Medsurg Midterm Exam - CIT-U BSN - PDF

MEDSURG MIDTERMS NCM331 \ FIRST SEMESTER \ DR. MAGIN ANTONIO S. RIOSA, PHD CIT-U|BSN DIAGNOSTIC...

MEDSURG MIDTERMS NCM331 \ FIRST SEMESTER \ DR. MAGIN ANTONIO S. RIOSA, PHD CIT-U|BSN DIAGNOSTIC EVALUATION AND THERAPEUTIC INTERVENTIONS FOR RESPIRATORY DISORDERS PULMONARY FUNCTION TEST (PFT) FACTORS AFFECTING PULSE OXIMETRY READINGS: Performed to assess respiratory function and to determine ✓ Anemia the extent of dysfunction, response to therapy, and as ✓ Abnormal hemoglobin screening tests in potentially hazardous industries ✓ Carbon monoxide poisoning Administered using a spirometer ✓ Patient movement (SHIVERING) Indications: CULTURE AND SENSITIVITY (C&S) o Chronic respiratory disorders o Patients for thoracic and upper abdominal surgery Culture - identifies pathogens o Obese Sensitivity - tests which drug/s is/are most effective against o Symptomatic patient with a history suggesting high risk identified pathogen o Sensitive o Intermediate o Resistant All cultures should be obtained PRIOR to the initiation of antibiotic therapy Preliminary results are usually available within 24 hours Final results are available after 48 to 72 hours Specimen: o Throat swab - useful in detecting streptococcal infections o Nasal/Nasopharyngeal swab - Staphylococcus aureus, Influenza Percentage Predicted Value: How well the performance of the o Sputum patient is compared with an average based on age, gender, SPUTUM STUDIES race, and height Sputum - thick type of mucus produced in the lungs PATIENT PREPARATION: o Gram staining: rapid method of detecting bacterial Instruct patient to avoid: infection; indicates whether it is gram-positive or gram- Smoking for 24 hours negative Drinking alcohol for at least 4 hours o Culture and sensitivity Vigorous exercise for at least 30 minutes o Acid-fast bacilli: to test for PTB Wearing any tight clothing Eating a large meal for at least 2 hours Taking short-acting bronchodilators for four hours Taking long-acting beta-2-agonist inhalers for 12 hours Taking slow-release medicines that affect respiratory Sputum Collection: function, and theophylline-based drugs for 24 hours o Obtain early in AM before intake or food or fluid o Instruct patient to rinse mouth with WATER prior to ARTERIAL BLOOD GAS STUDIES (ABG) collection Arterial Blood Gas (ABG) studies assess oxygenation and o Instruct to take a few deep breaths then cough deeply o Let patient expectorate sputum into sterile container acid-base balance o Offer oral care Preparation: NO special preparation Specimen: Arterial Blood Bright RED IN COLOR CHEST X-RAY SUMMARY OF PROCEDURE: Helps detect densities produced by fluid, tumors, foreign bodies, and other pathologic conditions ✓ Radial artery is the most common site for withdrawal of Contraindication: Pregnancy specimen Nursing Interventions: Inform patients that x-rays do not ✓ Perform Allen’s Test (Ulnar - Radial blood sufficiency) require fasting and is not painful ✓ Use heparinized syringe to draw blood specimen - to prevent clotting CHEST CT-SCAN ✓ Place specimen in a container with ice - to prevent Computed Tomography (CT) Scan hemolysis o A CT is an imaging method in which the lungs are scanned ✓ If hemolysis occurs, oxygen and carbon dioxide are in successive layers by a narrow-beam x-ray. released and cannot be measured accurately o The images produced provide a cross – sectional view of NORAMAL the chest DESCRIPTION ABNORMALITIES PROCEDURE VALUE Nursing interventions: Power of Less 7.5 acidosis o Inform patient that they will be required to remain in supine pH 7.35 to 7.45 Hydrogen Greater 7.45 alkalosis Partial pressure of position for about 30 minutes Less 35 mmHg alkalosis PaCO2 Carbon Dioxide in 35-45 mmHg o If contrast medium will be used: Greater 45 mmHg acidosis blood arterial o Asses for allergy to iodine Less 21 mEq/L acidosis HCO3 Bicarbonate 21-26 mEq/L Grreater 6 mEq/L alkalosis o Monitor kidney function Partial pressure of o Maintain NPO for 4 hours before procedure or as ordered PaO2 oxygen in arterial 80-100 mmHg Less 80 mmHg hypoxemia blood CHEST MRI PULSE OXIMETER (SpO2) Magnetic Resonance Imaging (MRI) o Uses magnetic fields and radiofrequency instead of A non-invasive method of continuously monitoring the radiation oxygen saturation of hemoglobin o Can produce a much more detailed diagnostic image than A probe or sensor is attached to the fingertip, forehead, x-rays and CT scan earlobe, or bridge of the nose. Contraindications: The sensor detects changes in oxygen saturation levels by o With metallic implants- absolute monitoring light signals generated by the oximeter and o Pacemakers- absolute reflected by blood pulsing through the tissue at the probe. o Morbid obesity o Confused/agitated patients RESULTS INTERPRETATION >95% Normal o Claustrophobia Hypoxia: Tissues are not receiving Nursing Interventions: