Week Four Objectives - Nursing - PDF

Week Four Objec ves Gas Exchange 1. Understand complications of impaired gas exchange. Hypoxemia- decreased oxygen levels in the blood due to ventilation/perfusion mismatch or shunt Hypoxia- Inadequate oxygen supply to tissues and organs, potentially causing organ damage Respiratory acidosis- Elev...

Week Four Objec ves Gas Exchange 1. Understand complications of impaired gas exchange. Hypoxemia- decreased oxygen levels in the blood due to ventilation/perfusion mismatch or shunt Hypoxia- Inadequate oxygen supply to tissues and organs, potentially causing organ damage Respiratory acidosis- Elevated carbon dioxide levels in the blood, leading to acidic pH Pulmonary hypertension- increased blood pressure in the lung’s arteries due to low oxygen Right-sided heart failure- the right ventricle has to work harder against high pulmonary pressures Polycythemia- The body compensates for chronic hypoxia by producing more red blood cells Cognitive impairment- Lack of oxygen to the bran can affect mental status and decision-making 2. Review function of the respiratory system. 1. Ventilation- the movement of air into and out of the lungs through inhalation and exhalation 2. External respiration- The diffusion of oxygen from inhaled air into the bloodstream across the alveolar-capillary membranes, and the diffusion of carbon dioxide from the blood into the alveoli to be exhaled 3. Internal respiration- The delivery of oxygenated blood to tissues via the cardiovascular system and the removal of carbon dioxide from tissues into venous blood. Air filtration, humidification, vocalization, and regulation of acid-base balance. Proper gas exchange is vital for all cells to receive adequate oxygenation and remove metabolic waste to sustain life. 3. Know how to assess the lungs and thorax and significance of abnormal findings. Inspection: Observe the rate, rhythm, depth, and symmetry of chest movements. Note any abnormalities like barrel chest (emphysema), unequal expansion, or use of accessory muscles. Palpation: feel for tactile fremitus, chest expansion, and areas of tenderness Percussion: percuss to assess for areas of dullness (fluid/consolidation) or hyper resonance (air trapping) Auscultation: listen for adventitious breath sounds like crackles, wheezing, or diminished sounds indicating airway obstruction or fluid. Abnormal findings and significance: Crackles: may indicate fluid in alveoli (pneumonia, heart failure) Wheezes: Airway obstruction from mucus, bronchospasm (asthma, COPD) Diminished sounds: Pleural effusion, pneumothorax, or airway obstruction Dullness: Fluid accumulation or consolidation Hyperresonance: Air trapping from obstructive lung diseases 4. Know where gas exchange occurs. Gas exchange occurs in the alveoli of the lungs. The alveoli are tiny air sacs clustered around terminal bronchioles. Surrounded by a dense network of capillaries, forming the respiratory ti  Week Four Objec ves membrane where oxygen diffuses from the alveoli into the bloodstream and carbon dioxide diffuses from the blood into the alveoli to be exhaled. 5. Know factors effecting gas exchange and lung compliance. Gas exchange: -alveolar surface area- reduced from diseases like emphysema -alveolar-capillary membrane thickness- increased thickness impairs diffusion -ventilation/perfusion mismatch- from conditions like pulmonary embolism -shunting- deoxygenated blood bypassing ventilated alveoli Lung compliance: -surfactant levels- deficiency increases surface tension, reducing compliance -lung tissue elasticity- decreased from fibrosis or edema -chest wall abnormalities- like kyphosis or obesity, restricting expansion -airway resistance- increased from mucus, bronchospasm, or airway obstruction -lung volume- over-inflation or atelectasis reduces compliance 6. Know factors effecting oxygenation. -Ventilation (rate and depth of breathing) -Diffusion capacity across alveolar-capillary membrane -Ventilation/perfusion mismatch -Shunting of deoxygenated blood -Inspired oxygen concentration -Hemoglobin levels and oxygen carrying capacity a. Early vs. late signs of hypoxia Early: -restlessness, apprehension -inability to concentrate -dizziness -increased respiratory rate Late: -Confusion, impaired cognition -cyanosis -bradycardia -hypotension -dysrhythmias -decreased level of consciousness Recognizing early signs of hypoxia is crucial, as progressive tissue hypoxia can lead to organ damage and life-threatening complications if not promptly treated. 7. Understand different breathing patterns and lung sounds. Crackles/Rales - Discontinuous, non-musical sounds caused by air passing through fluid in airways. Wheezes - Musical, continuous sounds from airway narrowing or obstruction. ti  Week Four Objec ves Stridor - High-pitched, harsh, monophonic wheeze caused by upper airway obstruction. Pleural friction rub - Grating, creaking sound from inflamed pleural surfaces rubbing together. 8. Know normal changes in the respiratory system that occur with aging. -Decreased respiratory muscle strength and chest wall compliance due to calcification of costal cartilages -Increased anteroposterior diameter of the thoracic cavity and dorsal kyphosis (curvature of the spine) -Decreased lung elasticity and surface area for gas exchange from enlargement of alveoli -Decreased effectiveness of the cough reflex due to reduced number of functional cilia -Stiffening of the chest wall, making it more difficult to breathe deeply -Increase susceptibility to respiratory infections like pneumonia 9. Know proper administration of O2 therapy and nursing considerations. Proper administration of oxygen therapy involves selecting the appropriate delivery system and flow rate based on the patient’s condition and oxygen needs. Nasal cannulas are commonly used for mild to moderate hypoxia, delivering 24-44% oxygen concentration. For higher concentrations, masks like simple face masks or non-rebreather masks are used. Venturi masks allow precise oxygen concentration delivery. Nursing considerations include monitoring oxygen saturation levels, assessing for signs of hypoxia or hyperemia, ensuring proper fit and positioning of the delivery system, and providing skin care to prevent irritation. Safety is paramount- post “Oxygen in Use” signs to ensure no open flames or ignition sources are present, and instruct on fire hazards. Frequent documentation and monitoring is essential. 10. Know nursing interventions for patient with respiratory problems. Oxygen therapy administration and monitoring oxygen saturation levels Incentive spirometry to improve lung expansion and prevent atelectasis Positioning like semi-fowlers to optimize breathing mechanics Coughing and deep breathing exercises to mobilize secretions Suctioning of airways if needed to clear mucus plugs Monitoring respiratory rate, effort, breath sounds Administering bronchodilators or other prescribed respiratory medications Patient education on energy conservation techniques Promoting adequate hydration to thin secretions Smoking cessation counseling if applicable The goals are to improve oxygenation, clear airways, prevent complications like pneumonia, and optimize respiratory function. Early mobility and pulmonary hygiene are crucial even for patients without an active respiratory diagnosis. 11. Know nursing intervention for patients with impaired gas exchange. ti  Week Four Objec ves Administering supplemental oxygen therapy via appropriate delivery system and monitoring oxygen saturation levels Positioning the patient to optimize ventilation, such as semi-Fowler’s or side-lying Encouraging deep breathing exercises, incentive spirometry, and coughing to improve lung expansion Suctioning the airway if needed to clear secretions Monitoring respiratory rate, effort, breath sounds, and signs of respiratory distress Administering prescribed bronchodilators, corticosteroids, and other respiratory medications Providing emotional support and reassurance to reduce anxiety Collaborating with the healthcare team for potential ventilatory support if gas exchange remains severely impaired The overall goals are to improve oxygenation, enhance ventilation, clear airways, reduce work of breathing, and prevent complications while addressing the underlying cause. 12. Understand atelectasis: causes, assessment findings, treatment and nursing interventions. Atelectasis is the collapse or delation of alveoli in the lungs, leading to impaired gas exchange. Causes include airway obstruction, shallow breathing, mucus plugging, and compression from pleural effusion or pneumothorax. Assessment findings may include diminished or absent breath sounds, crackles, hypoxemia, tachypnea, and asymmetric chest expansion. Chest X-ray can confirm atelectasis. Treatment aims to re-expand the affected lung area. Interventions include deep breathing exercises, incentive spirometry, chest physiotherapy, suctioning, bronchodilators, and potentially bronchoscopy or surgery for persistent atelectasis. Key nursing interventions are position to allow maximum lung expansion, encouraging coughing and deep breathing, administering prescribed respiratory treatments, monitoring respiratory status, and providing patient education on lung re-expansion techniques. Early mobilization and pulmonary hygiene help prevent atelectasis. Perfusion 13. Understand complications of impaired perfusion. Ischemia- reversible cellular injury due to insufficient oxygen supply to tissues. Infarction/Necrosis- Irreversible cell death and tissue damage if ischemia is prolonged Organ dysfunction/failure- Impaired perfusion to vital organs like the heart, brain, kidneys can lead to organ failure if severe. Systemic effects- Extensive impaired perfusion can affect multiple organs and potentially lead to cardiovascular collapse. Exacerbation of underlying condition- Impaired perfusion can worse the original cause, creating a cycle that further impairs perfusion. ti  Week Four Objec ves The severity of complications depends on the location, extent, and duration of impaired blood flow and oxygenation to tissues. Prompt recognition and treatment of impaired perfusion is crucial to prevent irreversible damage. 14. Review anatomy & function of the heart. The heart is a muscular pump divided into four chambers- two aria and two ventricles. The right atrium receives deoxygenated blood from the body and pumps it to the right ventricle. The right ventricle pumps the deoxygenated blood from the lungs and transfers it to the left ventricle. The powerful left ventricle pumps oxygenated blood out to the body’s tissues and organs. The heart has a specialized electrical conduction system that generates electrical impulses, causing the atria and ventricles to contract in a coordinated sequence. This allows efficient pumping, with the atria contracting first to fill the ventricles, followed by ventricular contraction to eject blood. Heart valves ensure one-way flow through the chambers. The thickness of each chamber wall relates to the amount of force required for pumping blood against resistance. 15. Know assessment of cardiovascular system and significance of abnormal findings. Inspection: Skin color, edema, visible pulsations, jugular venous distension Palpation: Apical pulse, peripheral pulses, edema, thrills Percussion: Determining heart borders Auscultation: Heart sounds, murmurs, extra sounds Abnormal findings: -Irregular heart rate/rhythm: arrhythmia, conduction issues -murmurs: valvular disorders, shunts -Displaced apical pulse: cardiomegaly, heart failure -Jugular venous distension: right heart failure -Diminished/absent peripheral pulses: arterial disease -Edema: heart failure, venous insufficiency -Cyanosis- hypoxemia 16. Know how blood flows through the heart and cardiac electrical conduction. Deoxygenated blood from the body enters the right atrium, then flows into the right ventricle. The right ventricle pumps the deoxygenated blood to the lungs for oxygenation. Oxygenated blood returns from the lungs to the left atrium, then flows into the powerful left ventricle. The left ventricle pumps oxygenated blood out to the body’s tissues and organs through the systemic circulation. The cardiac electrical conduction system coordinates this blood flow. Electrical impulses originate in the SA node and travel through the atria, causing them to contract. The impulse reaches the atrioventricular (AV) node, then travels down the bundle of His and Purkinje fibers, causing the ventricles to contract and pump blood out of the heart. This coordinated electrical activity allows the heart’s chambers to contract in sequence for efficient pumping. 17. Know how the autonomic nervous system effects the heart function. ti  Week Four Objec ves Sympathetic: Parasympathetic: Increases heart rate, conduction velocity, Controlled by vagus nerve and contractility. Decreases heart rate and contractility. Enhances cardiac output by releasing Allows the heart to conserve energy at rest. norepinephrine and epinephrine. This prepares the body for “fight or flight” situations. 18. Know risk factors for cardiovascular disease: modifiable and nonmodifiable. Nonmodifiable: Modifiable: Age (risk increases with advancing age) Smoking Gender (men have higher risk than Dyslipidemia (high LDL cholesterol, low premenopausal women) HDL cholesterol Family history/genetics Hypertension Diabetes mellitus Obesity Sedentary lifestyle Unhealthy diet Excessive alcohol consumption 19. Know normal cardiac changes that occur as we age. Increased stiffness of the heart muscle and blood vessels (arteriosclerosis) Thickening of the heart muscle (left ventricular hypertrophy) Slowed electrical conduction through the heart Decreased pumping ability of the heart (reduced cardiac output) Increased risk of arrhythmias like atrial fibrillation Valvular calcification and stiffening Decreased baroreceptor sensitivity, impacting blood pressure regulation These age-related changes can contribute to conditions like hypertension, coronary artery disease, and heart failure. 20. Know hypertension (HTN)- causes/ risk factors. a. Differentiate between essential and secondary HTN. Essential (primary) hypertension has no identifiable cause, while secondary hypertension results from an underlying condition. Risk factors for essential hypertension include obesity, high sodium intake, excessive alcohol, sedentary lifestyles, stress, genetics, and aging. Secondary causes include kidney disease, endocrine disorders (e.g. Cushing’s syndrome, pheochromocytoma), sleep apnea, medications, and pregnancy complications like preeclampsia. 21. Nursing interventions for patient with HTN. ti  Week Four Objec ves Provide education on lifestyle modifications like a low-sodium diet, regular exercise, weight management, smoking cessation, and stress reduction techniques. Emphasize medication adherence and the importance of a routine blood pressure monitoring. Assess for potential side effects of antihypertensive medications. Encourage the patient to be an active partner in their care plan. Reinforce the need for regular follow-ups to monitor blood pressure control and adjust treatment as needed. 22. Know different types of antihypertensive medications: action, side effects, common suffixes and nursing action when giving these medications. Diuretics (e.g. hydrochlorothiazide, furosemide)- promote sodium and water excretion, reducing blood volume. Side effects include electrolyte imbalances, dehydration, and glucose intolerance. ACE inhibitors (e.g lisinopril, enalapril)- Block angiotensin converting enzyme to dilate blood vessels. Watch for cough, hyperkalemia, and acute kidney injury. Angiotensin 2 Receptor blockers (ARBs) (e.g losartan, valsartan) - Block angiotensin 2 receptors, similar to ACE inhibitors but without the cough side effect. Calcium Channel Blockers (e.g. amlodipine, diltiazem)- Relax vascular smooth muscle by blocking calcium entry. May cause edema, flushing, headache. Beta blockers (e.g. metoprolol, atenolol)- Decrease cardiac output and renin release. Monitor for bradycardia, bronchospasm, fatigue. Alpha blockers (e.g. doxazosin, prazosin)- Dilate arteries by blocking alpha-1 receptors. Orthostatic hypotension is a concern. Vasodilators (e.g hydralazine, minoxidil)- Directly relax vascular smooth muscle. Tachycardia and fluid retention may occur 23. Know difference between arteriosclerosis and atherosclerosis. Arteriosclerosis refers to the general hardening and loss of elasticity of the arterial walls, which can occur with normal aging. Atherosclerosis is a specific type of arteriosclerosis characterized by the buildup of fatty deposits called plaque within the arterial walls. This plaque accumulation can narrow the arteries and restrict blood flow, increasing the risk of heart disease and stroke. While arteriosclerosis is a normal part of aging, atherosclerosis is a progressive disease process driven by inflammation and the accumulation of cholesterol, calcium and cellular debris within the arteries. 24. Know treatment/medications for arteriosclerosis and atherosclerosis. For arteriosclerosis (general hardening of arteries), treatment focuses on lifestyle modifications like exercise, smoking cessation, and a healthy diet to slow progression. Medications are not typically used specifically for arteriosclerosis. For atherosclerosis (buildup of plaque in arteries), medications play a key role -antihypertensives control high blood pressure, a risk factor for atherosclerosis -antiplatelet drugs like aspirin and clopidogrel prevent clot formation -fibrates (e.g fenofibrate) and niacin can help improve HDL and triglyceride levels. -PCSK9 inhibitors (e.g evolocumab, alirocumab) are newer drugs that lower LDL cholesterol ti  Week Four Objec ves 25. Patient education regarding decreasing cardiac risk factors. Encourage smoking cessation and avoidance of secondhand smoke exposure. Recommend a diet low in saturated fats, trans fats, cholesterol, and sodium. Emphasize the importance of regular aerobic exercise and maintaining a healthy weight. Advise limiting alcohol intake. Discuss stress management techniques like meditation, yoga, or counseling. For patients with diabetes, reinforce glycemic control through diet, exercise, and medication adherence. Educate on the dangers of uncontrolled hypertension and the need for routine monitoring. Promote medication adherence for conditions like high cholesterol and high BP. 26. Understand the difference between localized and central perfusion. Localized perfusion refers to the blood flow and delivery of oxygen and nutrients to a specific tissue or organ. Central perfusion refers to the overall blood flow from the heart to the body’s vital organs like the brain, kidneys, and liver. Impaired localized perfusion can occur due to blockages or constrictions in specific arteries supplying that area, such as a stroke caused by a blocked cerebral artery. Central perfusion issues involve a significant reduction in the heart’s overall ability, impacting multiple organs simultaneously. Examples include heart failure or hypovolemic shock. Patient Education: 27. Know methods to encourage medication compliance. Simplify medication regimens as much as possible. Provide clear instructions using simple language and visuals. Encourage use of pill boxes or blister packs. Involve family members or caregivers. Explore cost-saving options like generics or patient assistance programs. Address health beliefs and cultural factors that may impact adherence. Use motivational interviewing to identify barriers and facilitate behavior change. 28. Identify barriers to clients complying with medical regimens. Lack of understanding about the condition or treatment rationale. Complexity of the treatment regimen (multiple medications, complicated dosing schedules) Cost or lack of insurance coverage for medications/treatments Forgetfulness or lack of organizational skills Cultural beliefs or language barriers Low health literacy Side effects of medications Lack of social support or transportation issues Cognitive impairment Lack of motivation or perceived benefit of the treatment 29. Understand the nurse’s role in promoting smoking cessation. Utilize the 5 A’s model. (Ask, Advise, Assess, Assist, Arrange) Ask about the smoking status at every encounter, advise quitting in a clear and personalized manner, assess willingness to quit, assist by providing counseling and pharmacotherapy options, and arrange follow-up. Offer ti  Week Four Objec ves nonjudgmental support, educate on benefits of quitting, and connect patients with cessation resources. Leverage motivational interviewing to facilitate behavior change. Advocate for smoke-free policies and serve as a role model by not using tobacco products yourself. Your consistent efforts can empower patients to successfully quit smoking. ti