Lifespan Exam 2 Study Guide PDF

Oxygenation Exemplars: Pneumonia: Signs and symptoms: anxiety, fatigue, weakness, chest discomfort, confusion from hypoxia (older adults) fever, chills, flushed face, diaphoresis, sob, tachypnea, sharp pleuritic chest pain, sputum production, crackles and wheezes, dull chest percus...

Oxygenation Exemplars: Pneumonia: Signs and symptoms: anxiety, fatigue, weakness, chest discomfort, confusion from hypoxia (older adults) fever, chills, flushed face, diaphoresis, sob, tachypnea, sharp pleuritic chest pain, sputum production, crackles and wheezes, dull chest percussion over areas of consolidation, decreased oxygen saturation Treatments and interventions: Nursing interventions: High fowlers Encourage coughing or suction to remove secretions Administer oxygen therapy Monitor for skin breakdown around nose/mouth from oxygen device Deep breathing with an incentive spirometer to prevent alveolar collapse Adequate nutrition and fluid intake (fluid promotes thinning of secretions) Treatment can take time Medications: Antibiotics (penicillins and cephalosporins) most often initially given IV and switched to oral as condition improves ○ Nursing intervention: monitor kidney function especially in older adults when taking these antibiotics Bronchodilators to reduce bronchospasms and reduce irritation Anti-inflammatories to decrease airway inflammation How do we prevent post op pneumonia and/or atelectasis? Atelectasis is a complication of pneumonia - airway inflammation and edema that leads to alveolar collapse and increases the risk of hypoxemia Deep breathing with an incentive spirometer to prevent alveolar collapse Chest x-ray post op Control pain so its not painful to breathe Coughing is the most effective method but suctioning when that is not possible Limit time on ventilators if possible PPE Tuberculosis (TB) ** airborne precautions Signs and symptoms: Persistent cough lasting longer than 3 weeks, purulent sputum, fatigue and lethargy, weight loss and anorexia, night sweats and low-grade fever in the afternoon Older adults often present with altered behavior, fever, anorexia, and weight loss Treatment/Interventions: Screening and immunizations to prevent Mantoux test: a positive test can indicate the client has developed an immune response to TB. it does not confirm the disease is present Nursing interventions: heated and humidified oxygen Prevent infection transmission (wearing N95, placing client in negative airflow room and implement airborne precautions) Medications: Antituberculin medications (isoniazid, rifampin, pyrazinamide, and ethambutol) must be taken for 6 -12 months ○ Isoniazid: liver function testing should be done prior and monthly after starting, causes increased risk of hepatotoxicity, yellowing of skin and tingling of hands is an adverse effect ○ Rifampin: liver function should be monitored as well, causes orange urine and secretions, can interfere with efficacy of oral contraceptives, report pain or swelling of joints, loss of appetite, jaundice, or malaise ○ Pyrazinamide: liver enzyme should be completed every 2 weeks after starting, contraindicated for those with gout, report pain or swelling of joints, loss of appetite, jaundice, or malaise ○ Ethambutol: obtain baseline visual acuity and check monthly after starting, stop medication if ocular toxicity occurs and report vision changes Streptomycin sulfate: only for clients with multidrug resistant TB, can cause ototoxicity and is highly toxic Croup *** medical emergency, usually caused by Haemophilus influenzae Signs and symptoms: Drooling, agitation, absence of spontaneous cough, tripod position Thick muffled voice, frog like croaking sound (Dysphonia) Dysphagia Inspiratory stridor, suprasternal and substernal retractions, sore throat, high fever, and restlessness Treatment/Interventions: Nursing interventions: Protect airway, prepare for intubation, provide humidified oxygen, monitor continuous oximetry Corticosteroids and IV fluids as prescribed Droplet isolation precautions for first 24 hours after IV antibiotics initiated Croup syndromes: acute laryngotracheobronchitis and acute spasmodic laryngitis Acute laryngotracheobronchitis: low grade fever, restlessness, hoarseness, barky cough, dyspnea, inspiratory stridor, and retractions ○ Infants and toddlers: nasal flaring, intercostal retractions, tachypnea, and continuous stridor Acute spasmodic laryngitis: croupy barky cough, restlessness, difficulty breathing, hoarseness, nighttime episodes of laryngeal obstruction Nursing care: Provide humidity with cool mist, oxygen if needed, continuous oximetry, nebulized racemic epinephrine as prescribes, corticosteroids, IV fluids How do we prevent the spread of croup? Hand hygiene, droplet precautions, cold and flu preventions How do we prevent the spread of tuberculosis? PPE, ventilation systems, airborne precautions, regular screening and immunizations. Pneumothorax (Spontaneous, Tension and hemopneumothorax) **lung collapse Tension pneumothorax: occurs when air enters the pleural space during inspiration and is not able to exit upon expiration, trapped air causes pressure on the heart and lungs. Venous return is limited leading to a decrease in cardiac output. Death can result if not treated immediately. Causes a mediastinal shift. Hemopneumothorax: accumulation of blood in the pleural space Spontaneous pneumothorax: can occur when there has been no trauma. Small bleb on the lung ruptures and air enters the pleural space Signs and symptoms: Anxiety, pleuritic pain Respiratory distress Tracheal deviation of the unaffected side (tension pneumothorax) Reduced or absent breath sounds on affected side Asymmetrical chest wall movement Hyperresonance on percussion due to trapped air Dull percussion (hemothorax) Subcutaneous emphysema Treatment/Interventions: Thoracentesis: can confirm hemothorax, surgical perforation of chest wall and pleural space with large-bore needle Administer oxygen therapy Auscultate heart and lung sounds and monitor vital signs every 4 hours ABGs, SaO2, CBC, and chest x ray results High fowler's position Chest tubes are inserted to drain fluid, blood, or re-establish a negative pressure and restore normal intrapleural pressure Medications: Benzodiazepines (sedatives)  Opioid agonists for pain How do we assess oxygenation? Patients health history, pulse ox, respiratory rates, blood pressure, inspecting patients skin and mental status What interventions do we make for patients with low oxygenation? Proper positioning (high fowlers usually) Deep-breathing exercises, Incentive spirometry, diaphragmatic breathing, pursed lip breathing, voluntary coughing, suctioning airway Bronchodilators supplemental oxygen ○ Least invasive to most 1. Room air: 21% FiO2 2. Nasal cannula: regular or high flow cannula a. 1 L/pm = 24% Fi02 3. Simple mask a. 5L/pm = 40% b. Gives more FiO2 4. Venturi mask a. 24-80% FiO2 depending on attachment b. Each % corresponds to a flow rate c. You need a FiO2 barrel 5. Non rebreather mask a. 10% per L/pm b. 10 L/pm = almost 100% c. Emergency short term 6. CPAP a. oxygenation b. long term sleep apnea c. Short term for COPD 7. BiPAP a. bilevel positive pressure, helps ventilate b. ex. Acute COPD, heart failure 8. Invasive ventilation a. ETT (intubation) b. Trach (long-term) i. Trach collar ii. T-piece Perfusion Exemplars: Peripheral arterial disease (PAD): ** affects arteries (carry blood away from the heart) - Results from atherosclerosis (thickening of the arteries) usually in the arteries of the lower extremities and inadequate blood flow Examples: buerger’s disease, subclavian steal syndrome, thoracic outlet syndrome, Raynaud’s, popliteal entrapment Signs/symptoms: Burning, cramping, and pain in the legs during exercise (intermittent claudication) Numbness or burning pain primarily in the feet when in bed Pain relieved by placing legs at rest in a dependent position Bruit over femoral and aortic arteries , decreased capillary refill, nonpalpable pulses Loss of hair on lower calf, ankle, and foot Dry, scaly, mottled skin Thick toenails, ulcers and possible gangrene of toes Cold and cyanotic extremity, pallor of extremity with elevation Dependent rubor of extremity, muscle atrophy Treatment/interventions: Nursing interventions: Warm environment for client, wear insulated socks, never apply heat directly to affected area, avoid cold exposure Avoid vasoconstriction (stress, caffeine, nicotine) Avoid crossing legs, refrain from wearing restrictive garments, elevate legs (but not above the heart) Medications: Antiplatelet medications (increases blood flow in extremities) Statins (can relieve intermittent claudication) Peripheral venous disease (PVD) ** affects veins (carry blood toward the heart) can result in blood stasis - Examples: Venous thromboembolism (VTE), venous insufficiency, and varicose veins Signs/symptoms: Aching pain and feeling of fullness or heaviness in the legs after standing Venous insufficiency: stasis dermatitis (brown discoloration along the ankles and up the calf), edema, stasis ulcers around ankles Varicose veins: distended, superficial veins visible just below the skin, muscle cramping and aches, pain after sitting, and pruritus Treatment/interventions: D-dimer test - positive test indicates that thrombus formation has possibly occurred Elevation of legs and elevate legs above heart when in bed (venous insufficiency) Signs/symptoms/treatment of DVT Can be asymptomatic Calf or groin pain, tenderness, and sudden onset of edema of the extremity Warmth, edema, and induration and hardness over involved blood vessel Treatment involves anticoagulant therapy, compression stockings, and potentially an inferior vena cava filter Pulmonary Embolism (PE) ** emboli originating from VTE is most common cause Signs/symptoms: Anxiety, sudden onset of chest pressure, pain upon inspiration and chest wall tenderness Dyspnea and air hunger, cough, hemoptysis (less common) Pleurisy, pleural friction rub, tachycardia, hypotension, tachypnea, crackles Heart murmur in S3 and S4 Diaphoresis, low grade fever, low SaO2, cyanosis Petechiae, distended neck veins, syncope Who is at risk: Older adults and young females have higher mortality rate Long-term immobility Oral contraceptive use and estrogen therapy, pregnancy Tobacco use Hypercoagulability Obesity Recent surgery especially orthopedic of lower extremities or pelvis, central venous catheters Heart failure or chronic a fib sickle cell anemia, cancer Long bone fractures, trauma Speticemia What is the priority for a patient with a PE: anticoagulants warfarin and heparin Treatment/Interventions: Oxygen therapy to relieve hypoxemia and dyspnea High fowler's position to maximize ventilation Assess respiratory status every 30 mins at least Assess cardiac status Medications: Anticoagulants (heparin, enoxaparin, warfarin) used to prevent clots from getting larger or additional clots from forming Rivaroxabn, apixaban, fondaparinux inhibits the production of thrombin Direct thrombin inhibitors (Dabigatran) Thrombolytic therapy (alteplase, reteplase, and tenecteplase) are used to dissolve blood clots and restore pulmonary blood flow Atherosclerosis *** abnormal accumulation of fatty substances and fibrous tissue lining arterial blood vessel walls, blocks and narrows coronary vessels reducing blood flow to myocardium Signs/symptoms: Chest pain if very progressive, but often no symptoms until plaque ruptures or severe build up blocks blood flow Treatment/interventions: Diet low in saturated fat and high in soluble fiber can prevent Lipid lowering medications (statins fibrates, resins, cholesterol absorption inhibitors, fish oil) CABG (coronary artery bypass graft) Cerebral Vascular Accidents (CVA) signs/symptoms: Severe headache, vertigo, dizziness, gait impairment, vision impairment, confusion, trouble articulating, unilateral numbness and paresthesia Expressive and receptive aphasia (inability to speak and understand language) Agnosia (unable to recognize familiar objects) Alexia (difficulty reading) Agraphia (difficulty writing) Right or left extremity paralysis or weakness Altered perception of deficits Ataxia (decreased coordination, loss of balance) Apraxia (inability to perform simple commands) Unilateral neglect syndrome Loss of depth perception, poor impulse control and judgment Visual changes (hemianopsia = loss of visual field in one or both eyes) What are the priorities for the patient experiencing a stroke? Assessing level of consciousness, maintaining airway patency, and checking vital signs and circulation What considerations does the nurse need to make when caring for a patient who experienced a stroke? Assisting clients communication skills if speech is impaired, avoid yes or no questions, provide client with alternate forms of communication, speak slowly and clearly Keep client NPO until swallowing is evaluated and monitor for dysphagia Avoid use of straws for liquids, assist with feeding, client should eat in upright position and swallow with the head and neck flexed slightly forward, have suction ready, place food on the unaffected side of the clients mouth Prevent complications of immobility Complications to watch out for = aspiration pneumonia and unilateral neglect Hemorrhagic: occurs secondary to a ruptured artery or aneurysm, poor ischemia and increased intracranial pressure caused by expanding collection of blood. Treatment/interventions: Clot can be evacuated if caught early Ischemic: most common type of stroke, caused by blockage of circulation to the brain Types: Thrombotic strokes occur secondary to the development of a blood clot on an atherosclerotic plaque in a cerebral artery that gradually shuts off the artery and causes ischemia distal to the occlusion. Manifestations of a thrombotic stroke evolve over a period of several hours to days. Embolic strokes are caused by an embolus traveling from another part of the body to a cerebral artery. Blood to the brain distal to the occlusion is immediately shut off causing neurologic deficits or a loss of consciousness to instantly occur. Treatment/interventions: tPA if given within 3-4.5 hours of manifestations (alteplase) Anticoagulants and antiplatelets Hypertension Signs/symptoms: Headaches, facial flushing, dizziness, fainting, retinal changes and visual disturbances >130/80 blood pressure Treatment/interventions: Medications: Diuretics (hydrochlorothiazide, furosemide, spironolactone) Calcium-channel blockers (verapamil, amlodipine, diltiazem) ACE inhibitors (lisinopril and enalapril) ARB’s (valsartan and losartan) Aldosterone-receptor antagonists (eplerenone, spironolactone) Beta blockers (metoprolol, atenolol) Alpha-adrenergic Antagonists (prazosin, doxazosin) Nursing Interventions: Limit alcohol, consume less than 2.3g/day of sodium, consume foods rich in calcium and magnesium, increase potassium consumption if not contraindicated by medications (potassium sparing diuretics and ARBs) smoking cessation, exercise 3x per week What is an appropriate diet for a patient with hypertension? DASH diet - high in fruits, vegetables, and low fat dairy foods Mediterranean diet - plant based foods, fish, healthy fats, little to no red meat What are the risks/complications of untreated hypertension? Hypertensive crisis: Can lead to heart attack or heart failure, stroke, kidney problems, eye problems ○ Signs and symptoms of hypertensive crisis: Severe headache, extremely high BP >180/120, blurred vision, dizziness, disorientation, epistaxis ABC - achy head, blurred vision, chest pain What are SCDs? Why, when and how are they used? Sequential Compression Device Device to help blood circulation and prevention of DVTs and blood clots Used around the legs to improve blood flow, typically worn anytime the client is in bed Used for hospitalized clients, after surgery, people who are at risk for blood clots, pregnancy What are ted stockings? Why, when and how are they used? Thrombo embolic deterrent Prevent blood clots in the legs Typically for those who are immobile or after recent surgery and at risk for DVT Provide stronger compression levels than compression socks What lab values would you want on a patient experiencing increased bruising? CBC, platelets, prothrombin time, partial thromboplastin time, renal and liver function tests