RN MedSurg Final Review 2022 (Answered) Complete Verified Solution

RN MedSurg Final Review 2022 (Answered) Complete Verified Solution Perfusion Circulation of blood within an organ or tissue in adequate amounts to meet current needs of the cells. peripheral arterial disease (PAD) disease of the arteries in the arms and legs, resulting in narrowing or complete obstruction of the artery signs and symptoms of peripheral arterial disease Intermittent claudication, pain at rest, tightening pressure in calves or buttocks, and ischemic changes. BP in the effected extremity is lower. Pallor with elevation, rubor when dependent. Peripheral Venous Disease (PVD) damage, defects or blockage in the veins that carry blood from the hands and feet to the heart signs and symptoms of peripheral venous disease - ruddy, cyanotic, brownish pigmentation - edema usually present, better with elevation - normal nails - normal pulses - warm - moist at bony ankle Ted hose, compression stockings, anti-embolic hose special stocking used to help prevent swelling and blood clots and to aid circulation (aka elastic or compression stockings) Plavix (clopidogrel) Antiplatelet Buerger's disease A condition in which the blood vessels, especially those supplying the legs, are constricted whenever nicotine enters the bloodstream, the ultimate result being gangrene and amputation. Raynaud's disease a peripheral arterial occlusive disease in which intermittent attacks are triggered by cold or stress high cholesterol Hyperlipidemia (HLD) Atherosclerosis condition in which fatty deposits called plaque build up on the inner walls of the arteries respiratory acidosis A drop in blood pH due to hypoventilation (too little breathing) and a resulting accumulation of Co2. respiratory alkalosis Arise in blood pH due to hyperventilation (excessive breathing) and a resulting decrease in CO2. metabolic alkalosis elevation of HCO3- usually caused by an excessive loss of metabolic acids metabolic acidosis decreased pH in blood and body tissues as a result of an upset in metabolism S/S of metabolic acidosis Changing leves of consciousness, ranging from fatigue, & confusion to stupor & coma, headache, vomiting & diarrhea, anorexia, muscle weakness & cardiac dysrhythmias. S/S of metabolic alkalosis observe LOC decreased K levels muscle cramps and life threatening arrhythmias S/S of respiratory acidosis Headache Restlessness Mental status changes, such as drowsiness and confusion Visual disturbances Diaphoresis Cyanosis as the hypoxia becomes more acute Hyperkalemia Rapid, irregular pulse Dysrhythmias leading to ventricular fibrillation S/S of respiratory alkalosis lightheaded, faint, peri-oral numbness, numbness and tingling in fingers and toes acid-base balance equilibrium between acid and base concentrations in the body fluids cardon dioxide Product of metabolism Cells bicarbonate buffer system CO2 (g)+ H2O(l)↔H2 CO3 (aq)↔H+ (aq)+HCO3- (aq) -Blowing off CO2 (hyperventilation) decreases levels of CO2 which causes reaction to shift left consuming H+ and reducing H+ in the blood making pH less acidic -mechanism that deals w/ acidemia (excess H+ in blood) COPD (chronic obstructive pulmonary disease) disease with enlarged lung spaces, usually from smoking can cause shortness of breath S/S of COPD -Dyspnea -SOB -Clubbing of finger nails -Barrel chest -Cough -Crackles and wheezing -Low O2 sat -shallow respirations -Orthopnea -Pale, ashen skin color Treatment for COPD Low flow oxygen Aerosolized bronchodilators Bronchial hygiene as indicated Inhaled corticosteroids Antibiotics of indicated by sputum culture referral to smoking cessation program (nicotine replacement therapy) Pulmonary rehabilitation, proper nutrition and fluid intake Consider NPPV for acute exacerbations of ventilatory failure bronchodilator a medication that relaxes and expands the bronchial passages into the lungs Prednisone Corticosteroid Albuterol Bronchodilator COPD treatment COPD TREATMENT ● Immunizations ● Antibiotics ● Bronchodialators ● Corticosteroids - Oral and Inhaled ● Beta-Adrenergic Agonists ● Oxygen Therapy - Low flow rate: Normally, CO2 stimulates breathing b/c it initiates Hypoxic Drive. Chronic COPD patients have chronic elevated carbon dioxide levels. They "retrain" their bodies to breath when they are low in oxygen. High rate flow may actually stop breathing. This will increase PaC02 leading to somulence and respiratory failure. COPD oxygen therapy hypoxemia relief lower levels of oxygen chronic hypercarbia COPD goals Prevention of disease progression Ability to perform ADLs Relief from symptoms No complications related to COPD Knowledge and ability to implement long-term regimen Overall improved quality of life COPD diet soft, high-calorie, low-carbohydrate, high-fat, small frequent feedings Emphysema a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness. chronic bronchitis inflammation of bronchi persisting over a long time; type of chronic obstructive pulmonary disease (COPD) Blue bloater Chronic bronchitis- hypoxemia, hypercapnia pink puffer Dyspnea, hyperventilation (emphysema) lung cancer a condition in which cancer cells form in the tissues of the lung Lung cancer screening The USPSTF recommends annual screening for lung cancer with low-dose computed tomography in adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. Lung cancer risk factors -Smoking (including 2nd hand exposure) -Radon gas (miners) -Asbestos -Metals (arsenic, nick, chromium) -Family hx -Pulmonary fibrosis -COPD -Sarcoidosis -Age > 40 lobectomy removal of a lobe of a lung chest tube Catheter inserted through the thorax into the chest cavity for removing air or fluid; used after chest or heart surgery or pneumothorax. chest tube tidaling is when there is a visible fluctuation in water, if there is no fluctuation it could mean loose connection of chest tube chest tube bubbling Ask yourself where and when Water seal - intermittent = Good = Document - Continuous = BAD = leak in the system = find the leak and put tape on it. Suction control chamber - intermittent = Bad = suction is too low = go to the dial at the wall and turn it up until it bubbles continuously Two are good and two are Bad What is good in one is bad in the other! ONLY REMEMBER - if something is sealed which chamber are you talking about? water SEAL = sealed = should be sealed up! therefore cont. bubbling is BAD! Intermittent is good! Then just know for suction control it is opposite If you see a (Sealed) soda and it is bubbling continuously, are you going to buy it? NO! Bc the seal is broken bc its bubbling nonstop! Chest tube assessment and management tubing--no dependent loops keep collection chamber lower than chest water seal chamber-tidaling with deep inspiration AIR LEAK--bubbling in water seal chamber Suction control chamber-gauge or water level determines amt of suction Clamp only when changing system lung biopsy Surgical removal of lung tissue followed by microscopic examination of cells. bronchoscopy the visual examination of the bronchi using a bronchoscope prostate cancer cancer of the prostate gland, usually occurring in men middle-aged and older prostate cancer risk factors genetics diet (high fat intake*) obesity African Americans Prostate cancer screening -Start screening at age 50; High risk begin discussions at 40-45 -If PSA < 2.5; test q 2yrs -If PSA > 2.5; annual testing -If PSA > 4.0; refer for evaluation PSA prostate-specific antigen prostate biopsy a procedure in which prostate gland tissue samples are removed from the body for examination under a microscope to determine whether cancerous or other abnormal cells are present Prostate Radiation and Radiation seed implant Side effects: less recovery, impair functions, Doesn't kill all cells, surgery not possible prostatectomy surgical removal of the prostate Bladder irrigation -Removes mucus, blood clots, and other tissue from the bladders -Introduces medication into the bladder prostate cancer education