Nurs 101 Reading Guide Module 3 PDF

Module 3: Introduction to Health and Illness Concepts II ======================================================== **Day 1: Giddens Concept 14: Nutrition & Yoost Ch 30: Nutrition (pg 676-681 Implementation & Evaluation)** - What populations are at risk for alterations in nutrition? Why are th...

Module 3: Introduction to Health and Illness Concepts II ======================================================== **Day 1: Giddens Concept 14: Nutrition & Yoost Ch 30: Nutrition (pg 676-681 Implementation & Evaluation)** - What populations are at risk for alterations in nutrition? Why are they at higher risk? Infants/ children-(weight doubles in 6m, triples in 1 yr., newborns need strong suck-swallow reflex to ensure adequate nutrition Pregnancy/ Lactation- expected weight gain, nutrient needs change Premenopausal/post-estrogen and metabolism decreases, fat distribution changes Older adults- Reduced ability to ingest, absorb, and metabolism nutrients - What are the physiologic consequences of a poor-quality diet? **Insufficient Nutrition** Macronutrient deficiencies (carbs, proteins, fats) -Decreased ability to repair/replace body tissues (ex: decreased wound healing) -Decreased muscle mass -Reduction in immune function -Infants/children severely impacts growth and dev Micronutrient deficiencies (minerals, vitamins) -Iron, folate, zinc, iodine, Vit A: poor growth and development, higher morbidity & mortality -Vitamin D A diagram of the human body Description automatically generated - Be able to describe individual risk factors that influence nutritional status -Genetics -Lifestyle & Patterns of eating \*learned stress-coping mechanisms \*interpersonal relationships \*Family & peer influences -Personal food choice \*Taste, habit, hunger, psychological factors -Medical Conditions \*Conditions that impact ability to ingest, digest, or absorb \*Conditions that increase metabolic demand \*Failure of organs involved in digestion and metabolism - What physical assessments will the nurse perform to evaluate nutritional status? ### - Obtain height, weight, and calculate body mass index (BMI), Measure waist circumference and hip-to-waist ratio - Assess general appearance - level of alertness, demeanor, Inspect skin integrity, turgor, and presence of edema - Examine hair for shininess and brittleness, Check nails for smoothness, color, and firmness - Observe oral mucous membranes and teeth for dryness, lesions, cavities - Palpate muscle mass and subcutaneous fat stores, Note any physical signs of vitamin/mineral deficiencies A comprehensive nutritional assessment involves anthropometric measurements, general observation, and evaluation of diet history along with physical examination findings. This allows the nurse to identify potential nutritional deficits or excesses. - Be able to describe lab tests that are included in an evaluation of nutritional status - Serum albumin: Circulating protein - Serum Prealbumin: Recent dietary protein intake (indicator of nutritional status than albumin - Hemoglobin A1C: Average blood glucose over 3 months - Lipid profiles: LDL (bad), HDL (good), triglycerides  - Electrolytes: general health status, fluid balance - Hemoglobin and Hematocrit: used to diagnose anemia, looks at fluid balance - What nursing education will the nurse include when discussing prevention of illness, as it relates to nutrition? **Healthy eating:** -dietary guidelines for Americans -aimed at preventing chronic health disease r/t excess nutrition -Healthy dietary patterns by life stage \- Focus on veggies, fruits, legumes, whole grains, low-or non-fat dairy, lean meats/poultry, seafood, nuts, unsaturated veg oils **Physical Activity:** -30 min physical activity most days of the week -150 min or more weekly (moderate intensity) -At least 2 days of muscle-strengthening activities -Exercise guidelines should be individualized - Be able to describe the role of a dietitian Conducting complex nutritional assessments and diagnosing nutritional issues \- Developing individualized nutrition therapy plans and diet interventions \- Providing medical nutrition therapy, which are reimbursable nutrition services \- Collaborating with the healthcare team, including nurses, for optimal nutritional outcomes \- Educating patients on nutrition and dietary management of conditions like diabetes \- Adjusting meal plans to align with health goals while considering cultural, financial, and lifestyle factors \- Monitoring and evaluating the effectiveness of nutrition interventions - How is nutrition provided in a client who cannot safely swallow or eat by mouth? Enteral Nutrition -Nutrition provided through a tube into the Gi tract -Unable to eat or swallow, but GI tract functions -May go into stomach (gastric) or small intestine (jejunum) -NG, OG, ND, NJ, G-tube, J-tube, GJ- tube, PEG Parenteral Nutrition -IV nutrition -Unable to be fed orally or enterally -Glucose, electrolytes, mineral, amino acids -Fats may administered separately Short or long-term therapy - Be able to describe the characteristics of vegetarian & vegan diets - Vegetarian diets exclude meat, poultry, and seafood, but may include dairy products and eggs (lacto-ovo vegetarian). Vegan diets are more restrictive, eliminating all animal products including dairy, eggs, honey, and gelatin. - Be able to describe common dietary preferences/restrictions based on religious traditions - Kosher diet, Islamic consideration (NO pork, fasting during Ramadan, halal food prep) - Be able to identify specific foods that are appropriate for special diets, such as clear liquid, full liquid, pureed, mechanical soft, thickened liquids and regular diets. - Clear liquid diet: Liquids you can 'see' through; Water, broth, gelatin, popsicles, clear juices without pulp. - Full liquid diet: Liquids at room or body temperature, juices with and without pulp, milk, yogurt, milkshakes - Pureed diet: No chewing needed, smooth texture - Mechanical soft diet: Easy to chew and swallow, extra moisture, tiny sized pieces - Thickened liquids: Thickening agent for clients at risk for aspiration and have difficulty swallowing - Regular diet: No restrictions, includes all food groups and textures. - What nursing care is required for a client that is NPO? - Providing frequent oral care/ lip-oral moisturizer - Ensuring alternative nutrition is provided via enteral or parenteral routes as ordered. - Educating the patient and family on the rationale for NPO status and expected duration. **Day 2: Giddens Concept 15: Elimination- Excretion of waste products** - Be able to identify common risk factors of incontinence and retention of both urine and stool [Urinary Retention] - Incomplete emptying or inability to urinate - Problems with nervous system - Obstruction to pass urine (ex. enlarged - prostate) - Changes in bladder shape (ex. - constipation that presses against - bladder) - Side effects from meds (anticholinergics) - Use of urinary catheter - Involuntary loss of urine Scopeà - Minimal loss (ex: urine leakage when coughing, sneezing, or laughing) - Complete loss of control - Infrequent or difficult bowel movements - If urge to defecate is delayed - As side effect from meds (opioids!) - Reduced peristalsis (ex. after surgery) - Intestinal blockage - Can also happen with changes in diet, - routines, physical activity - Minimal loss of control (ex. Inadvertent passage while passing gas) - Complete loss of control (r/t loss of sphincter) - Can commonly happen with diarrhea & intestinal cramping - Can occur r/t cognitive changes - What are the potential consequences of impaired elimination processes? Fluid and electrolyte imbalances\ - Metabolic disturbances\ - Impaired wound healing\ - Infection risk\ - Organ damage or failure (e.g. kidney failure from urinary retention)\ - Malnutrition and dehydration\ - Discomfort, pain, and decreased quality of life\ \ What physical assessments will the nurse include when assessing elimination status? ### [Urinary Elimination:] - Inspect urine color, clarity, and odor - Palpate bladder for distension or tenderness - Assess skin turgor and mucous membrane moisture for hydration status [Bowel Elimination:] - Inspect abdomen for distension, masses, or tenderness - Auscultate bowel sounds - Palpate for masses or tenderness - Inspect stool for color, consistency, amount, and presence of blood or mucus - Assess anal area for hemorrhoids, fissures, or skin irritation The nurse should also evaluate factors that may contribute to elimination issues, such as medications, diet, activity level, and any medical conditions or procedures affecting the urinary or gastrointestinal systems. What interventions/education are appropriate to prevent alterations in elimination? **Primary Prevention:** -Avoid contaminated food/water -Maintain hydration (adult 30mL/urine per hour) -Dietary fiber (25-30g/day) -Physical activity (increases peristalsis) -Maintain regular toileting practice (avoid holding urine or stool, avoid foods that cause digestive discomfort) **Secondary Prevention:** -Screening for colon cancer (hemoccult for blood in stool, at age 45 and older) -Screening for prostate cancer (prostate-specific antigen men 55-69 years and older) What interventions can the nurse implement to facilitate a regular bowel elimination pattern? **Procedures & Surgical interventions:** -Colectomy: colon resection \- Colostomy/Ileostomy: diversion through stoma -rectal prolapse repair -Hemorrhoidectomy -Fecal Collection system **Interventions for Constipation:** -Dietary changes: high fiber foods, Increase fluid intake -Physical Activity=Increase peristalsis -Pharmacologic Interventions: 4 drug classes of laxatives, "do not give laxatives for intestinal obstruction", Laxative dependence can occur- pt teaching is important **Yoost Ch 40: Bowel Elimination (pg 1025-1028, Abnormal defecation patterns, bowel diversions and pgs 1034-1039 Interventions)** - What is the purpose of bowel diversions? How does the location of the diversion affect the characteristics of stool output? Provides a temporary or permanent way for waste to leave the body when the normal pathway is compromised Colostomy connected to big intestine formed stool Ileostomy connected to small intestine watery stool - What type of dietary changes can be beneficial for a client with constipation? With diarrhea? [For a client with constipation, beneficial dietary changes include:]\ -Dietary changes: high fiber foods, Increase fluid intake -Physical Activity=Increase peristalsis (motility) -Pharmacologic Interventions: 4 drug classes of laxatives, "do not give laxatives for intestinal obstruction", Laxative dependence can occur- pt teaching is important [For a client with diarrhea, helpful dietary modifications are:]\ - Following a bland (mild), small, frequent meals \- Avoiding gas-producing foods like beans, broccoli, and carbonated beverages\ - Limiting milk products, caffeine, alcohol, and greasy/spicy foods\ - Staying hydrated with clear fluids like broths and electrolyte drinks **Yoost Ch 41: Urinary Elimination (pg 1053-1055 Abnormal urination patterns and pgs 1062-1066 Implementation)** - How are issues with urinary incontinence managed? -Pelvic floor training -Weight loss (if applicable) -Smoking cessation -Estrogen (post-menopausal) -Treat constipation -Bladder training (scheduled voiding intervals increasing time between intervals) -Timed and prompted voiding -Pessary: internal device -Surgery: bladder sling -Devices: Condom Cath, Pure Wick - Be able to describe the difference between oliguria, polyuria, nocturia, dysuria and hematuria - ### Oliguria refers to reduced urine output, typically less than 500 mL per day in adults. - ### Polyuria is excessive urine production and excretion, usually over 2500 mL per day. - ### Nocturia is excessive urination at night. - ### Dysuria means painful urination. - ### Hematuria is the presence of blood in the urine. - Be able to describe the differences between urge, stress, mixed, functional and overflow incontinence ### Urge incontinence involves a sudden, strong urge to urinate followed by involuntary loss of urine. (over-activity of detrusor muscle) ### Stress incontinence is leakage during activities that increase abdominal pressure like coughing or exercise. ### Mixed incontinence is a combination of urge and stress incontinence. ### Functional incontinence refers to an inability to reach the toilet due to physical or cognitive impairments. ### Overflow incontinence occurs when the bladder doesn\'t fully empty, leading to frequent dribbling of urine. (Decreases detrusor contractility or bladder outlet obstruction) - What interventions can the nurse implement to facilitate a regular urinary elimination pattern? - Pelvic floor training - Weight loss, if appropriate - Smoking cessation - Estrogen for post-menopausal people - Treat constipation - Bladder training: scheduled voiding at set intervals, slowly increasing time between intervals - Times and prompted voiding - Pessary: Internal device - Surgery: Bladder sling - Devices: condom Cath, Pure Wick **McCuistion Ch 45 GI Drugs** - What is an antiemetic medication used for? - What are common nonpharmacologic measures used to decrease nausea and vomiting? -Clear liquids (Gatorade, Pedialyte) -Bland foods (toast, crackers) - Be able to describe the differences in the 4 types of laxatives. Know an example of each. 1. Osmotic (saline laxative) à salts pull water into colon, increases bulk peristalsis (ex: Polyethylene glycol with electrolytes, Lactulose) 2. Stimulants sensory nerves in intestinal mucosa are stimulated = peristalsis (ex: Bisacodyl, Senna, Castor Oil) 3. Bulk Forming natural fibrous substances that absorb water into intestines increasing bulk= peristalsis (MiraLAX, Metamucil) 4. Emollients increases water in stool and lowers surface tension = easier passage (ex: Docusate sodium, Docusate calcium) [Promethazine Hydrochloride:]\ Mechanism of Action: Promethazine is a phenothiazine derivative that acts as an antihistamine, sedative, antiemetic, and anticholinergic agent. It blocks histamine receptors and has a depressant effect on the reticular activating system, which contributes to its sedative and antiemetic properties.\ \ Side Effects: Drowsiness, dizziness, blurred vision, dry mouth, constipation, urinary retention.\ \ Adverse Effects: Respiratory depression, jaundice, blood dyscrasias, extrapyramidal symptoms, neuroleptic malignant syndrome.\ \ Administration Guidelines: Administer with caution in patients with respiratory disorders, glaucoma, or urinary bladder obstruction. Avoid alcohol and other CNS depressants. IV administration requires dilution and slow infusion.\ \ Nursing Implications: Monitor for excessive sedation, respiratory depression, and anticholinergic effects. Provide safety measures to prevent falls. Encourage fluid intake to minimize dry mouth and constipation.\ \ Patient Education: Advise patients about the sedative effects and cautions against driving or operating machinery. Encourage reporting of adverse effects like muscle stiffness or yellowing of skin/eyes.\ \ [Diphenoxylate with Atropine:]\ Mechanism of Action: Diphenoxylate is an opioid agonist that slows intestinal motility and reduces fluid secretion. Atropine is an anticholinergic agent that further decreases gastrointestinal motility and secretions.\ \ Side Effects: Constipation, dry mouth, blurred vision, urinary retention, drowsiness.\ \ Adverse Effects: Respiratory depression, paralytic ileus, toxic megacolon, dependence with prolonged use.\ \ Administration Guidelines: Contraindicated in patients with diarrhea associated with pseudomembranous colitis or antibiotic-associated colitis. Avoid use in children under 2 years old.\ \ Nursing Implications: Monitor for constipation and other anticholinergic effects. Encourage fluid intake and use of stool softeners if needed. Assess for signs of respiratory depression or paralytic ileus.\ \ Patient Education: Advise patients about the potential for constipation and the importance of adequate fluid intake. Caution against abrupt discontinuation after prolonged use to prevent withdrawal symptoms.\ \ [Bisacodyl:]\ Mechanism of Action: Bisacodyl is a stimulant laxative that acts directly on the intestinal mucosa, increasing motility and fluid secretion into the intestines.\ \ Side Effects: Abdominal cramps, nausea, diarrhea.\ \ Adverse Effects: Electrolyte imbalances, dehydration, dependence with prolonged use.\ \ Administration Guidelines: Administer with caution in patients with inflammatory bowel disease, intestinal obstruction, or severe dehydration. Avoid prolonged use.\ \ Nursing Implications: Monitor for signs of dehydration, electrolyte imbalances, and abdominal discomfort. Encourage fluid intake and proper dietary fiber intake.\ \ Patient Education: Advise patients about the potential for abdominal cramps and diarrhea. Caution against prolonged use and encourage proper hydration.\ \ [Psyllium:]\ \ Mechanism of Action: Psyllium is a bulk-forming laxative that absorbs water in the intestines, increasing the bulk and softening of the stool, promoting regular bowel movements.\ \ Side Effects: Flatulence, bloating, abdominal discomfort.\ \ Adverse Effects: Intestinal obstruction or impaction if not taken with adequate fluids.\ \ Administration Guidelines: Administer with at least 8 ounces of water or other fluids. Gradually increase the dosage to minimize gastrointestinal side effects.\ \ Nursing Implications: Encourage adequate fluid intake and monitor for signs of intestinal obstruction or impaction. Assess for relief of constipation.\ \ Patient Education: Advise patients about the importance of taking psyllium with plenty of fluids and gradually increasing the dosage to minimize side effects.\ \ [Ondansetron:]\ \ Mechanism of Action: Ondansetron is a selective 5-HT3 receptor antagonist that blocks serotonin receptors in the brain and gastrointestinal tract, reducing the sensation of nausea and vomiting.\ \ Side Effects: Headache, diarrhea, constipation, abdominal pain.\ \ Adverse Effects: QT prolongation, serotonin syndrome (when combined with other serotonergic drugs), hypersensitivity reactions.\ \ Administration Guidelines: Administer IV slowly over 15-30 minutes. Adjust dosage in patients with hepatic impairment.\ \ Nursing Implications: Monitor for relief of nausea and vomiting. Assess for signs of QT prolongation or serotonin syndrome, especially when combined with other serotonergic drugs.\ \ Patient Education: Advise patients about the potential side effects and the importance of reporting any adverse reactions or persistent nausea/vomiting **Day 3: Giddens Concept 16: Perfusion** - Be able to describe central perfusion and tissue perfusion [Central Perfusion:] Action of heart and large vessels delivering oxygenated blood to organs and tissues -Conduction: electrical impulses are needed -Cardiac cycle: systole (ventricles ejecting blood), diastole (ventricles filling) -Cardiac output: amount of blood pumped out by the heart per minute (stroke volume x HR) [Tissue Perfusion:] Blood that flows through arteries, capillaries to target tissues - What are some conditions that can result in impaired central perfusion? Impaired tissue perfusion? [Impaired Central Perfusion ] Altered Conduction (cardiac dysrhythmia) Reduced myocardial contraction (heart unable to pump effectively: reduce cardiac output) Ineffective heart valves (stenosis, regurg, congenital valve defects=reduce cardiac output) Intravascular volume (decreased volume= reduced cardiac output, Increased volume overtime can reduce cardiac output Systemic vascular resistance (increased or decreased= effect on cardiac output) [Impaired Tissue Perfusion ] Significant reduction of central perfusion (ex: trauma=decreased peripheral perfusion) With blockage or constriction of artery that interferes with blood flow (ex: ischemic stroke, myocardial infraction) Due to other mechanisms (ex: excessive edema LE=interfere with adequate perfusion) - What are the consequences of impaired tissue perfusion? Affects the ability to deliver oxygen and nutrients -Decreased oxygen to cells leads to ischemia (if treated early can be reversed, prolonged = cell and tissue death) -Can have cascading effect (ex: acute myocardial infraction=damage to heart muscle less effective at pumping blood reduced cardiac output and impaired central perfusion - What populations are at risk for alterations in perfusion? Why are they at higher risk? Infants -Heart is larger in size in relation to total body size (systolic BP lower until left ventricle of neonate gains strength during first 6 weeks of life) -Heart rate decreases, and BP rises through childhood Adolescents -Increases in heart size during puberty Older Adults -Reduced cardiac efficiency, increased oxygen demand \*Myocardial tissue becomes thicker and more stiff \*Decreased elasticity of arterial walls (increases BP) \*Heart valves ten to calcify and become fibrotic - What individual risk factors are associated with alterations in perfusion? -Genetics -Lifestyle (smoking, inactivity, diet, obesity) -Immobility (increases risk of pressure ulcers and ischemia, increases risk of slow blood flow=venous thrombi) - What symptoms might alert a nurse that there is a problem with perfusion? Pain (chest pain, angina, leg pain Syncope (dizziness, light headedness) Dyspnea Edema Fatigue - What physical assessments will the nurse include when assessing perfusion status? -VS, including O2 sat -Auscultation of heart and lung sounds -Inspect (skin color; presence of petechiae, ecchymosis, purpura) -Palpate \*Skin temp, pulses, cap refill, edema, JVD \*Pain, redness, edema in extremities (clot), palpable vein that is tender to touch Mnemonic: 5 P's (circulation checks) \*Pain, pallor, pulse, paresthesia, paralysis - What are common diagnostics/tests to identify problems with perfusion? **Lab tests:** ABGs (arterial blood gas) - pH: measures acid/base - SaO2: saturation of arterial blood - PaO2 &PaCO2: pressure of oxygen or carbon dioxide in arterial blood - HCO3:Bicarb **CBC(complete blood count)** - RBC - Hemoglobin (hgb) - Hematocrit (Hct)- % of RBC in Plasma - WBC - **Sputum** - **Chest X-ray (helps see if problems with ventilation)** - **CT, MRI (assess for tumors, PE)** - **Pulmonary function tests (PFTs) measure air volume moving in and out of lungs/lug capacity** - **Bronchoscopy** - Be able to describe health promotion recommendations & common collaborative interventions to promote healthy perfusion Healthy diet: low sodium, lean meats, low fat dairy Physical Activity: 150 min weekly moderate intensity Not smoking/vaping: Avoid secondhand smoke exposures Use of a statin (lowers cholesterol) adults 40-75 with CV risk factors Prevention of blood clots: Leg exercises, walking, compression socks - Consider the following drug classes. Be able to explain how/why they are used to address perfusion issues - Diuretics, anticoagulants, vasodilators, antilipidemic Diuretics reduce fluid overload and edema, improving venous return and cardiac output to promote perfusion. Anticoagulants like heparin and warfarin prevent clot formation, maintaining blood flow through vessels. Vasodilators such as nitroglycerin and hydralazine dilate blood vessels, decreasing vascular resistance and improving perfusion. Antilipidemic or cholesterol-lowering drugs like statins help manage atherosclerosis and prevent plaque buildup that can obstruct blood flow. **Giddens Concept 17: Clotting** - What are some of the consequences when too much clotting occurs? What about when there is not enough clotting? - What are signs/symptoms of too much clotting? - What are signs/symptoms of too little clotting (bleeding)? - Be able to describe the common diagnostics/tests to identify problems with clotting Lab Tests -CBC (assesses oxygen carrying-capacity and risk of clotting, RBCs, Hgb/Hct, Platelets) -Clotting studies: PT, PTT, INR -Lipids (helps evaluate risk of heart disease, LDLs, HDLs, triglycerides) Cardiac enzymes/markers (can help identify MI, creatine kinase, cardiac troponin, myoglobin, C-reactive protein indicates inflammation) Diagnostics -Electrocardiogram (ECG) detects electrical abnormalities) -Cardiac Stress Test detects cardiac perfusion issues while exercising -Chest X-ray -Ultrasound -Arteriogram/Venogram looks at blood flow using dye **Supplemental Reading, located on Canvas:** - **AHA Hypertension Link "Let's Talk about Blood Pressure"** - **What are potential consequences of untreated high blood pressure?** - **Be able to describe risks for high blood pressure?** - **What are strategies to lower blood pressure?** - **Venous Thromboembolism (VTE)** - **Be able to describe risk factors for VTE** ### There are several key risk factors that increase the likelihood of developing venous thromboembolism (VTE): Immobility/Reduced mobility - Prolonged bed rest, paralysis, or lack of movement allows blood to pool and clot. Surgery - Especially orthopedic, cancer, or major abdominal/pelvic surgeries due to vascular trauma and immobility. Cancer - Malignancies can cause hypercoagulability and compress blood vessels. Obesity - Increased pressure in vessels and inflammatory state. Pregnancy/Postpartum - Hypercoagulable state and venous stasis. Oral contraceptives/Hormone therapy - Increases clotting factors. Advanced age - Vascular changes and comorbidities. Previous VTE - Increases risk of recurrence. Inherited thrombophilias - Genetic conditions like Factor V Leiden that promote clotting. Acute medical illness - Conditions like heart failure, respiratory failure, inflammatory bowel disease. Smoking - Damages blood vessels and increases clotting risk. Central venous catheters/Pacemakers - Can irritate vessel walls. - What are common symptoms of deep vein thrombosis (DVT)? \- Swelling, usually in one leg\ - Pain or tenderness, especially when standing or walking\ - Increased warmth in the affected leg\ - Red or discolored skin on the leg\ - Distended superficial veins\ Some patients may not experience any symptoms, while others may have more severe symptoms like leg heaviness, difficulty walking, or low-grade fever. It\'s important to seek medical attention promptly if DVT is suspected, as the clot can potentially break off and travel to the lungs, causing a life-threatening pulmonary embolism. - How can folks prevent VTE? There are several ways to help prevent venous thromboembolism (VTE):\ - Early and frequent ambulation - Getting out of bed and walking as soon as possible after surgery or during illness promotes blood flow.\ - Compression stockings - Graduated compression stockings improve venous return from the legs.\ - Anticoagulant medications - Drugs like heparin, low molecular weight heparins, or factor Xa inhibitors thin the blood and prevent clot formation.\ - Pneumatic compression devices - Inflatable sleeves wrapped around the legs intermittently squeeze to increase blood flow.\ - Hydration - Drinking plenty of fluids prevents blood from thickening.\ - Leg exercises - Simple exercises like ankle pumps and circles keep blood moving in the legs.\ Identifying and managing risk factors like obesity, smoking, cancer, and immobility is also crucial for VTE prevention. Early intervention with preventive measures is key, especially for high-risk surgical patients and those with limited mobility. **Day 4: Giddens Concept 18: Gas Exchange; Yoost Ch 38: Oxygenation and Tissue Perfusion (pgs 932-933 Pneumonia and 939-944 Oxygen Therapy)** - What are the differences between ventilation, transport and perfusion? ### Ventilation: ### \*Inhalation and exhalation ### \*Can be impaired by unavailability of oxygen from high altitudes ### \*Or disorders r/t airways, lungs, or respiratory muscles ### Transport: ### \*Availability of hemoglobin (in RBCs) to carry oxygen to cells and to bring carbon dioxide back to alveoli ### Perfusion: ### \*Ability of blood to transport oxygen and nutrients to cells ### \*Impaired perfusion directly impacts gas exchange ### While ventilation occurs in the lungs, transport occurs through the cardiovascular system, and perfusion takes place at the tissue level. - What are the consequences of impaired gas exchange? \*Fatigue \*Build up of carbon dioxide in alveoli acidosis \*Increased HR & RR \*May lead to cellular and tissue ischemia, necrosis \*Death - What populations are at risk for alterations in gas exchange? Why are they at higher risk? ### Infants, young children and older adults Infants have fetal hemoglobin (shortened survival of erythrocytes) Infants/young children at risk for impaired gas exchanged less alveolar surface area, narrowing branches of peripheral airway Older adults chest walls stiffer loss of elastic recoil - What populations & individual risk factors are associated with alterations in gas exchange? Infants - Fetal hemoglobin at birth, slowly transitions to adult hemoglobin. Results in RBC having shorter lifespan anemia - Infants & young children have narrowed peripheral airways more easily blocked by mucus, edema, foreign objects Older Adults - Physiologic changes that occur with aging Individual Risk Factors - Age (very young and elderly) - Smoking - Most significant risk factor for problems with gas exchange - Altered LOC - R/t problems with intracranial regulation - R/t alcohol or drug use - Tracheal intubation - Prolonged immobility & bed rest - Chronic disease, such as COPD, heart failure - What symptoms might alert a nurse that there is a problem with gas exchange? Cough/wheezing, shortness of breath, chest pain with breathing, low oxygen saturation - What physical assessments will the nurse include when assessing the status of gas exchange? Inspection: Observe respiratory rate, depth, effort, use of accessory muscles, nasal flaring, skin color (cyanosis), nail clubbing, chest shape/symmetry.\ Palpation: Assess tactile fremitus, chest expansion, tracheal position.\ Percussion: Percuss lung fields to detect areas of dullness or hyperresonance.\ Auscultation: Auscultate lung fields for adventitious breath sounds like crackles, wheezes, or decreased breath sounds. Also auscultate heart sounds. Measure oxygen saturation levels using pulse oximetry.\ Obtain arterial blood gas measurements if severe impairment is suspected.\ The nurse should also monitor vital signs like heart rate, blood pressure, temperature, and mental status changes that could indicate impaired gas exchange. - Be able to describe how the RBC count, Hemoglobin level, and hematocrit level relate to gas exchange RBC- \# of circulating RBCs in 1mm3, provides indirect measure of oxygen- carrying capacity of blood Hemoglobin (Hgb)- reflects oxygen and carbon dioxide transport capacity \# of rbc in blood Hematocrit(Hct)- % of blood volume composed of red blood cells Closely reflects hemoglobin level and RBC - What types of prevention strategies are used to promote healthy gas exchange? Infection Control - Prevent respiratory tract infections Smoking Cessation - Reduce use of tobacco - Reduce initiation of smoking - Adapting policies to increase smoke-free areas - Increase healthcare coverage of evidence-based treatments to stop smoking Immunizations - Prevent respiratory infections Preventing post-op pulmonary complications **Secondary screening prevention** Routine screening for potential risks - Asking about nicotine/tobacco use during well checks - Cigarette smoking - E-cigarettes/Vaping - Smokeless tobacco Mantoux skin test - Clients at risk of TB - What types of collaborative strategies are used when there is impaired gas exchange? Smoking Cessation Nutrition therapy - High protein, high calorie, foods and drinks - Small portions if dyspnic while eating Positioning - Sitting up \*(high fowlers) or lateral recumbent/prone Rest - Cluster care - Provide rest before meal or exercise Chest Physiotherapy & postural drainage - Loosens & moves secretions - Commonly performed by Respiratory Therapy (RT) - Nasal cannula: Up to 6 L/min - Simple face mask: Short term, less precise O~2~ delivery - High-flow nasal cannula: 20-60 L/min, up to 100% O~2~ - Venturi masks: Improved ability to delivery precise % - Partial rebreather or nonrebreathing masks - Commonly used in emergencies, can provide up to 100% O~2~ - Nasopharyngeal or oropharyngeal airway - CPAP, BiAP - Endotracheal intubation - Use of a ventilator - Antihistamines (allergic rhinitis) - Decongestants (relieves congestion) - Glucocorticoids (suppresses inflammation in bronchi) - Sympathomimetics (relaxes muscles to relieve bronchospasm) - Anticholinergics (prevents constriction and causes bronchodilation) - Mucous removal - Mucolytics and Expectorants - Antitussives - Example: antibiotics to treat respiratory tract infections - Nicotine replacement therapy - Tube inserted to drain blood or air in the pleura - Connected to drainage collecting device - Procedure to remove blood or air in the pleura - Uses a scope to look at bronchus - What are bronchodilators used to treat? What are common examples? Bronchodilators are medications used to treat conditions like asthma, chronic obstructive pulmonary disease (COPD), and other respiratory disorders characterized by bronchoconstriction and airway obstruction. Common examples of bronchodilator drugs include:\ Ex: albuterol, levalbuterol, and formoterol Upper airway meds: antihistamines (allergic rhinitis), Decongestants (Sudafed) - Be able to describe various oxygen delivery systems and when they might be used: **Low flow:** Nasal cannula: (1-6 L/min), providing 24-44% oxygen concentration. Used for mild to moderate hypoxemia in stable patients.\ Simple face mask: (5-10 L/min) for concentrations of 40-60%. Used when higher concentrations are needed. **High Flow**\ Venturi mask: Precisely controls FiO2 between 24-60% 4-12L by entraining specific air:oxygen ratios. Used when exact oxygen levels are required.\ High-flow nasal cannula: 20-60 L/min of heated, humidified oxygen. Used in hypoxemic respiratory failure. **Reservoir** Partial rebreather or nonrebreathing masks-emergencies can provide up to 100% O2 - What type of positioning can be used to improve gas exchange? 1\. Upright positioning like high-Fowler\'s, Fowler\'s, or semi-Fowler\'s position.\ 2. Prone or lateral positioning. 3\. Tripod - What signs and symptoms might indicate to a nurse that their client has pneumonia? **Day 5: Yoost Ch 32: Stress and Coping (supplement with Giddens Ch. 29 Stress and Coping)** - What are the physiologic responses to stress? (think fight or flight!) Involve activation of the sympathetic nervous system and the endocrine system. Key physiological changes include: \- Increased heart rate, blood pressure, and cardiac output \- Dilated bronchial airways and increased respiratory rate \- Dilated pupils \- Increased blood flow to skeletal muscles \- Release of glucose from the liver for quick energy \- Inhibition of digestive and reproductive system functions \- Release of stress hormones like cortisol and adrenaline - What are potential psychologic responses to stress? - Include anxiety, irritability, difficulty concentrating, feelings of overwhelm, mood changes like depression or emotional lability, changes in appetite, social withdrawal, and disrupted sleep patterns. - Chronic, unrelieved stress can contribute to the development of mental health conditions like anxiety disorders, depression, or post-traumatic stress disorder. - Coping mechanisms, social support, and stress management techniques can help mitigate the negative psychological impacts of stress. - What happens in the body during prolonged or severe stress? (Section Altered Structure and Function) Consequences of Stress Chronic Effects Long term effects of SNS and elevated stress hormone levels can increase risk of cardiovascular disease (htn, arrhythmias, stroke, obesity) Impacts cognitive function: headaches, irritability, problems with decision making, insomnia Stress-induced immunosuppression Increased muscle tension (pain & discomfort, esp head, neck, shoulders) GI disorders: gastritis, ulcerative colitis, diarrhea Integ: stress related mouth ulcers, worsening skin problems (acne, eczema) Sexuality: reduced libido, worsened menstrual symptoms or menopausal symptoms - What nursing assessments will the nurse employ to assess for sources of stress and consequences of stress? Irritability Nervousness, anxiety Overwhelmed Depressed/sad Unexplained headaches, abdominal pain, insomnia, fatigue, restlessness, lack of concentration - Be able to describe health promotion recommendations to promote stress management and healthy coping, including complementary and alternative therapies Time management strategies Social support groups Exercise Optimal nutrition Sleep Music therapy Relaxation strategies: guided imagery, massage, meditation, relaxation breathing, yoga Therapeutic lifestyle change: tools/behaviors to improve health and well-being Pharmacotherapy: antidepressants, antianxiety, muscle relaxants **Giddens Concept 30: Mood and Affect** - Be able to describe variations in mood and affect Variations in affect can include: - What types of screenings are done to detect possible mood disorders? - Screening for possible mental health disorders at well visits - Screening for acute and chronic stress - Screening for maladaptive coping **Yoost Ch 33: Sleep** - Be able to describe the differences in common sleep disorders: insomnia, sleep apnea, & sleep deprivation - Insomnia is the inability to fall asleep or stay asleep, resulting in poor quality or insufficient sleep. It can be acute or chronic. - Sleep apnea is a disorder characterized by repeated episodes of breathing cessation during sleep due to airway obstruction or lack of respiratory effort. This leads to disrupted sleep and low oxygen levels. - Sleep deprivation refers to not obtaining adequate total sleep, either due to a lack of opportunity or ability to sleep sufficiently. It results in excessive daytime sleepiness and impaired functioning. - What are common individual factors for developing sleep disorders? - What signs and symptoms will the nurse assess for while evaluating for a possible sleep disorder? History taking sleep patterns, energy levels, other factors General Survey: Fatigue, decreased affect, yawning Assess for sleep apnea: snoring, tiredness during the day, high BMI, neck circumference - Be able to describe nonpharmacologic interventions for sleep disorders Sleep Bedtime routines: wake up/go to bed at same time every day, prepare sleeping environment Nutrition: Avoid caffeine, alcohol, and heavy meals 2 hours before bed Physical activity: Daily exercise promotes sleep (except before bedtime) Relaxation **McCuistion Ch 18: Depressants (pages 206-212, Sleep)** [Alprazolam:]\ Mechanism of Action: Alprazolam is a benzodiazepine that enhances the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain. This leads to increased GABA activity, resulting in sedation, muscle relaxation, and reduced anxiety.\ \ Side Effects: Drowsiness, dizziness, fatigue, impaired coordination, memory problems, dry mouth, constipation.\ \ Adverse Effects: Respiratory depression, paradoxical reactions (increased anxiety, aggression), physical dependence, withdrawal symptoms upon abrupt discontinuation.\ \ Administration Guidelines: Start with the lowest effective dose and gradually increase if needed. Avoid abrupt discontinuation after prolonged use. Use caution in elderly patients and those with respiratory disorders.\ \ Nursing Implications: Monitor for excessive sedation, respiratory depression, and signs of dependence or withdrawal. Provide safety measures to prevent falls. Encourage gradual dose tapering upon discontinuation.\ \ Patient Education: Advise patients about the potential for sedation and cautions against driving or operating machinery. Warn about the risks of dependence and withdrawal symptoms with abrupt discontinuation.\ \ [Zolpidem:]\ Mechanism of Action: Zolpidem is a non-benzodiazepine hypnotic that binds to the GABA-A receptor complex, enhancing the inhibitory effects of GABA in the brain. This promotes sedation and facilitates sleep onset.\ \ Side Effects: Drowsiness, dizziness, headache, nausea, fatigue, amnesia.\ \ Adverse Effects: Sleep-related behaviors (sleepwalking, sleep-driving), respiratory depression, dependence with prolonged use, withdrawal symptoms upon discontinuation.\ \ Administration Guidelines: Administer immediately before bedtime. Avoid alcohol and other CNS depressants. Use lower doses in elderly patients and those with hepatic impairment.\ \ Nursing Implications: Monitor for excessive sedation, respiratory depression, and complex sleep-related behaviors. Provide safety measures to prevent falls or injuries during sleep. Assess for signs of dependence or withdrawal.\ \ Patient Education: Advise patients about the potential for drowsiness and cautions against driving or engaging in activities requiring alertness after taking zolpidem. Warn about the risks of dependence and withdrawal symptoms with prolonged use.