144 Final Exam Blueprint PDF

***144 Final Exam Blueprint*** Oxygenation -- 7 questions -- 12% ================================= - Lungs oxygenate the body and remove CO2 - Alveoli performs gas exchange - Alveoli -- endpoint of the respiratory system, exchange oxygen and carbon dioxide in the blood stream...

***144 Final Exam Blueprint*** Oxygenation -- 7 questions -- 12% ================================= - Lungs oxygenate the body and remove CO2 - Alveoli performs gas exchange - Alveoli -- endpoint of the respiratory system, exchange oxygen and carbon dioxide in the blood stream - (from ATI) Oxygenation can be affected by several illnesses and conditions that influence the body's ability to perform ventilation, perfusion, and gas exchange. These alterations may interfere with the respiratory function by causing hyperventilation, hypoventilation, and hypoxia #### Terminology - [Ventilation]: the flow of air inside or outside of the alveoli. Oxygen is transported into the alveoli and carbon dioxide is taken out. - [Hyperventilation] -- co2 ↓, increase in rate + depth of breathing - low level of CO2 in blood can cause arterial pH to rise & cause alkalosis - [Hypoventilation] -- co2 ↑, not enough O2, shallow + lower respiratory rate - high level of carbonic acid in blood, pH decrease & cause acidosis - [Perfusion]: delivery of oxygenated blood to organs and tissues - [Hypoxemia]: low level of oxygen in blood, PaO2 \ - **[Risk Factors]** - [Modifiable: ] - Diet -- low sodium, low added sugar, high in fiber, omega-3, fatty acids - Exercise -- 30-60 minutes a day to lower risk, help improve circulation - Smoking -- 1^st^ + 2^nd^ hand, vasoconstrictive effects of nicotine reduce the amount of oxygen in the blood - Stress -- prolonged/unmanaged stress can raise BP, cortisol - Environmental factors -- pollution - [Non-modifiable:] age, family history - **[Signs + Symptoms]** - Difficulty breathing -- accessory muscle usage, cyanosis - Clubbing of the fingers/toes - Deformities in the chest wall -- barrel chest - Tripoding to enhance breathing - Jugular vein distention (JVD) - Delayed capillary refill -- longer then 3 seconds - Wheezing -- whistling noise heard on exhalation caused by constricted airways - Rhonchi -- rattling noise, caused by obstruction of airway. - **[Complications ]** - Recurrent infections - Need for long-term ventilation - Progression to cardiac disease (CHF) - Pulmonary hypertension - Psychosocial impact - Depression - [**Emphysema --** Pink Puffer (effects the alveoli)] - [Barrel chest] - Pursed lip breathing -- relieves symptoms, improve air exchange, strengthens lungs - Cachexia -- weakness/wasting of the body due to chronic illness - Tripod position - Pink skin - Accessory muscle use - Hypercapnia - Dyspnea - Tachypnea - Crackles + wheezes - Fatigue - [**Chronic bronchitis** - Blue Bloater] - Chronic productive cough - Purulent sputum - Cyanosis - Obesity - Dyspnea - Tachypnea - Crackles + wheezes - Fatigue - [Medical Diagnosis] - Chest X-ray - Arterial Blood Gas -- used to measure the levels of O2 + CO2 in the blood - [Medical treatment] - long term management -- no cure - o2 - nebulizer treatments - corticosteroids - pulmonary rehab - supportive care through the exacerbation - o2 - bronchodilator inhaler - corticosteroid inhaler - antibiotics - IV fluids - [Interventions and consideration] - Monitor O2 sat -- normal is 88-92% for COPD - Monitor PaO2 (ABGs) -- 80-100 mmHG is normal - Monitor PaCO2 (ABGs) -- 38-42 mmHG is normal - Sit them up, encourage coughing, incentive spirometer - May use pursed lip breathing to improve air exchange, strengthen lungs, relieve symptoms - Sputum sample assists in diagnosis and treatment [Questions] 1. Identify 4 symptoms of COPD that are unique to emphysema a. Barrel chest, cachexia, pursed lip breathing, pink skin, hypercapnea Fluid and Electrolytes -- 6 questions -- 10% ============================================ As fluid decreases, solutes increase #### Hypervolemia + Hypovolemia - Malnutrition - Interstitial fluid shift - SIADH - Excess fluid or sodium intake - Kidney/heart/liver failure -- late-stage complication - Respiratory -- pulmonary congestion (crackles in lungs), SOB - Cardiovascular -- bounding pulses, BP↑ JVD↑, tachycardia, presence of S3 - Edema -- seen before respiratory issues, pitting edema, - Nausea, changes in LOC, anorexia, etc. - Monitor I&O - Daily weights - VS & respiratory status - Enforce fluid/diet restrictions - Administer diuretics - Patient education - Excessive diaphoresis - Vomiting - Fever - Frequent urination - Lack of fluid intake - Medications - Diabetes - Pregnancy - Elderly have less body water & decreased sense of thirst - Changes in skin turgor, skin tenting, dry skin, sticky/dry mucous membranes - Tachycardia, weak/diminished pulse - Postural hypotension -- BP may drop when standing too quickly, pt becomes dizzy - Confusion - Concentrated urine - Monitor I&O - VS - Check skin turgor - Weigh daily - Administer ordered IV fluids + encourage fluid intake #### IV Fluid Osmolarity and Fluid Examples - Osmosis: water moves from higher -\ lower concentration of water - [Osmolality:] particles/kg - [Osmolarity]: particles/liter -- LAR + LITER - [IV fluid tonicity:] how does the fluid change the cell? A diagram of different types of solutes Description automatically generated - [**Isotonic**:] "I'm so perfect" - solutes are equivalent - treat FVD, fluid resuscitation - normal saline (0.9% NS) - lactated ringers (LR) - 5% dextrose in water (D5W) - The cell does not sink or expand - Indicated for treatment of vascular system deficit, dehydration - **[Hypertonic]**: "hyper people are skinny" - concentrated solutes on the outside - treat hyponatremia (not enough sodium) - 10% dextrose in water (D10W) - 5% dextrose in 0.9% saline (D5NS) - 5% dextrose in 0.45% saline (D5W in 0.45% NaCl) - The cell would shrink because the water is going from the ICF to the ECF. - Indicated when serum osmolality is critically low - Which solution could cause a cell to look like the one in the photo? - Hypertonic -- D5% + 0.45% Normal Saline Solution (D5 ½ NS) -  - Which solute concentration is higher than what is inside the cell? - Hypertonic, D10W, D51/2NS, D5NS - [**Hypotonic**:] "HIPPOtonic" - diluted solutes on the outside, - treat intracellular dehydration, diabetic ketoacidosis (too much acid in blood) - 0.45% normal saline (0.45% NS) - [**Hemolysis**:] RBC have become so swollen that they burst because too much water is being pulled into the cell. - Which solution could cause a cell to look like this (swell/burst)? - Hypotonic -- 0.45% Normal Saline solution (1/2 NS), may cause cells to swell A red ball with blue streaks and blue streaks Description automatically generated with medium confidence  #### Hyper/Hypokalemia -- K+/potassium (most important intracellular ion) \* Potassium overloud/deficit would indicate cardiovascular complications [**HYPOkalemia** -- K+ too low, serum levels \ - Muscle weakness + cramping - Fatigue - Vomiting - Decreased bowel motility - Paresthesia - Dysrhythmias - Flat &/or inverted T-waves RCG - Monitor labs (K+ \ - Muscle twitching + paresthesia (early) - Ascending muscle weakness (start in legs & move to upper body) - Increased bowel motility - Ventricular dysrhythmias (more life threatening) - Peak T-wave ECG - Monitor labs, ECG, bowel sounds - Dialysis - Administer medications (loop diuretics) **Questions** 1. A client has diuresis. The nurse should be concerned with the risk of what electrolyte imbalance? a. Hypokalemia 2. A client has been experiencing vomiting and diarrhea for 3 days. The nurse would be most concerned with what electrolyte imbalance? b. Hypokalemia 3. Which electrolyte imbalance has the most risk for causing life-threatening dysrhythmias? c. Hyperkalemia #### Hyper/Hyponatremia -- Sodium (most important extracellular ion) \*Sodium overloud/deficiency would indicate more neurological complications [**HYPOnatremia** -- not enough sodium, serum levels \