NUR 460 - Study Guide 1 - Pulmonary Disorders and Blood Gases
NUR 460 - Study Guide 1 - Pulmonary Disorders and Blood Gases 460
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This 9 page Study Guide was uploaded by ndp33 on Wednesday July 13, 2016. The Study Guide belongs to 460 at Niagara University taught by in Summer 2016. Since its upload, it has received 9 views. For similar materials see Nursing Concepts IV: Health of Maturing Adults / Chronic Disease in Nursing and Health Sciences at Niagara University.
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Date Created: 07/13/16
Nur460 Exam I Study guide Resp COPD- s/sx, -3 main symptoms: cough, sputum, dyspnea -weight loss -decreased activity level - inability to perform ADLs -SOB w/ exertion -use of accessory muscles -“barrel chested”, convex abdomen look at anteroposterior and transverse chest diameters: ratio is 1:1, as the diameter enlarges, instead of 1:2, as it is in pts w/ normal chest diameter ratio diameters -tachypnea -wheezing upon auscultation -orthopnea Note: COPD is airflow limitation -reversible inflammation -4 leading cause othdeath in US and projected to be 4 leading cause of death worldwide by 2030 due to an increase in smoking rates and demographic changes in many countries Causes: -smoking 80-90% caused by smoking pack yrs avg # of packs smoked daily x # of yrs smoked most life-long smokers will dev COPD risk incr as age incr plus continued smoke exposure -occupational exposure dusts coal mining, gold mining and textile industry chemicals cadium welding fumes increased risk even in nonsmokers -air pollution people who live in lg cities have a high rate of COPD as it thought to slow the normal growth of lungs -genetics alpha 1 antitrypsin deficiency 2% of the cases, 1 in 3000 Americans sensitive to environmental factors -other cured meats repeated lung infections -autoimmune research ongoing In general: -COPD is caused by noxious particles or as, most commonly from tobacco smoking triggers an abnormal inflammatory response in the lung Patho: -increased number of hyperplasia and hypertrophy of the goblet cells and mucous glands of the airway -more mucous than usual in the airways -narrowing of the airways -causing a cough w/ sputum -infiltration of the airways walls w/ inflammatory cells - inflammation is following by scarring and remodeling that thickens the walls and also results in narrowing of the airways -abnormal change in the tissue lining the inside of the airway and thickening and scarring of the airway wall -limitation of airflow Exacerbations: -the natural course of COPD is characterized by occasional sudden worsening most of which are caused by infections or air pollution Complications -infection d/t inability of airway to filter out sub entering the lungs pneumonia atelectasis pneumothorax pulmonary HTN CO2 toxicity – O2 must be used cautiously Life-threatening complications -respiratory insufficiency -respiratory failure -s/sx poor PFT’s rapidly decreasing pulse ox SOB mechanical ventilation required COPD-nsg dx, -Health hx and physical exam -pulmonary fxn exam spirometry test bronchodilator reversibility testing spirometry testing done, inhaled bronchodilator give, spirometry repeated -arterial blood gases det the amount of O2 in blood % of hgb saturated w/ O2 amount Co2 in blood pH acidity Nursing Assessment -airway patency -IPPA -resp rate, rhythm, and depth -color -conditioning of nail beds clubbing -O2 sat -circulatory assessment capillary refill, color, temp skin -cough sputum color, amt, odor, consistency Chest Assessment I- respirations equal, chest rise and fall equally, shape of the chest P- normal – resonance, abnormal dull indicated bone, increased fluid P – increase in tactile fremitis A – wheezing (inspiratory/expiratory), crackles COPD-nsg interventions Nursing management -smoking cessation -improved activity tolerance - maximal self-management -improved coping ability -adherence to therapeutic regiment and home care -absence of complications -health teaching -breathing exercises to reduce air trapping diaphragmatic breathing goal- use and strengthen the diaphragm during breathing pursed lip breathing -focus on rehabilitation activities to improve ADLs and promote independence -pacing of activities -exercise training -walking aides - utilization of a collaborative approach -prevention pneumoccocal and influenza vaccinations may reduce the incidence of complications -bronchodilators reduce obstruction increase O2 distribution administered via metered-dose inhalers, nebulizers, oral Albuteral, Alupent, Atrovent, Maxair -Corticosteroids do not slow decline in lung fxn Pulmacort, vanceril Surgical Management: -lung volume reduction surgery - improvement of quality of life not a cure -may be minimally invasive -lung transplant currently the only cure for COPD low survival rate Atelectasis- prevention -frequent turning, early mobilization -strategies to improve ventilation: deep breathing exercises at least q2hrs, incentive spirometer -strategies to remove secretions: coughing exercises, suctioning, aerosol therapy, and chest physiotherapy Note: atelectasis is collapse or airless condition of alveoli - cause:hypoventilation, -obstruction to airways, or compression, -bronchial obstruction by secretions due to impaired cough mechanism or conditions that restrict normal lung expansion on inspiration *****post-operative patients at high risk -acute or chronic: acute: -postop following abd/chest surg injury to the chest(car accident, fall, stabbing) involves most alveoli in 1 or more lung regions -risks lg doses of opiods tight bandages immobility chest/abd pain abd distention Chronic:-middle lob syndrome right lobe contracts, usu because of pressure on the brochus form enlarged lymph glands or tumor -causes: penumonia that fails to resolve completely and leads to chronic inflammation -scarring, and bronchiectasis Note: dx -chest x-ray post-surgical atelectasis will be bibasal in pattern computed tomography bronchoscopy S/sx: -cough -sputum production -low- grade fever - respiratory distress anxiety -symptoms of hypoxia occur if large areas of lung are affected Treatments: -bronchodilators -sodium bicarb assist in expectoration -PEEP- positive and expiratory pressure -dependent upon cause increase secretions suctions -chest PT chest percussion and postural drainage mobilize secretions - bronchoscopy removes secretions improves ventilation Pneumonia- assessment, -I- SOB, accessory muscles, short, shallow, rapid resp -P- dullness -P – increase in tactile fremitus -A- crackles, diminished breath sounds -s/sx: dependent upon causative org & underlying conditions -chills -fever -chest pain w/ inspiration and expiration -tachypnea: accessory muscles, SOB -rapid, bounding pulse -bradycardia -orthopnea -poor appetite - diaphoresis -productive cough -increase in diminished breath sounds Assessment-ABC’s: -Airway -Respiratory status IPPA, rate, rhythm, depth of respirations, pulse ox, cough (frequency and severity). Sputum production (color, amount, consistency) -circulatory status HR, B/P, skin color, temp -pain pleuritic in nature increases w/ inspiration and coughing 1-10 scale PQRST -laboratory values -s/e of therapy Pnuemonia-dx, -physical exam -CXR -Sputum C/S -Blood culture -WBC: <4500 or <11K Pneumonia-interventions, Nursing Care: -maximize airway patency enc hydration 2-3L/day-unless contradindicated inc C&DB frequent position changes administer O2 and titrate per protocol -promote rest and comfort H/T pt to avoid overexertion moderate activity upon D/C - health teaching s/sx to report risk factors importance &purpose of medical regimen Medical Management for Pneumonia- Community acquired: -classified in terms of treatment settings, risk factors, and specific pathogens -prompt administration is key -w/in 4-8 hrs Zithromax, Levoquin, Tequin, Ceftin, Amoxicillin Hospital Acquired: -broad spectrum antibiotics Cipro, Unasyn, Rocephin - Cephalosporins Ceftin -For pts w/ MRSA Vancomycin Zyvox Viral Pnuemonia: -sim to the treatment of bacterial pneumonia -more supportive management of s/sx -other treatments: hydration- IV or oral nasal decongestants antipyretics O2 therapy respiratory treatments: chest PT bed rest aggressive treatments incl: intubation, -mechanical ventilation -high conc of O2 Pneumonia-pursed lip breathing -goal-prolong exhalation, increase airway pressuring during exhalation reduces amt of trapped air and airway resistance Sarcoidosis- what is it, -multisystem disease -cause is unknown; hypersensitivity response -most commonly affects the lungs -common in women, AA 30-40 yrs -Treatment: corticosteroids -may have remissions w/o treatment Sarcoidosis/sx -dyspnea, -anorexia, -fatigue, -weight loss, - lesions on lungs Blood gases: Blood gases- Interpretation, Blood gases- nursing interventions, Nursing dx for specific gasses Math dosage Questions: 3 questions
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