Class notes
UPNS 232 HESI HINTS NOTES
- Course
- Adult Health UPNS 232
- Institution
- Duquesne University
This is a comprehensive and detailed note that contains key hints and concepts for Hesi. Enjoy!!
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MEDSURG: 1● Health Promotion and Disease Prevention
o Changing unhealthy behaviors can modify or even prevent some chronic illnesses. RN
play a major role in helping pt. manage their chronic illnesses and disabilities through
behavioral changes. Health teaching and counseling often are the role of the RN in
helping the pt focus on improving health habits.
▪ Areas of behavioral change
● Physical activity
● Nutrition
● Stress
● Use of tobacco or marijuana or alcohol
● Spiritual perspectives
● Coping skills
● Support systems
o According to the American Lung Association smoke is harmful to lung health. Burning
wood, tobacco, or marijuana releases toxins and carcinogens
o To develop a collaborative learning environment between RN and pt, the RN must be
acutely aware of their own beliefs and values about teaching- learning process, including
pt empowerment
o Obtain a cultural and spiritual assessment and include cultural and spiritual preferences in
the plan of care when appropriate and feasible. RN are expected to provide care to all pt.
it is important to note that pt are culturally diverse, regardless of their ethnicity, race, or
socioeconomically status and to note that every cultural subgroup may form. However,
culturally diverse pt may be distinguished from mainstream culture by ethnicity, social
class, and/or language. Since the 2000 census there has been a notable change in the
cultural, ethnic, and racial alignment of the USA.
▪ Cultural influences how pt seek medical attention/treat themselves.
o Reasons why pt use herbal medications
▪ Cultural influence
▪ Perception that supplements are safer and healthier than conventional drugs- they
think
▪ Sense of control over one’s care
▪ Emotional comfort from taking action
▪ Limited access to professional care
▪ Lack of health insurance
▪ Convenience
▪ Media hype and aggressive marketing
▪ Recommendation by family and friends.
● Respiratory System
o Pneumonia affects people of all ages, especially those 65 or older or infants under age 2
(because their immune systems are still developing)
o Increased temperature also increases metabolism and the demands for O2. Fever can also
cause dehydration because of excessive fluid loss due to diaphoresis
o Pt at high risk for Pneumonia
▪ Altered level of consciousness
▪ Brain injury
▪ Depressed or absent gag reflex
, MEDSURG: 2
▪ Susceptible to aspiration oropharyngeal secretions, including alcoholics,
anesthetized individuals
▪ Drug overdose
▪ Stroke victims
▪ Immunocompromised
o Bronchial breath sounds are heard over areas of density or consolidation. Sound waves
are easily transmitted over consolidated tissue
o Hydration
▪ Thins out the mucus trapped in the bronchioles and alveoli, facilitating
expectoration
▪ Is essential for experiencing fever
▪ Is important because 300-400 mL of fluid is lost daily by the lungs through
evaporation
o Irritability and restlessness are early signs of cerebral hypoxia; the pt brain is not
receiving enough O2.
o Pneumonia Preventions
▪ Older adults: annual flu vaccinations; pneumococcal vaccination at age 65 or
older and younger pt who are high risk. (repeat vaccinations may be
recommended see centers for disease control and prevention CDC guidelines);
avoiding sources of infection and indoor pollutants (dust, smoke, and aerosols);
no smoking
▪ Immunosuppressed and debilitated persons: annual flu vaccinations, pneumonia
vaccine, avoid infections, sensible nutrition, adequate fluid intake, appropriate
balance of rest and activity
▪ Comatose and immobile persons: elevate HOB at least 30 degrees for feedings
and for 1 hour after feeding; turn frequently
▪ Patients with functional or anatomic asplenia: flu and pneumonia vaccinations
● Chronic Airflow Limitations (CAL)
o Exposure to tobacco smoke is the primary cause of COPD in the USA
o Compensation occurs over time in pt with chronic lung disease, and ABGs are altered
o As COPD progresses, the amount of oxygen in the blood decreases (hypoxemia) and the
amount of carbon dioxide increases (hypercapnia) causing chronic respiratory acidosis
(increased arterial carbon dioxide PaCO2), which results in kidney retaining bicarbonate
as compensation
o Not all pt with COPD are CO2 retainers, even with hypoxemia is present, because CO2
diffuses more easily across lung membranes than O2
o In advanced emphysema, due to the alveoli being affected, hypercarbia is a problem,
rather than in the bronchitis, where the airways are affected
o It is imperative that baseline data is obtained for these pt
o Productive cough and comfort can be facilitated by semi-fowler or high folwers position,
which lessens pressure on the diaphragm by abdominal organs. Gastric distention
becomes a problem in these pt because it elevates the diaphragm and inhibits full lung
expansion
o ABGS
▪ pH- 7.35-7.45
▪ PCO2- 35-45
, MEDSURG: 3
▪ HCO3- 21-28
▪ PO2- 80-100
o Over inflation of the lungs causes the rib cage to remain partially expanded, giving the
characteristic appearance of a barrel chest. The persons works harder to breath, but the
amount of O2 taken in is not adequate to oxygenate the tissues
o Insufficient oxygenation occurs with chronic bronchitis leads to generalized cyanosis and
often right sided heart failure
o Cells of the body depends on O2 to carry out their functions. Inadequate arterial
oxygenation is manifested by cyanosis and slow capillary refill (<3 sec). a chronic sign is
clubbing of the fingernails and a late sign is clubbing of the fingers
o Health Promotion
▪ Eating consumes energy needed for breathing. After mechanically soft diets
which do not require as much chewing and digestion. Assist with feeding if
needed
▪ Prevent secondary infections; avoid crowds, contact with persons who have
infectious disease and respiratory irritants (tobacco smoke)
▪ Teach pt to report any changes in their sputum
▪ Encourage then to hydrate well (3L a day) and decrease caffeine due to diuretic
effect
▪ Obtain immunizations when needed (flu and pneumonia)
o When asked to prioritize nursing actions always use ABC
▪ Airway
▪ Breathing
▪ Circulation
▪ CPR- use CAB
o Look & listen! If breath sounds are clear but the pt is cyanotic and lethargic, adequate
oxygen is not occurring
o The key to respiratory status is assessment of breath sounds, as well as visualization of
the pt. breath sounds are better described, not named
▪ Example: crackles, wheezes, or high pitched whistling
▪ Not: rhonchi, rales- which may not mean the same thing to everyone practicing
medicine
o In adults O2 must bubbles through a type of water solution so it can be humidify if given
at >4 L or delivered directly to the trachea. If given 1-4 L or by mask or nasal cannula the
oropharynx and nasopharynx provide adequate humidification
● Cancer of Larynx
o The tongue and the mouth often appear white, gray, dark brown, or black and appear
patchy
o Tracheostomy care involving cleaning the inner cannula, suctioning, and applying clean
dressings
o Air entering the lungs is humidified along with nasobronchial tree. This natural
humidifying pathway is gone for the pt who has a laryngectomy. If the air is not
humidified before entering the lungs sections tend to be thick and crusty.
o A laryngectomy tube has a larger lumen and shorter than a tracheostomy tube. Observe
the pt for any signs of bleeding or occlusion, which are immediate postop risk
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