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Study Guide for Med-Surg Lecture Exam 1
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Study Guide for Med-Surg Lecture Exam 1
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NR324-Adult Health IExam #1 Objectives
All fluid imbalances (including fluid volume excess & fluid volume deficit)
Electrolyte imbalances
Respiratory system alterations:
Sleep apnea
when tongue or muscles in pharynx block the airway Moments of no breathing & no airflow
S/S: Daytime- headaches, sleepiness, chronic fatigue, irritability, mood swings, depression
Nighttime- snoring, episodes of apnea
Causes: Obese/Overweight, Sedatives before bed(Benzos, Opiates), Alcohol
Pt Education: Lose weight/exercise, Limit alcohol, no napping during the day, no sedatives at
bedtime, no eating bedtime snacks
Care: CPAP- continuous positive airway pressure (mask and air pump) keeps pharynx and
tongue from collapsing backwards
Sinusitis
S/S: nasal obstruction, congestion, fever, malaise; pain over affected sinus, purulent nasal
drainage, recurrent headaches are common
CARE: Don’t take meds for more than 3-4 days to prevent rebound congestion
-
Influenza
Acute bronchitis
Before bed: mobilize secretions, Guaifenesin (Mucinex), use cool mist humidifier at night
Pursed Lip breathing: inhale by nose for 2 sec, exhale from mouth for 4 sec
Cystic Fibrosis
Genetic disorder causes mucus secretions to be thicker and stickier than normal. Mucus builds up
in lungs causing infection and digestive system poor weight gain and failure to thrive
*** PRIORITY= resp. failure low pulse oximetry reading (norm. 95-100%), sudden drop in O2
saturation
S/S: Normal findings: recurrent lunch infections and blood-tinged sputum, weight loss and loss
of appetite, constipation and lose, fatty stool (steatorrhea)
CARE: Diet high in calories, enzymes WITH MEALS, mucus- increase fluid intake, exercise,
chest physiotherapy, postural drainage, financial counseling
DIAGNOSTICS: Sweat chloride test, DNA, stool test
MEDS: Acetylcysteine (mucomyst)- not asthma safe!! Can cause bronchospasms
(also an antidote for Tylenol poisoning)
, NR324-Adult Health I
Exam #1 Objectives
COPD
Chronic destruction of the lungs resulting in decreased gas exchange chronic air trapping and
high CO2 in body
S/S: Low O2 stats is expected (88-93% is NORMAL)
- Emphysema (PINK PUFFER)- damage to alveoli lose lung elasticity
o Pink skin, pursed lips, barrel chest, no chronic cough, keep tripod
- Chronic Bronchitis “BLUE BLOATER:
o big and blue skin (cyanosis), long term chronic cough & sputum, unusual lung
sounds (crackles and wheezes), peripheral edema bc of cor pulmonale
Complications: respiratory failure: hypoxemia, hypercapnia BIPAP
DRUGS TO AVOID: opioids (morphine, hydromorphone, hydrocodone, oxycodone), Benzos
(diazepam-valium, lorazepam-ativan)
TEACHING: eat small, frequent meals high in calories & protein,
- AVOID
o high carbs, exercising 1 hour before/after meals, gassy foods, high fiber foods,
carbonated drinks, drinking fludis while eating
- drink 8 glasses of fluid a day (2-3 L)
IMPENDING RESPIRATORY FAILURE:
tachycardia, restlessness, headaches, increase BP, dyspnea
Pneumonia
Infection that causes severe inflammation in the lungs- makes alveoli fill with mucus, fluid and
debris impaired gas exchange where CO2 can’t get out and O2 can’t get in
S/S: altered mental status (restlessness, agitation, confusion), Fever (over 100.4/38), productive
cough (yellow sputum), fine/coarse crackles, dyspnea,
- pleuritic chest pain REPORT THIS! (sharp chest pain upon inspiration or coughing)
RISK FACTORS: over 65 y/o, Ventilator associated pneumonia (reposition q 2 hours, oral
care/suction q 2 hours, chlorhexidine) positive sputum culture, fever, x-ray shows infiltrates,
using corticosteroids causes immunosuppression, prolonged immobility, post-op anesthesia
CARE: chest physiotherapy, turn cough & deep breath, huff coughing technique, AVOID
COUGH Suppressants, drink 203 L water/day, high-fowlers positioning, good lung down, bad
lung up!!!!!! (lay on side of good lung)
Critical Complications:
- Pleural Effusion: fluid in pleural space--? Prevents full expansion of lungs
o Chest pain during inhalation, dyspnea, diminished breath sounds, dull resonance
o ***PRIORITY to report- asymmetrical chest expansion, decreased breath sounds
- ARDS: deadly stiff lungs; hard stuff
o Refractory hypoxemia, resistant to O2, LOW O2= confusion, agitation,
restlessness
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