NURS 3561 MED SURG EXAM TWO STUDY GUIDE latest update 2022/2023

NURS 3561 MED SURG EXAM TWO STUDY GUIDE latest update 2022/2023Respiratory System - HAYLEE Explain & discuss assessment findings manifest in lower respiratory disorders (COPD, asthma, pneumonia, tuberculosis), and relate them to underlying pathophysiological processes. COPD consists of emphysema and chronic bronchitis – irreversible. Chronic bronchitis causes structural and inflammation changes. Emphysema damages and enlarges alveoli (air sacs) causing breathlessness. Risk factors: smoking!!!, occupational chemicals and dust, air pollution, infection and some genetic factors (AAT deficiency). Develops slowly, chronic intermittent cough may occur first. Dyspnea is progressive, occurring with exertion. Unable to take a deep breath. Will interfere with ADLs. With advanced COPD, you'll see weight loss despite adequate intake, fatigue, wheezes, adventitious or decreased breath sounds, severe cough leading to fainting/breaking a rib, barrel chest, relief in tripod position, pursed lip breathing, usage of accessory muscles, hypoxemia, blue/red color of skin, retaining CO2 (look at ABGs), edema in the ankles secondary to right sided heart involvement (aka cor pulmonale). Patients with COPD are at a high risk of respiratory failure. Use of beta-adrenergic blockers (atenolol) can improve survival rate and decrease risk of exacerbations. Nurse assessment in acute exacerbation event: increase in dyspnea, sputum volume and purulence, malaise, insomnia, fatigue, depression, confusion, decrease in exercise tolerance, confusion, increase in wheezing, may have a fever. Nursing considerations: if the patient retains CO2, careful monitoring when on oxygen or during surgery and post op is crucial. They might appear to be resting comfortably, but actually aren't. Abdominal surgery can lead to ineffective ventilation and respiratory failure due to the inability to take deep breaths. Diagnostics: spirometry – must confirm obstruction. Pulmonary function test. Chest x-ray will show a flat diaphragm, hyper inflated lungs. Serum and antitrypsin level (genetics), ABGs. 6 minute walk test, COPD assessment test, BODE index. Medications/treatments for COPD exacerbation event: bronchodilators, supplemental oxygen, short acting anticholinergic, corticosteroids, noninvasive mechanical ventilation (CPAP). Expected SPO2: 90% goal of oxygen therapy Inflammatory Disorder - Asthma A chronic inflammatory response in the lungs, chronic. Usually reversible. Can be severe and life-threatening. When a patient is exposed to a trigger, it leads to inflammation, a bronchospasm and narrowing of airways to make it difficult to breathe. Risk factors: genetics, immune response, allergens, exercise, air pollution, occupational hazards, respiratory tract infections, nose and sinus issues, drug and food allergens/additives, GERD, psychological factors (extreme emotion can cause an episode). Types of triggers: strong odors, pollution, anger, stress, pets, exercise, pollen, bugs, chemicals, cold air, spores, dust and smoke. There are different triggers from person to person. Peak flow meter: used to see where they are at, to plan for their cares. FEV1 – forced expiratory volume for 1 second. Aerochamber: seals the medication in the chamber – helpful when patient is coughing while trying to take medication so they don't lose it. Asthma classifications (Per the lecture, we don't need to know specifics, but we need to be aware of them): Intermittent – symptoms are less than 2 days a week, 0-1 exacerbations per year. No limitations.