NUR2571 RN 2 Study Guide: Exam 2 Complete (Gas Exchange, Cardiac, Perfusion) Latest Update

RN 2 Study Guide: Exam 2 Gas Exchange: What causes obstructive sleep apnea? Muscles relax, tongue and neck structures are displaced = upper airway ob- struction, but chest movement unimpaired, last longer than 10 sec. Highest risk-obesity/smokers Cpap- able to stop when losing weight/stop smoking Pneumonia: how does it correlate with possible acidosis, what are nursing in- terventions to prevent acidosis from occurring? Respiratory acidosis develops when lungs cannot expel CO2 adequately which occurs with pneumonia. Interventions – administer O2, encourage coughing/deep breathing, suction, ad- minister antibiotics for infection turn cough/deep breath, adequate hydration. Incentive spiramitor Why are oral cares important for an intubated patient? Provides patients’ comfort, reduces dental plaque and mucosal inflammation, and promotes oral health. Prevention? Decrease bacterial infections ABG interpretation (3 questions) pH – 7.35-7.45 PaCO2 – 35-45 HCO3 – 22-26 Respiratory Acidosis – CAUSES – hypoventilation, OD of sedatives, aspiration, emphysema S/SX – muscle weakness, unconsciousness, convulsions, headaches Respiratory Alkalosis – CAUSES – anxiety, fever, hypoxemia, pulmonary emboli, mechanical ventilator S/SX – light headedness, numbness, tingling, sweating, n/v, palpitations Metabolic Acidosis – CAUSES – diarrhea, diabetic ketoacidosis, renal failure, ingestion of toxins S/SX – headache, confusion, n/v, drowsiness, increased respirations Metabolic Alkalosis – CAUSES – vomiting/suction, hypokalemia, Cushings, Alkali ingestion, K+ losing diuretics What is COPD? S/SX – dizziness, tingling toes/fingers, headache, confusion, lethargy, arrhythmia Inflammatory respiratory disease, progressive and incompletely reversible airflow obstruction— bronchitis/emphazima = smoking, bronchitis= chronic asthma (linked) Signs and Symptoms? SOB, wheezing, chest tightness, clear throat first thing in the morning due to excess fluid in lungs, chronic cough w/ yellow/greenish sputum Asthma: Assessment Physical assessment associated w/ s/sx. Lab assessment ABG levels – PaO2 may decrease during an asthma attack. Pulmonary function tests measure airflow using spirometer. Asthma Treatment: Short Acting Bronchodilator vs. Long Acting Bronchodilator. Think of a sce- nario when each would be needed. Short-Acting bronchodilator – quick relief (increases HR), Methylprednisolone sodium succinate (Solu-Medrol), Prednisone, Magnesium—- albuterol Long-term bronchodilator: –Salmeterol & Formoterol (Floradil), Fluticasone propionate (Flovent), Fluticasone & Salmeterol (Advair Diskus), Theophylline, Montelukast (Singulair) Long vs short: acute attack albuterol, morphine Asthma- bronchoconstriction What is status asthmaticus? A severe condition in which asthma attacks follow one another w/o pause Actue attack, needing treatment How do we treat? Albuteral- beta 2 agnoist Fluid replacement IV NS @ reasonable rate w/ attention to electrolytes to prevent hypokalemia from corticosteroid or beta- agonist use. O2 therapy Medications? Beta-agonists, corticosteroids, theophylline What are signs/symptoms of a pneumothorax? Sudden chest pain, SOB, pleuritic chest pain on affected side, dyspnea, tachypnea, tachycardia, hypotension, respiratory distress, air hunger, tra- cheal deviation, anxiety What is Cystic Fibrosis? To much secretion-increase mucus production— GI lining, lungs, not absorp- tion food, can lead to diabetic Affects respiratory, digestive, intestinal, and pancreas; inherited autosomal recessive, chronic, progressive, and freq. fatal disease of the body’s exocrine mucus-producing glands. S&S? Fatty stools, infertility productive cough, wheezing, dyspnea, recurrent infections, bronchiectasis, infiltrates, scarring, increased chest circumference, hyperres- onance w/ percussion, apical crackles Common GI issue with this disease? Pancreas, liver, and intestinal issues causing malnutrition, constipation, liver disease, abdominal pain Does hyperventilation affect PCO2 levels? Decreased co2 levels- repiritorty alkolotic During hyperventilation, the average PO2 decreases in proportion to the de- crease in arterial PCO2. What are signs and symptoms of lung cancer? dyspnea, pain, anorexia, chestpain, horseness, reoccurring illness Cough that does not go away or gets worse. Coughing up blood or rust-col- ored sputum. Chest pain that is often worse w/ deep breathing, coughing, or laughing. Understand TB meds (INH, Rifampin), possible side effects. INH – Isoniazid – used to treat active TB infections. Works by stopping the growth of the bacte- ria. Side effects – N/V, stomach upset Rifampin – used to treat and prevent TB infections. Side effects – upset stomach, heartburn, nausea, menstrual changes, headache, drowsiness, or dizziness. May produce harmless reddish coloration of urine, sweat, saliva, or tears. Soft contact lenses could be permanently stained. Know Signs & Symptoms of tuberculosis. Coughing that lasts 3 or more weeks, coughing up blood, chest pain or pain w/ breathing/coughing, unin- tentional weight loss, fatigue, fever, night sweats, chills Perfusion: What is Infective endocarditis? Strep Infection of the endocardium, usually w/ bacteria (commonly streptococci or staphylococci) or fungi. S&S? LOW BP, weakness, fainting, fever, HR tachycardia Fever, flu-like symptoms, heart murmurs, petechiae, anemia, embolic phenomena, and endo- cardial vegetations. S&S of decreased cardiac output? PO2 level decrese. Edema, dec. urination(kidney fail), Fatigue, confusion, agitation and/or de- creased LOC, cool peripheries, mottled peripheries, delayed cap refill time, hypotension, tachy- or bradycardia, thread pulse, raised jugular venous pressure, breathlessness and hypoxaemia What are S&S of heart failure? SOB (dyspnea) when you exert yourself or lie down; fatigue/weakness; swelling (edema) in legs, ankles, feet; rapid/irregular heartbeat; reduced abil- ity to exercise; persistent cough/wheezing w/ white/pink blood-tinged phlegm; congested lungs; fluid/water retention What causes heart failure? Buildup of fatty deposits (plaque) in arteries which reduce blood flow and can lead to heart attack. HTN F – FAULTY HEART VALVES A – ARRHYTHMIAS (A-FIB, TACHYCARDIA) I – INFARCTION L – LINIAGE U – UNCONTROLLED HTN R – RECREATIONAL DRUG USE (COCAINE/ETOH) E – EVADERS (VIRUS, INFECTION) What’s the difference between left sided and right sided heart failure? Right side of heart usually becomes weaker IN RESPONSE to failure on the left side. When left side weakens, the right side has to work harder to compensate. LEFT SIDED – causes chronic coronary artery blockage, HTN, excessive alcohol use, MI, hypothy- roidism, infection,,, dec urine output (oliguria) frothy sputum, fainting, aortic stenosis—Confu- sion RIGHT SIDED – chronic lung disease, congenital heart disease, primary pulmonary HTN, heart valve disease, right ventricular MI,,, DBJ- distended, abdominal girth, peripheral edema, de- pendent edema—- having left sided puts you at risk for R BNP LAB OF 500 OR GREATER PUTS YOU @ HIGHER RISK FOR HF AND INCREASES W/ AGE NO CELERY Meds to know: Digoxin (be sure to understand toxicity and proper nursing interventions) CHECK BP/HR PRIOR TO ADMIN (therapeutic level 0.5-1) used to treat heart failure, increases force of myocardial contraction, prolongs refractory period of AV node; SIDE EFFECTS – N/V, headache, dizziness, loss of appetite, diarrhea; TOXICITY – HALOS-yellow, S/SX – gastrointestinal and include N/V, abdominal pain, diarrhea, atrial tachycardia w/ 2:1 block and bidirectional ventricular tachycardia; INTERVENTIONS – Teach pt to take pulse and contact PCP 60 or 100; Lasix-ferosemide what labs are important to have prior to administering? Monitor electrolytes (potassium) , renal and hepatic function, serum glucose, and uric acid lev- els. May cause decrease in serum sodium, calcium, and magnesium Why? Can lead to profound diuresis w/ water and electrolyte depletion. K+ WASTING Amlodipine- what patient teaching is important f