Exam 2 Blueprint PDF

Exam 2 Blueprint: - Drug calculation related to penicillin - Nursing related to COPD:\ -Oxygenation: high- fowlers, maintain 02 stat above 90%, stop smoking\ -Pursed lip breathing- helps slow expiration, prevent airway collapse, helps control rate and depth of breathing, allows...

Exam 2 Blueprint: - Drug calculation related to penicillin - Nursing related to COPD:\ -Oxygenation: high- fowlers, maintain 02 stat above 90%, stop smoking\ -Pursed lip breathing- helps slow expiration, prevent airway collapse, helps control rate and depth of breathing, allows for control over dyspnea\ -Nutritional Management: smaller meals that are easy to digest -Meds:\ Bronchodilator: Albuterol inhaler as a rescue med, theophylline\ Glucocorticoid: IV takes longer to work: will then be given PO and tapered off ( ex: prednisone)\ Antitussives: cough suppressants\ Mucolytics: helps liquify secretions\ Antimicrobials for infection\ Antihistamines\ Expectorants and decongestants\ -Pt teaching: learn triggers, know signs of exacerbation, \*new normal due to COPD\*- decreased activity and restrictions\ \ Chronic Bronchitis:\ -Inflammation of bronchi which results in increased production of mucous and development of chronic cough for at least 3 months a year for 2 years\ -Blue bloater- cyanosis bc of bronchial inflammation and excess mucous production- does not allow oxygen to reach alveoli no matter how hard they try to breath, patient has fluid retention which leads to peripheral edema (due to impaired circulation)\ -Pt care: stabilize and decrease inflammation, use of appropriate inhalers to decrease inflammation and to help with breathing\ \ Emphysema:\ -Loss of elastin (due to smoking mostly) leads to diminished recoil of lungs which leads to decreased SA available for gas exchange and dec expiration bc of premature closing of airways. Grapes to grapefruit\ -Blebs and bullae lead to areas of dead space not available for gas exchange\ -Pink puffer- taking frequent huff breaths to get enough oxygen so it turns them pink due to hyperventilation, often thin and skinny bc they expend a lot of energy to breathe, barrel chest due to overdevelopment of muscles that are trying to help, tachypnea, dyspnea, clubbed fingers and toes, - Thoracotomy: 2 priority questions\ Thoracotomy- surgery opening the chest to insert a chest tube\ Chest Tube: removes air, blood or fluid from chest cavity\ for pneumothorax (lung collapse) -- helps to create negative pressure to reinflate lung, auscultate lung for lung sounds\ -Priority concerns: infection, blood clot, air leaks, airway obstruction, pulse ox, lung expansion (encourage deep breathing), monitor for signs of infection, SOB, changes in LOC, decreased lung sounds could mean worsening of pneumothorax or lung collapsed again.\ -chest tube site needs to be covered (occlusive dressing) to prevent air from getting into the body from insertion site, keep sterile water nearby in case tube comes out\ - maintain semi-fowlers to encourage drainage\ -make sure water level in water seal chamber is sufficient amount, make sure there is intermittent bubbling- no bubbling means blockage and continuous bubbling indicates a leak\ -keep drainage below patient's chest (preferably on the floor)\ -pain meds may be necessary to encourage patients to do deep breathing\ \ Thoracentesis- procedure to remove fluid when there is pleural effusion with a needle or catheter - Peripheral Arterial Occlusion Disease: narrowing of arteries or damage to endothelial lining that leads to arterial occlusion, usually in extremities. reduced or absent peripheral blood flow that can lead to ischemia and necrosis.\ -Manifestations: intermittent claudication, resting pain, trophic changes in nails and skin\ -Interventions: dangle legs, avoid constricting clothes, keep warm, avoid caffeine and smoking (vasoconstriction), teach importance of foot care due to arterial ulcers on toes and upper aspect of foot\ \ Care of pt undergone amputation:\ -monitor for bleeding at site, elevate the extremity, prevent hip flexion, assess for infection, apply gauze and ace bandage to prevent edema -Teach pt: no lotion or powder on the stump, report redness or abrasions, wear prosthetic all day\ -admin pain meds- can have phantom foot pain- the pain is real due to injured nerves - Teaching Question: Angina\ Angina: chest pain due to myocardial ischemia because of insufficient blood supply from the heart. Due to atherosclerosis or blood clot. When occlusion occurs, cardiac cells being anaerobic metabolism and lactic acid produced irritates myocardial nerve fibers and sends a pain signal\ -Caused by: physical exertion, exposure to cold, eating a heavy meal, emotional stress\ Teach:\ -take sublingual nitroglycerin every 5 min x 2, after that call 911 if pain doesn't go away.\ -causes orthostatic hypotension due to vasodilation- sit down after taking tablet\ -put tablet under tongue- has no first pass effect\ -take an aspirin in case it is an MI\ -store in a dark bottle, it is good for 6 months\ -do not take with Viagra\ -as nurses: check BP before we give nitroglycerin- can drop BP too low\ \ Chest pain in men: dyspnea, diaphoresis, nausea (from vagal nerve), urge to void, elephant on chest, belching, apprehension substernal pain, pain radiating down arm to back of neck to jaw or upper abdomen.\ \ Chest pain in women: nausea, SOB, abdominal discomfort, discomfort in jaw, neck, thigh. Stabbing pain, burning or fullness sensation. In smaller arteries (microvascular) - Teaching Question : Lopressor (metoprolol)- beta blocker, decreases HR, BP and heart contractibility (forces contraction)\ -need to take vitals prior to administering\ Teaching Question:\ -do not stop suddenly you need to be tapered off to prevent rebound hypertension\ -taking with alcohol can lead to hypotension\ - watch for bradycardia if pt is also on digoxin - Teaching Question : Lasix (furosemide)- loop diuretic (blocks Cl and Na reabsorption in the loop of Henle (increases excretion of Na and water), it is a potassium wasting drug\ -can lead to hypokalemia- signs and symptoms are muscle fatigue and weakness, leg cramps, cardiac dysrhythmias, nausea, constipation, polyuria\ -Teaching Question: look for signs of low potassium, eat foods high in potassium (avocado, potato skins, nuts), need to stay hydrated, change positions slowly (to avoid orthostatic hypotension), daily weights\ -nursing: monitor pt's potassium levels, if it is low see if patient is taking a water pill in MAR, for IV monitor patient for some time since effects will start in a few min, take BP before administering, fluid and sodium restriction - EKG: Tachycardia on EKG\ A picture containing shoji Description automatically generated\ -treatment: calcium channel blockers, beta blockers - CHF: 4 priority questions, clinical manifestations,\ CHF: right ventricle is enlarged, hypertension, leaves fluid in pleural spaces ( shortness of breath) and feet (pitting edema)\ -can be due to left-sided or right-sided heart failure\ -BNP : any level \>100 indicates heart failure (the higher the BNP the worse it is)\ -Manifestations:\ -left-sided: dyspnea, fatigue, anxiety, wheeze, rhonchi, cough, crackles,\ -right-sided: jugular vein distention, ascites, peripheral edema, weight gain\ -Nursing/ teaching- Order of priority: Oxygenation- monitor SpO2, monitor BP, high fowlers, 1-2 liter fluid restriction, low sodium diet, bedrest until stable, daily weights\ -Meds:\ ACE inhibitors: vasodilation (-pril)\ ARBs: vasodilation, lowers BP (-sartan)\ Diuretics: decrease fluid in the body and lungs\ Positive inotropes: strengthen heart beat\ Cardiac glycoside: increases the strength of the heart muscle contractions, slows HR, commonly used for afib (digoxin)\ Beta Blockers: only used in compensated HF: lowers HR and BP - Signs and symptoms of Hyperkalemia:\ Hypokalemia: muscle fatigue and weakness, cardiac dysarythmias\ Hyperkalemia: flaccid paralysis, heart block, asystole, tingling, syncope, irreg heart beat, palpitations - Diarrhea: give lactated ringers IV fluid, if not available use NS. - Pt receiving Heparin for DVT what is priority nursing:\ -check for signs of bleeding and bruising: bleeding gums, petechiae\ -monitor for PE, use pumps for legs, warm moist soaks for affected area - Nursing Care for Vasotec (enalapril):\ -ACE inhibitor: vasodilation to dec BP\ -take BP before administration, monitor kidney function (BUN and creatinine)-can cause renal issues, make sure patient does not get dehydrated, monitor potassium levels (can lead to hyperkalemia) , monitor for hypotension, daily weights, teach pt to change positions slowly (orthostatic hypotension)\ -can cause dry cough, loss of appetite - Priority action for patient who has SOB:\ -sit them up (high fowlers)\ -administer O2 and respiratory meds\ -breathing exercises\ -decrease anxiety - A fib: list of actions and give them in priority order\ Atrial Fibrilation: atrial rhythym is very irreg: 300-600 beats/min and ventricular rate : 120-200 beats/min. decreased cardiac output\ -results from ectopic impulses firing off from where they innapropriately implanted in atria. Atria is receiving impulses from all over and atria doesnt know what to listen to so it reacts to all impulses: valves don't stay open long enough for blood to fill ventricles- leads to pooling in atria\ -symptoms: SOB, palpitations, irreg heart beat, dizziness, chest pain, pulmonary edema\ -do TEE to see if there is a clot, if there is a clot then you cant do cardioversion so you continue to medicate them.\ -Priority actions (in order): for rate control\ -cardioversion if patient is unstable- ventricular rate \>150. Does not cure- pt can still go in and out of Afib\ -Meds: beta blockers, calcium channel blockers, antiarrhythmics, heparin, coumadin, antiplatelet aggregators (aspirin)\ -maze procedure- sutures in strategic sites to prevent a fib\ -radiofrequency catheter ablation- interrupts all communication between atria and ventricles- requires a pacemaker\ -Nursing: neuro checks, admin meds, give drips - Pt undergoing laryngectomy what is a priority:\ Laryngectomy:\ -Partial laryngectomy: removal of one vocal cord with temporary trach to breathe until swelling goes down.\ -Total laryngectomy: removal of larynx , hyoid bone and tracheal ring with closure of pharynx and formation of permanent trach with stoma. Loss of voice (have to relearn speech)\ -Nursing Priority : immediate concern is airway: will need trach care and suctioning- secretions due to inflammatory process, admin 02, suction prn, provide emotional support, teach trach care - What does P wave and PRI stand for and normal ranges:\ P wave: atrial depolarization (atria contracts) 0.06 to 0.12 seconds\ PR segment: the delay in signal the AV node created\ PR interval: before P wave to before QRS complex, time for the signal to travel from atria to AV node; 0.12 to 0.2 seconds\ QRS: ventricular depolarization (ventricle contracts); \65\ -if HR \>100 it could indicate toxicity - Calcium:\ Hypercalcemia: flaccid muscles, bradypnea, calcium stones, brittle bones\ Hypocalcemia: Numbness and tingling, Trosseau and Chovstek signs, spasms, face twitching - Hypovolemia vs dehydration:\ -dehydration: all the cells are there and can return to normal function after rehydration\ -hypovolemia: due to blood loss and volume loss from surgery, birth, etc. Cells need to be replaced- need packed cells bc of blood loss to fix the decreased cardiac output, can also get lactated ringers or NS - Teaching question for asthma:\ Asthma: chronic inflammatory disease of the airways. Characterized by bronchoconstriction, mucosal edema, excessive secretions\ -manifestations: hacking dry cough, wheezing, SOB, chest pain, orthopnea, diminished breath sounds\ -Pt teaching: have a plan in case of an attack, learn triggers and try to stay away from them, keep rescue med (albuterol) on person, do not wait for symptoms to become severe, teach the proper way to use an inhaler, use a spacer, stop smoking -Everything drives toward impaired gas exchange and decreased cardiac output so when doing priority it's to keep patient oxygenating and perfusing \- IV fluids as priority before encourage coughing and breathing