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Class notes NURS 324 Lewis's Medical-Surgical Nursing
This is a study guide made for the final for Nurc 324 at Indiana State University.
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1. Respiratory Problemsa. Asthma
Assessment
Symptoms: Dyspnea, wheezing, chest tightness, cough (often worse at night or early
morning).
Physical Examination: Prolonged expiration, use of accessory muscles, decreased
oxygen saturation during exacerbations.
Diagnostics:
Peak Expiratory Flow Rate (PEFR): Decreased during an attack.
Pulmonary Function Tests: FEV1/FVC ratio decreased.
Allergy Testing: To identify triggers.
Management
Medications:
Rescue Inhalers: Short-acting beta-agonists (e.g., albuterol).
Controller Medications: Inhaled corticosteroids (e.g., fluticasone), leukotriene
modifiers (e.g., montelukast).
Severe Exacerbations: IV corticosteroids, oxygen therapy, and magnesium
sulfate.
Patient Education:
Proper inhaler technique.
Trigger avoidance (e.g., allergens, smoke, stress).
Monitoring symptoms using a peak flow meter.
b. Tracheostomy
Management
Regular stoma care: Cleaning and ensuring the area remains free of infection.
Assess for complications: Tube dislodgment, infection, tracheal stenosis.
Humidified air to prevent mucus plugging.
Suctioning
Indications: Excessive secretions, respiratory distress, audible gurgling.
Procedure:
Use sterile technique.
Limit suctioning to 10-15 seconds per pass to prevent hypoxia.
Monitor oxygen saturation and heart rate.
c. Chronic Obstructive Pulmonary Disease (COPD)
Vaccines
Annual influenza vaccine.
Pneumococcal vaccine (e.g., PCV13, PPSV23).
, Patient Education
Smoking cessation is critical.
Energy conservation techniques.
Adequate hydration (to thin secretions).
Avoiding respiratory irritants (e.g., pollution, dust).
Postural Drainage
Positioning to facilitate mucus drainage from different lung segments.
Often used in conjunction with percussion or vibration.
Pursed-Lip Breathing
Technique: Inhale through the nose, exhale slowly through pursed lips.
Benefits: Reduces air trapping and dyspnea, improves oxygenation.
Management/Nursing Care
Medications:
Bronchodilators: Beta-agonists (e.g., salmeterol) and anticholinergics (e.g.,
tiotropium).
Inhaled corticosteroids for exacerbations.
Oxygen Therapy: Target oxygen saturation 88-92% to prevent CO2 retention.
Monitor for signs of exacerbation: Increased dyspnea, sputum changes, fever.
d. Tuberculosis (TB)
Risk Factors/Transmission
Risk Factors: HIV infection, crowded living conditions, malnutrition, healthcare
exposure.
Transmission: Airborne droplets. TB spreads when an infected person coughs, sneezes,
or talks.
Medications
Isoniazid (INH): Monitor for hepatotoxicity and peripheral neuropathy (prevent with
pyridoxine).
Rifampin: Common side effects include orange discoloration of bodily fluids and
hepatotoxicity.
e. Pulmonary Embolism (PE)
Management
Immediate Actions: Administer oxygen, elevate the head of the bed.
Monitor vital signs, especially for signs of shock or hypoxia.
Treatment
Anticoagulants: Heparin (IV) initially, followed by oral warfarin or DOACs (e.g.,
rivaroxaban).
Thrombolytics: For massive PE with hemodynamic instability.
, Preventive Measures: Early ambulation, compression stockings, prophylactic
anticoagulation for high-risk patients.
f. Pneumonia
Types
Community-Acquired (CAP): Acquired outside hospital settings.
Hospital-Acquired (HAP): Onset ≥48 hours after hospital admission.
Aspiration Pneumonia: Inhalation of food, liquid, or gastric contents.
Risk Factors
Advanced age, chronic diseases (e.g., diabetes, COPD).
Immunosuppression (e.g., HIV, chemotherapy).
Smoking, prolonged immobility, recent surgery or intubation.
2. Fluids and Electrolytes
a. Arterial Blood Gas (ABG)
Interpretation of ABG Results
Key Components:
pH: Normal range 7.35–7.45.
PaCO₂: Normal range 35–45 mmHg (respiratory component).
HCO₃⁻: Normal range 22–26 mEq/L (metabolic component).
PaO₂: Normal range 80–100 mmHg (oxygenation status).
O₂ Saturation: Normal >95%.
Acid-Base Imbalances:
Respiratory Acidosis: ↓ pH, ↑ PaCO₂ (e.g., COPD, hypoventilation).
Respiratory Alkalosis: ↑ pH, ↓ PaCO₂ (e.g., hyperventilation).
Metabolic Acidosis: ↓ pH, ↓ HCO₃⁻ (e.g., ketoacidosis, renal failure).
Metabolic Alkalosis: ↑ pH, ↑ HCO₃⁻ (e.g., vomiting, excessive antacid use).
Assessment/Clinical Manifestations
Respiratory Acidosis: Confusion, drowsiness, headache, hypoventilation.
Respiratory Alkalosis: Dizziness, tingling, tachypnea.
Metabolic Acidosis: Kussmaul respirations, hypotension, confusion.
Metabolic Alkalosis: Nausea, muscle cramps, slow breathing.
b. Dehydration
Clinical Manifestations
Thirst, dry mucous membranes, decreased urine output.
Tachycardia, hypotension, increased hematocrit, and BUN.
Severe: Altered mental status, hypovolemic shock.
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