflammation with excessive pulmonary secretions, fatigue, muscle weakness - Potential for sepsis due to the presence of microorganisms in a very vascular area and reduced immunity -Acute Pain related to pleuritic pain and coughing -Deficient Fluid Volume related to insensible fluid losses 70.What are the nursing interventions when a patient receives a bronchoscopy procedure? Monitor signs and symptoms –Hoarse voice –Sore throat Assessments - Vital signs - Respiratory - Gag Reflex -Anxiety Preprocedure: - Obtain informed consent and ensure NPO status - Administer premedications like anxiolytics or bronchodilators as ordered - Ensure proper equipment and monitoring is available During procedure: - Monitor vital signs, oxygen saturation, and level of sedation - Administer supplemental oxygen as needed - Assist with positioning and suctioning secretions - Provide emotional support and reassurance Postprocedure: - Monitor respiratory status, vital signs, and oxygen saturation - Encourage coughing and deep breathing exercises - Provide analgesics for sore throat as needed - Monitor for potential complications like bleeding or pneumothorax - Reinforce activity restrictions until full recovery 71.Explain the treatment for pneumonia Oxygen therapy Nutritional support Fluid and electrolyte management Antibiotic therapy Bronchodilators medication for wheezing Blood culture Sputum culture Albuterol, Metaproterenol  Deep breathing exercises and spirometry Chest physiotherapy Percussion and Vibration Postural drainage Nasotracheal suctioning Maintain elevated head of bead Frequent repositioning -Antivirals may be used for viral pneumonia in certain cases. - IV fluids for hydration, -respiratory treatments like incentive spirometry 72.Explain the medication treatment for pneumonia. – Macrolide Antibiotic: Azithromycin *Macrolide Antibiotics like azithromycin are used to treat bacterial pneumonia – Quinolone antibiotics: Levofloxacin *Quinolone antibiotics such as levofloxacin provide broad-spectrum coverage against bacterial pathogens, including atypical organisms – Antiviral: Amantadine *Antivirals like amantadine may be used for viral pneumonia caused by influenza A. – Antifungal: Fluconazole & voriconazole *Antifungals such as fluconazole or voriconazole treat fungal pneumonia from organisms like Pneumocystis jirovecii. -Expectorants: Guaifenesin *Expectorants like guaifenesin help thin and loosen mucus secretions, promoting productive coughing. -Analgesic: Ibuprofen *Analgesics like ibuprofen provide symptomatic relief by reducing fever, body aches, and pleuritic chest pain associated with pneumonia. 73.What are the nursing interventions for a patient with pneumonia? - Monitoring respiratory status (rate, effort, oxygen saturation) - Administering supplemental oxygen as needed - Encouraging coughing, deep breathing, and use of incentive spirometry - Providing bronchodilators and mucolytics to improve airway clearance - Maintaining proper hydration to thin secretions - Administering antibiotics, antivirals, or antifungals as prescribed - Providing analgesics for pleuritic chest pain - Monitoring intake/output and nutritional status - Promoting rest and energy conservation - Providing patient education on disease process and home care - Monitoring for complications like respiratory failure or sepsis -Blood and sputum culture -Nutritional support -fluid and electrolyte management -Oxygen therapy Chest physiotherapy Percussion and Vibration Postural drainage Nasotracheal suctioning 74. Explain patient education for a patient diagnosed with pneumonia. -Rests and conserves energy by limiting activities -Maintains adequate hydration. -Consumes adequate dietary intake. -Medication regimen and side effects -Slowly start an exercise program -Prevention strategies -Report signs and symptoms to the doctor 75.Identify the 4 factors that influence blood pressure. -Cardiac Output (CO) -Peripheral Vascular Resistance (PVR) -Blood Volume -Blood Viscosity -Heart rate -Vasconstriciton -Vasodialation -Fluid volume 76.Explain how to calculate the MAP MAP = (2 x DBP) + SBP / 3 MAP= 2 (diastolic Pressure + Systolic pressure) MAP = 2(DBP) + SBP Ex. B/P 120/80 2 (80) + 120 /3 = 93 mmHg 76.What is the normal range of MAP? Normal MAP 70-100 mmHg 77.Explain the indication of the blood pressure MAP The average arterial pressure measurement throughout one cardiac cycle: Systole and diastole -MAP is influenced by cardiac output and systemic vascular resistance. -Blood flow (Cardiac output) -Resistance -Pressure -The mean arterial pressure (MAP) indicates the average pressure in the arteries throughout the cardiac cycle. It is a useful measure because it closely approximates the perfusion pressure seen by vital organs like the brain, heart, and kidneys. -Monitoring the MAP can help assess the adequacy of organ perfusion and guide treatment in conditions like shock, heart failure, or hypertensive crisis where perfusion may be compromised. -The MAP provides a better overall estimate of tissue perfusion than just the systolic or diastolic pressures alone. 78.Identify an external method of performing hemodynamics 1. Finger cuff technology 2. Thoracic bioimpedance 3. Bioreactance 4. Pulse wave analysis 5. Ultrasound cardiac output monitoring 6. Transthoracic Doppler echocardiography 79.Explain the different types of hypertensive medications: classification, actions, side effects, and nursing implications. Spironolactone: Potassium-sparing diuretic. Promotes sodium and water excretion while retaining potassium. Side effects include hyperkalemia, gynecomastia. Monitor potassium levels and breast changes. Furosemide: Loop diuretic. Inhibits sodium reabsorption in the kidney loop of Henle. Side effects include hypokalemia, dehydration, ototoxicity. Monitor electrolytes, hydration status, and hearing. Hydrochlorothiazide: Thiazide diuretic. Increases sodium and water excretion. Side effects include hypokalemia, hyperglycemia, hyperlipidemia. Monitor electrolytes, blood sugars, and lipid levels. Lisinopril: ACE inhibitor. Blocks angiotensin converting enzyme to dilate blood vessels. Side effects include cough, hyperkalemia, acute kidney injury. Monitor respiratory symptoms, potassium, and kidney function. Minoxidil: Vasodilator. Directly relaxes vascular smooth muscle. Side effects include excessive hair growth, pericardial effusion, edema. Monitor for signs of fluid retention. Hydralazine: Vasodilator. Relaxes arteriolar smooth muscle. Side effects include tachycardia, headache, lupus-like syndrome. Monitor heart rate, symptoms of lupus. 80.Explain the signs and symptoms of hypertension. -Headaches Chest pain Vision changes Shortness of breath Renal dysfunction Dizziness Fatigue Nosebleeds - Dizziness - Flushed face - Dyspnea - Irregular heartbeat - Blood in the urine 81.Explain the different hormonal systems that influence blood pressure. -Renin-Angiotensin-Aldosterone System (RAAS): Angiotensin II is a potent vasoconstrictor that raises blood pressure. Aldosterone promotes sodium and water reabsorption, increasing blood volume. -Natriuretic Peptides: Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) act as vasodilators and promote sodium and water excretion, lowering blood pressure. -Antidiuretic Hormone (ADH): Secreted by the posterior pituitary, ADH promotes water reabsorption in the kidneys, increasing blood volume and pressure. -Epinephrine and Norepinephrine: These catecholamines from the adrenal medulla cause vasoconstriction, raising blood pressure during the fight-or-flight response. -Endothelins: Potent vasoconstrictors released by vascular endothelial cells that increase blood pressure. -Inflammation 82.Explain patient teaching to a hypertensive patient. -Adherence to medication regimen- Explain their prescribed medications, dosages, potential side effects, and the need for consistent use as directed. - Adherence to lifestyle changes-Educate them on the importance of a low-sodium diet, regular exercise, weight management, smoking cessation, and limiting alcohol intake. - Monitor blood pressure at home -Instruct on proper home blood pressure monitoring techniques and target ranges. -Signs and symptoms of complications -Emphasize that hypertension is a chronic condition requiring lifelong management. -Encourage patients to keep follow-up appointments and address any concerns promptly. -Provide educational resources and involve family members to promote understanding and adherence 83.Which blood pressure value indicates a hypertensive crisis Hypertensive Crisis: Systolic over 190-180 and/or diastolic over 120 ​ Example: *180/90 *165/120 84.Explain the risk factors of peripheral vascular disease -Atherosclerosis ‒ Smoking ‒ Hypertension ‒ Diabetes ‒ Dyslipidemia -Hyperlipidemia -Obessity -Age -Family HX ‒ Sedentary lifestyle (no exercise) ‒ Ineffective stress management 85. Explain the cause of peripheral vascular disease -The primary cause of peripheral vascular disease (PVD) is atherosclerosis - the buildup of fatty deposits called plaque inside the arteries. This narrows the arteries and restricts blood flow to the extremities, most commonly the legs. -It is a chronic condition in which partial or total arterial occlusion (blockage) decreases perfusion to the extremities. -Insufficient blood supply to area causing ischemia (tisue death) 86. What are the signs and symptoms of PAD -Intermittent Claudication - Leg weakness or numbness - Sores or wounds on the toes, feet, or legs that are slow to heal - Hair loss or slowed hair growth on the legs - Shiny, tight, and thin skin on the legs - Thick toenails - Coolness or abnormal pale or bluish color in the legs - Absent or diminished pulses in the legs or feet 87. Explain a sign of intermittent claudication Intermittent Claudication is a symptom of Peripheral Artery Disease (PAD) that causes pain, cramping, or aching in the legs during physical activity, such as walking, and is relieved by rest. Intermittent claudication Oldness in the lower leg or foot, especially when compared with the other side Leg numbness or weakness Muscle pain, cramping, or burning occurs with exercise and is relieved with rest. Symptoms are reproducible with exercise. No pulse or a weak pulse in the legs or feet Painful cramping in one or both of the hips, thighs or calf muscles after certain activities, such as walking or climbing stairs Shiny skin on the legs Skin color changes on the legs Slower growth of the toenails Sores on the toes, feet or legs that won't heal Pain when using the arms, such as aching and cramping when knitting, writing or doing other manual tasks Erectile dysfunction Hair loss or slower hair growth on the leg’ 88. What are the diagnostic tests for PAD -Ankle-brachial index (ABI) -Doppler ultrasound -Angiography - Injects dye into the arteries to visualize blockages using X-rays (invasive). -CT angiography (CTA) Magnetic resonance angiography (MRA) -Treadmill test -Plethysmography 89. What are the nursing diagnoses for PAD -Acute/Chronic Pain related to impaired circulation and tissue ischemia -Impaired Peripheral Tissue Perfusion related to atherosclerotic obstruction -Risk for Impaired Skin Integrity related to diminished blood flow -Activity Intolerance related to claudication pain with ambulation -Self-Care Deficit related to pain, weakness, and mobility limitations -Risk for Ineffective Peripheral Tissue Perfusion related to atherosclerosis 90. What are the nursing interventions for a patient with PAD – Assessments INterventions Bilateral blood pressures Palpate all pulses in both legs Visual assessment of feet and limbs Temperature of extremities Assess bilateral muscle tone Pain – Action Interventions Administer medications as ordered Proper positioning – Teaching Interventions Positioning Inspect feet daily Report chest discomfort Lifestyle changes Pain management: Administer analgesics as prescribed and provide non-pharmacological methods like elevation and massage to relieve ischemic pain. Promote circulation: Encourage exercise therapy like walking until claudication, then resting. Instruct on positioning to enhance arterial flow to the extremities. Prevent skin breakdown: Inspect skin regularly, provide meticulous foot care, and protect from injury. Manage any wounds appropriately. Modify risk factors: Educate on smoking cessation, dietary changes for weight and cholesterol control, diabetes management, and increasing physical activity. Monitoring: Assess pulses, skin temperature, capillary refill, and signs of ischemia. Report worsening symptoms promptly. Patient education: Explain PAD, its complications, prescribed treatments, and the importance of adherence to the care plan. 91.Explain the which position to place a patient when sitting in a chair with PAD -Legs down but slightly elevated -The legs should not be elevated too high above heart level, as this can actually slow arterial flow to the feet. A slight elevation, such as resting the feet on a stool or ottoman 92.Explain the medication treatments for PAD -Antihypertension: Lisinopril (Zestril): help control blood pressure to improve tissue perfusion. -Anti-cholesterol: Simvastatin (Zocor):lower LDL and triglyceride levels to reduce atherosclerotic plaque buildup. -Antiplatelet drugs: Clopidogrel (Plavix):inhibit platelet aggregation, reducing risk of clots and improving blood flow. -Anticoagulants: Heparin (Lovenox): short-term after revascularization procedures to prevent clotting. 93.Explain patient education for a patient diagnosis with PAD Positioning Inspect feet daily Report chest discomfort Lifestyle changes -Understanding PAD: Explain the condition, its causes like atherosclerosis, symptoms like leg pain or non-healing wounds, and potential complications if not properly managed. -Lifestyle changes: Emphasize quitting smoking, eating a balanced diet low in saturated fats, exercising regularly with a structured walking program, and managing conditions like diabetes or hypertension. -Medications: Review the purpose, dosing instructions, and potential side effects of any prescribed antiplatelet, cholesterol, antihypertensive, or anticoagulant drugs. -Foot and leg care: Instruct on daily inspection, proper foot care, avoiding injury, and promptly reporting new wounds, discoloration, or pain. -Activity modifications: Recommend avoiding extended periods of sitting or leg crossing. Encourage frequent position changes and leg elevation when resting. -Self-monitoring: Teach techniques like checking pulses, skin temperature, and reporting worsening symptoms to the healthcare provider. -Available resources: Provide information on community resources, support groups, home care services if needed, and when to contact the provider. 92. Identify the risk for developing Chronic Renal Insufficiency - Diabetes mellitus - Hypertension/high blood pressure - Cardiovascular disease - Family history of kidney disease - Older age -