Nursing Study Guide Block 4 Final

muse Guide for the Final Exam here(predicate) atomic number 18 the rules please do non roar me or email me questions nearly the study guide. I will attend to questions ab break the study guide during the sketch review before the exam itself. You toilet non mulct the answers to the questions and do well on the exam- the questions are meant to stimulate thinking, non to be answers. delight remember to review the chapters on haze and MODS as there are questions on this content. 1.There are several ABG questions remember these in every case include oxygen numbers so be prepared to determine oxygenation in addition to acid base PH 7. 35- 7. 45 PCO2 35-45 HCO3 22-26 O2 94-100 2. suss fall out the care of the persevering with pneumonia, including applicable nursing diagnoses and mea authenticable outcomes Restrictive respiratory disorder lessen lung expansion- low PaO2, change magnitude lung compliance, normal to low P/Q ration, shunt, respiratory alkalosis (blowing off c o2, more bicarbonate) step-up RR, TV smaller.SOB/cough, dyspnea=how many words notify they say in one schnorkel chest pain, fatigue, wt. loss, lung crackles, care HOB 30deg, quiets to befool secretions, tidal plentynormal animate 500mL Nursing dx impaired gas exchange, inefficient airing pattern, discerning pain Outcomes maintains able alveolar oxygen-carbon dioxide exchange, clears lungs of fluids and exudates. Demonst measures effective RR, rhythm, and depth of respirations. Reports encounter of pain following relief measures. . reappraisal the treatment for TB (look in Lewis), including medications, aloofness of treatment, evaluation of treatment plan, who is closely probably to get TB transmittal, and side effectuate of the medications Medications aggressive TB treatment quadruplet drugs for 6 months, (INH, rifampin Rifadin, pyrazinamide PZA, and ethambutol) Newer rifamycins, rifubin, rifapentine, first air for special situations Length of treatment 6 months- 1 YearEvaluation of treatment plan heroism of the disease, normal pulmonary function, absence of any complication, no transmission of TB, Most plausibly to contract Asians have the highest TB mark, followed by Hawaiians and pacific islanders. African Americans are the highest rate inside the US. (45%) Higher rates of TB infections with patient roles with HIV infections Side effects of meds alcoholic drink change magnitudes hepatotoxicity of INH, monitor liver function.PZA may not be included in sign phase (due to liver disease or pregnancy) 4. recapitulation the care of a patient with lung surgery, including chest organ pipe centering To sustentation lung inflated &038 Drain fluid from interpleural set How do you know if collapsed lung Blood gases, knocker X-ray, Vital signs, Color Air let ons scintillant in water chamber impediment your tubes for air leak &038 make sure theyre always free of kinks. generate int milk the chest tube (unless ordered).Continued bubbli ng = pneumothorax not resolved yet, everlasting vigorous bubbling = air leak in system Should see tidaling if not attached to suction >100cc/hr. of drainage = call doc Determine if working decently by Monitor output, pain, breath sounds, survey patient breathing, auscultate, ABG, pulse ox (SPO2), scrape up/mucous membrane coloring, and respiratory reason Chest tube pain is common- go on pain meds >7/10 5.Review brass failure right-sided (acute and chronic), leave- sided (acute and chronic), pulmonary edema, cardiomyopathy and management of the patients remember to review the hemodynamic changes (and values) associated with right and left sided failure RIGHT SIDED HF (FLUID RETENTION) Corpulmonale, general edema, neck vein distention, weight gain, fluid retention, Risk COPD, hypoxia (pulmonary HTN), causes pulmonary vasoconstriction.CVP = change magnitude PVR = change magnitude SVR = change magnitude contract = increased contractility = change magnitude medication n itroglycerine to decrease venous return, fix preload LEFT SIDED HF (RESPIRATORY) dyspnoea ON EXERTION, back up in lungs, pink fulgid sputum, lessen O2 stat, increase RR. CVP = increased PVR = increased SVR = increased wedge = increased contractility = decreased HEART calamity Usually starts out with one heart ventricle.Nitroglycerine, aspirin, O2, pericardial thump, furosemide, ACE, + inotrope, Class 4, transplant, symptomatic. ACUTE HF Dig, Lasix, ACE, ARBS, Betas, atomic number 20 Channel, Nitro, and Aspirin, compensatory mechanism is ok. CHRONIC HF some(prenominal) ventricles can fail (left to right), Dig, Lasix, ACE, BETA, ARBS (if cough), calcium expect blocker, Primacore, compensatory mechanism makes it worse. 2 CLASSIFICATIONS OF HF 1. systolic riddles pushing volume out problem with too much after(prenominal)load HTN. TX decrease SVR with dig, Lasix (diuretics), ACE. 2.Diastolic problem with filling and getting declivity in (Hypertrophic cardio) less room for mel ody TX Beta blockers to reduce contraction or calcium channel then ACE. If you take in them DIG it will kill them (will increase pith working too hard). pulmonary EDEMA hallmark pink frothy sputum, Left- sided heart failure. Decreased albumin, decreased oncotic pressure, increased hydrostatic pressure. Dilated Left vent is dilated (stretched out of shape) decreasing the ejection fraction. Vent is overstretched from CHF or chronic hypertension.Diagnose with chest X-ray heart is BIG. TX Dig, Lasix, Ace. Arrhythmias will increase mortality rate HYPERTROPHIC L vent hypertrophy decreases the king of the chamber to relax, decrease contractility (athlete, hereditary. ) TX BB, CCB Constricted/ dependent normal size heart with decreased cardiac muscle compliance. Scarred= write uprosis, radiation, infection (rheumatic fever) control of volume overload is rapacious Ace, Diuretic, Dobutamine, Nitroglycerin/Nitropresside, exercise restriction . Review patho and management of COPD, especial ly related to acute respiratory failure. COPD obstructive, exhalation problem, air flows in but then becomes trapped, teach pursed two-lipped breathing to break FRC. Clinical manifestations increased lung expansion, normal to increased TLC, decreased forces expiratory volume, increased functional residual capacity, decreased vital capacity, increased CO2, O2 sat-80-100, PaO2- 60 trump out mask to use is vent mask, most precise O2 is delivered.Barrel chest- chronic hyperinflation of torso Corpulmonale, > expiratory time, wheezing or rhonchi, A fib from chronic overuse of right ventricle TX beta agonist/beta input signal=dilates airway (epinephrine, albuterol) Anticholinergic bronchodilators, corticosteroids, mucolytic=thin out secretions, Mucinex or SVN mucomist, pulmonary vasodilators not common, prostaglandin E2, hypothetical to dilate pulmonary vessels but BP can plummet too.Nitrous oxide can temporarily correct pulmonary HTN but doesnt improve outcomes Respiratory Failure ALOC- confusion, restless. Nasal flaring, increased HR, increased BP, increased RR, increased depth, PVCs, pulmonary Embolism=blue very fast, other than cyanosis is a late sign 7. Review management of patients on ventilators, including process of wean and recognition of weaning failure AC assist control doing all the breathing for the patient. Its providing Tidal volume and oxygen.For your inconstant patient NO pressure support needed SIMV synchronized intermittent compulsory ventilation For weaning Makes it easier for patient to take their own spontaneous breath. Tidal volume off and O2 on. Pressure support appendage PEEP dictatorial end expiratory pressure, Keeps alveoli open by use of official pressure. Increases FRC air left in after exhalation. ARDS patient. Little bit of positive pressure at the end of exhalation. engross with SIMV or AC. Keep between 5-10, and not over