Other
study guide medsurgII exam 2
- Course
- Med-sure II (NSG223)
- Institution
- Herzing University
MED SURG II EXAM 2 STUDY GUIDE, received an A in the class :) and on exam, very focused and helpful
[Show more]
4 reviews
By: celestialchild666 • 9 months ago
By: jakediaz • 1 year ago
By: GoldieFord • 1 year ago
Passed with an A. Everything on there. THANK YOU
By: bellejolie280 • 2 year ago
Content preview
EXAM 2 MED SURG IIDisorders Of the Respiratory System
Background
Respiratory Assessment
● “99”, whisper test, breathing to measure if hand’s separate 1 inch
● Lung sounds - apasis to basis
● Anterior lung sounds only if patient can’t breath well enough to sit up or turn
● Tell patient they will tire easily and prepare them for assessment
● Put stethoscope over tissues NOT BONES
● Listen for Lung Sounds (detect adventitious sounds)
○ Crackles (crinkled paper) - high pitched, heard during inspiration, not cleared
by cough
○ Rhonchi (rough) - rumbling, course sounds like a snore, during inspiration or
expiration, may clear with coughing or suctioning
○ Wheeze - musical noise during inspiration or expiration, usually louder during
expiration
Assessment of breathing patterns (picture on slides)
○ 12-20 normal respirations
○ 8/min dont give narcotics
Hypoxemia
● Inadequate O2 for metabolism
● Catching early signs is important (what are signs?)
● Early Signs
○ RAT (restlessness, anxiety, tachycardia / tachypnea)
● Late Signs
○ BED (bradycardia, extreme restlessness, dyspnea (severe))
● In PEDS
○ FINES (feeding difficulty, inspiratory stridor, nares flare, expiratory grunting,
sternal retractions)
● Common - hydrocarbonate+hypercapnia when hypoxia present d/t
hypoventilation and retention of CO2
● Need Oxygen Therapy!!! (LOW O2 IN BLOOD)
○ Teach deep breathing first
○ Normally dont go over 2L/min, know patients BASELINE
○ O2 - 92% and below put on oxygen
Pulmonary Edema
● Abnormal accumulation of fluid in the interstitial spaces and alveoli of the lungs
● Acute event resulting from left ventricular failure (or acute MI or chronic HF)
● Hacking cough, fatigue, weight gain, increased edema, decreased activity tolerance
are early indicators
● Early stage, treated with diuretics and reducing preload by
○ Placing t in upright position with feet & legs dependent
● Treated with oxygen, ventilatory support, IV meds, nursing assessments
&interventions
○ Oxygen - to relieve hypoxemia and dyspnea
○ Diuretics - promote excretion of sodium and water, Furosemide or another
loop diuretic given IV push or as continuous infusion
, ○ Vasodilators - IV nitroglycerin or nitroprusside for symptom relief,
contraindicated in pts who are hypotensive
Respiratory Failure
Acute Respiratory Failure - not disease, condition
● Results from inadequate gas exchange
● Hypoxemia: Decrease in arterial oxygen tension (PaO2) to less than 60 mmHg
○ Decrease in arterial O2 saturations
● Hypercapnia: Increase in arterial carbon dioxide tension (PaCO2) to greater than
50mmHg
○ Increase in arterial O2
● Arterial pH less than 7.35
● Ventilatory failure mechanisms
○ Impaired function of CNS
■ Drug OD, head trauma, infection, hemorrhage, sleep apnea
○ Neuromuscular dysfunction
■ Myasthenia gravis, guillain-barre syndrome, amyotrophic lateral
sclerosis, spinal cord trauma
○ Musculoskeletal dysfunction
■ Chest trauma, kyphoscoliosis, malnutrition
○ Pulmonary dysfunction
■ COPD, asthma, cystic fibrosis
○ Oxygen failure
■ Pneumonia, ARDs, HF, COPD, PE, restrictive lung diseases (diseases
that cause decrease in lung volumes)
1. Hypoxemic Respiratory Failure
● Oxygen failure (lung failure)
● O2 <60 mmHg on 60% oxygen
● Acute - min to hr
● Chronic - several days or longer
● Causes (4)
○ Ventilation-perfusion (V/Q) mismatch
○ Shunt
○ Diffusion limitation
○ Alveolar hypoventilation
2. Hypercapnic Respiratory Failure
● Ventilation failure (pump failure)
● O2 >45 mmHg and pH <7.35
● Acute - min to hr
● Chronic - several days or longer
● Imbalance between ventilatory supply and demand
● airway/aleoli (asthma, emphysema, cystic fibrosis)
● CNS (drug OD, brainstem infarction, spinal cord injury)
● Chest wall and neuromuscular conditions
Patient can have both of these at the same time
Chronic Respiratory Failure
● Deterioration of gas exchange function of the lung that developed insidiously or has
persisted for a long period after an episode of acute resp failure
● Two causes
, ○ COPD
○ Neuromuscular disease
● Develop tolerance to gradually worsening hypoxemia and hypercapnia
● Can also develop acute failure
Diagnostic Studies
● 1st - history and physical assessment
● Most definitive - ABG analysis
● Others: chest x-ray, CBC, sputum/blood cultures, electrolytes, ECG, urinalysis, V/Q
lung scan, pulmonary artery catheter
Prevention
● HX, physical assessment, identify at-risk pts
● Respiratory therapy : oxygen therapy delivery system should be
○ Tolerated by patient
○ Maintain PaO2 at 55-60mmHg or more & SaO2 at 90% ore more
○ Mobilize secretions
■ Hydration, humidification, chest PT, airway suctioning, augmented
cough, positioning
■
Treatment
● Augmented cough - mobilize secretions for obstructed airway, resp therapist does to
break secretions, like the vest that shakes
● Non Invasive PPV (positive pressure ventilation) - + pressure air, helps with
breathing, DO NOT TAKE OFF
● Bronchodilators to reduce airway inflammation
● Corticosteroids to reduce pulmonary congestion
● Diuretics, nitrates if HF present
● IV Antibiotics if treating underlying pulmonary infection
● Benzodiazepines and Narcotics to reduce anxiety, pain, agitation
● Enteral / Parenteral / Supplements - maintain nutrition, need protein
● Medical Supportive therapy - treat underlying cause, maintain adequate cardiac
output and hemoglobin concentration
Geriatric Considerations
● Physiologic aging results in
○ Decreased ventilatory capacity, alveolar dilation, larger air spaces, loss of
surface area, diminished elastic recoil, decreased respiratory muscle strength,
decreased chest wall compliance
● Lifelong smoking, poor nutritional status, less available physiologic reserve
(cardiovascular, respiratory, autonomic nervous system)
Pulmonary Embolism
● PE, refers to the obstruction of the pulmonary artery or one of its branches by a
thrombus (or thrombi) that originates somewhere in the venous system or in the
right side of the heart; common disorder of DVT
● DVT, a related condition, refers to thrombus formation in the deep veins, usually in
the calf or thigh but sometimes the arm, especially in pts with peripherally inserted
central caths
● VTE is a term that includes both DVT and PE
○ PE is the biggest concern of VTE, from clot breaking off
, ● PE can be associated with trauma, surgery (orthopedic, major abdominal, pelvic,
gynecologic), pregnancy, HF, 50+ age, hypercoagulable stages, and prolonged
immobility
● Caused by a blood clot (thrombus) (or air embolism or tissue tumor) that completely
or partially obstructs (blocks) the pulmonary artery and results in impaired gas
exchange
Medical MGT
● Massive PE is a life-threatening emergency, immediate priority to stabilize
cardiovascular system
○ Increases work of right ventricle, can cause right-sided HF w/ cardiogenic
shock
● Treatment
○ #1 priority - give oxygen via nasal cannula to relieve hypoxemia, respiratory
distress, and central cyanosis
■ Severe hypoxemia = emergency endotracheal intubation & mechanical
ventilatory support
○ IV infusion for meds & fluid
○ Vasopressor therapy (dobutamine, dopamine, norepinephrine)
○ Evaluation for hypoxemia (pulse ox, ABGs, MDCTA performed)
○ ECG monitoring for dysrhythmias / right ventricular failure
○ Blood draws (electrolytes, CBC, coagulation studies)
○ Indwelling cath, monitor output in massive PE
○ IV morphine / sedative to relieve anxiety, chest pain, tube placement,
ventilator
● Surgical MGT
○ Surgical embolectomy - indicated for massive PE or hemodynamic instability
or contraindications to thrombolytic (fibrinolytic) therapy
○ Pts who have contraindications to therapeutic anticoagulation or when
recurrent PE occurs, and inferior vena cava (IVC) filter may be inserted
■ Provides screen in the IVC, allowing blood to pass through while large
emboli from pelvis or lower extremities are blocked or fragmented
before reaching the lung
Nursing MGT
● Preventing thrombus formation
○ Encourage ambulation or active / passive leg exercises if bedridden
○ Instruct pt to move the legs in pumping exercise to engage leg muscles
○ Advise pt to not lie or sit for prolonged periods, cross legs, or wear
constrictive clothing
○ Intermittent pneumatic compression (IPC) devices - sleeves placed on legs
that inflate with sequential compression
■ Pt supine, legs shouldn’t dangle, feet resting on floor or chair
○ Don’t leave IV caths in place for prolonged periods
○ All increase venous flow and decrease venous stasis
○ Oxygen therapy to correct hypoxemia, relieve vasoconstriction, reduce pH
● Monitor Signs & Symptoms of PE
○ Extremities evaluated for warmth, redness, inflammation
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller lexioleniczak. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $8.89. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
67163 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now