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med surge exam 1 chaps 24-29

Terms in this set (73)

is capnometry/capnography invasive or noninvasive?
noninvasive
Normal range for Na:
135-145 mEq/L
Normal range for K
3.5-5.0 mEq/L
pH
7.35-7.45
PaO2
80-100 mmHg
PaCO2
35-45 mmHg
HCO3 (bicarb)
21-28 mEq/L
SaO2
95-100%
Normal range for WBC
4500-10000/microliter
Normal range for hemoglobin women:
men:
12-16g/dL
13.5-18.9g/dL
Normal range for hematocrit women:
men:
36-47%
41-52%
Normal range for platelets
100,000-450,000 / microliter
CT Contrast: Toxic to what organ?
What allergies do we need to assess for?
Nephrotoxic.
shellfish and iodine
CT contrast: what drug needs to be stopped 24hrs before contrast and not restarted until good kidney function is confirmed?
Metformin
Before pulmonary function tests, what drug needs held?
What can the patient not do 6-8 before?
Bronchodilators for 4-6hrs
smoking
What needs to be stressed during a thoracentesis?
What needs to be watched for during and after?
The patient does NOT move.
Shock, pain, nausea, pallor, diaphoresis, cyanosis, tachypnea, dyspnea.
Cystic fibrosis; Sweat ________ analysis
chloride
5 A's for smoking cessation
Ask
Advise
Assess
Assist
Arrange
What drugs can cause manic behavior?
Oral drugs bupropion and varenicline
With a partial rebreather, does the bag need to stay fully or slightly inflated at the end of inspiration?
What percentage range of oxygen is used?
slightly
60-75%
With a non-rebreather, what is the oxygen percentage above?
How full should the bag be with the flow rate up to 10-15?
90%
2/3rds full
Are there flaps over the exhalation ports of a nonrebreather?
yes
What are the risks and complications for noninvasive ventilation?
Sealed properly
Skin breakdown over nose and face
leaks- pressure around eyes
Vomiting leading to aspiration
Does the patient need to be alert to have noninvasive ventilation?
yes, must have ability to protect airway
Can a patient use their own CPAP/BiPAP while in the hospital?
what are the reasons to uses for these?
yes.
atelectasis after surgery, Cardiac induced pulm edema, COPD, post-extubation to prevent reintubation, those with DNIs, sleep apnea.
What needs to be checked pre/post op of cannulation with a tracheostomy?
Ensure patent airway.
Confirm bilateral breath sounds.
Hourly resp assess.
assess for complications
When is accidental decannulation an emergency?
Within the first 72 hours after surgery because the tracheostomy tracked has not matured and replacement may be difficult
Is constant oozing normal for a tracheostomy?
No
When should we suction a patient?
Audible/noisy secreitons
crackles
wheezes
restlessness
increasesp ulse or increases resp rate
pt requests (PRN)
increased peak airway pressure on the ventilator
T/F: suctioning ins scheduled.
FALSE, PRN
What risks are there to suctioning? (What can it cause)
Hypoxia
injury to tissue
trauma
infection
vagal stim
bronchospasm
cardiac dysrhythmia
How often should trach care be performed?
usually every 8 hours but follow hospital policy
What are the long term risks for OSA (Obstructive sleep apnea)
HTN, stroke, cog deficits, weight gain, diabetes, pulm and cardio disease.
How long and often does a patient with OSA experience interruptions?
10 seconds, 5x an hour at minimum
Why do patients wake with OSA?
Hypopnea, lower resp rate and depth, not breathing enough and the buildup of CO2 wakes them.
Post op to fix OSA, how often does the patient need assessed? what are we looking for?
Every 2 hours, looking for airway narrowing, partial obstruciton, increase resp effort, stridor, crowning, drooling, inability to swallow, decreased O2 sat, increased CO2 level. Call RRT if noticed, prevent a partial obstruction from becoming a complete.
If a patient has epistaxis (nose bleed), what are we watching for? ________ distress.
Respiratory
After tubes/packing is removed after a posterior nose bleed, what does the patient need educating to avoid?
Avoid nose blowing, aspirin, NSAIDs, heavy activity, lifting for one month.
If a patient has a nose fracture, what are we looking for in a dip-stick test and what does it mean?
Looking for a yellow halo/if it contains glucose. This means there is CSF leaking.
If a patient is on nicotine replacement therapy and sneak out to smoke, what are they at risk for?
Massive risk for stroke / heart attack.
What can chantix cause and unmask?
Manic state, hallucinations. Unmasks mental health issues
When auscultating the lungs, where must we listen?
anteriorly AND posteriorly, regardless if it makes them uncomfortable.
Do we need to respond to stridor?
Yes, obstruction occurred.
Indicators for respiratory inadequacy:
Biggest ones are change in LOC, acute confusion, agitation, and patient cannot speak more than 4-5 words w/out taking a pause to breath.
What bodily fluid labs will be taken for respiratory assessments?
CBC
ABGs
Sputum
What MUST be stopped before getting a sputum culture?
antibiotics
Preop to bronchoscopy, how long must the patient be NPO?
What must be assessed post-op before giving anything PO?
4-8hrs
Gag reflex must be intact. Assess every 15 for 2hrs
When oxygen is not helping a patients stats post bronchoscopy, what blood issue would be occuring?
Methemoglobinemia
What 4 things are needed before a Thoracentesis?
What is needed after? (For really all lung procedures)
Conset, allergies, identifiers, and chest x-ray
Chest x-ray
What is the goal of oxygen therapy?
What is usually ordered along with oxygen?
Use the lowest fraction of inspired O2 (FiO2) to maintain an acceptable blood O2 level w/out causing harmful effects.
Titration order.
Oxygen toxicity: What are we looking for if a patient has been on high percentage of oxygen for longer than 24-72hrs?
Lung damage, dyspnea, non-productive cough, chest pain beneath sternum, GI upset, crackles.
What would new onset crackles along with decreased breath sounds indicate?
Absorption atelectasis.
How often should humidification systems be changed?
every 7 days
What makes venturi masks special?
Why are they used with COPD patients more?
Valve delivers specific amount of O2.
Easier to control so we don't over-oxygenate.
What is going on if a trach tube is pulsing with the heart?
Trachea innominate artery fistula. Medical emergency. D/t poorly positioned tube, call RRT right away as tube as pushed and caused necrosis and erosion of innominate artery. Immediate removal of tube, apply direct pressure of artery at stoma, prep for surgery.
What does the battle sign indicate?
skull fracture. assess neuro, PERRLA
What vaccines should we recommend to older adults?
Pneumococcal, flu, COVID.
If status asthmaticus is not reversed, what treatments are started?
Fluids, potent systemic bronchodilators, steroids, epinephrine, O2, prep for emergency intubation.
What are controller therapy drugs used for?
How often?
Prevention.
Daily regardless of symptoms
What are reliever drugs used for?
Used to stop an attack one it's started
Where there is hypoxemia and acidosis with COPD patients, what organ are we worried about?
Heart b/c increased CO2 leads to increase K+
What is cor pulmonale?
Right-sided heart failure due to pulmonary hypertension
Non pulm symptoms of CF
Abdominal distention, GERD, steatorrhea, foul smelling stool, malnutrition, deficiency of fat sol vitamins(ADEK, because of steatorrhea)
We cannot delegate to UAP if:
Patient is unstable/complex.
Patient education.
Planning of care for pt.
Assessments
What can we delegate to UAP:
Tasks the require no judgement based on nursing knowledge and expertise.
Task is reasonably predictable.
What disease is indicated by rapid onset of severe HA, muscle ache, fever, chills, fatigue, and weakness?
Seasonal influenza
Drugs for flu must be given between what time period of symptom onset?
24-48hrs
What is consoldiation?
Abnormal solidification with lack of air spaces
What does rust colored sputum typically indicate?
pneumonia
For what disease is splinting of the chest used for?
Pneumonia
What are the main drugs for TB?
How long are they given for?
Isoniazid and rifampin.
18 weeks.
How often do TB patients need a sputum specimen?
Every 4 weeks after treatment starts, can stop after 3 negative cultures.
What are the side effects of rifampin?
Reddish orange urine and sweat, interferes with birth control w/ birth control up to 30 days after finishing drug.
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