NR224 Exam 2 Study Guide revised rated gold download for grade A

NR224 Exam 2 Study Guide Revised CH40: Oxygenation 1. What is atelectasis and how do we prevent it? - A collapse of the alveoli that prevents normal exchange of oxygen and carbon dioxide. - 2. Respiratory wise, what are you looking for/at when observing a patient? Breathing patterns, chest wall movement and expansion, AP diameter? 3. What are the 6 P’s of dyspnea? - Pulmonary Bronchial Constriction - Possible Foreign Body - Pulmonary Embolus - Pneumothorax - Pump Failure - Pneumonia 4. If a patient has a pulse ox of 89% we do not immediately place on oxygen, what do we do instead? 5. What is orthopnea? - abnormal condition in which a patient uses multiple pillows when reclining to breathe easier or sits leaning forward with arms elevated. The number of pillows used usually helps to quantify the orthopnea (e.g., two- or three-pillow orthopnea) 6. If a client is experience orthopnea while laying flat in bed, what intervention can we recommend to improve their condition short term? - patient must sleep in a recliner chair to breathe easier. 7. What are the clinical signs and symptoms of hypoxia? - apprehension, restlessness, inability to concentrate, decreased level of consciousness, dizziness, and behavioral changes. 8. What is the first sign of hypoxia that you will observe in a patient? - blood pressure is elevated unless the condition is caused by shock. As the hypoxia worsens, the respiratory rate declines as a result of respiratory muscle fatigue. 9. What clinical manifestations of hypoxia are found late stages? - Cyanosis, blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries. 10. What do you do if you get an abnormal pulse ox reading that does not match your physical assessment? Retake it??? - Example: a SPO2 reading of 76% for a client who’s breathing is unlabored at a rate of 12 without evidence of hypoxia 11. Who should receive a flu vaccine? - Annual flu vaccines are recommended for all people 6 months and older; patients with chronic illnesses (heart, lung, kidney, or immunocompromised), infants, older adults, and pregnant women can get very sick; thus they should be immunized. Close contacts of infants under 6 months should also be immunized. Seasonal flu vaccine protects against influenza viruses that research indicates will be the most common during that year. 12. Who should receive the pneumonia vaccine? - Pneumococcal vaccine (PCV13) is routinely given to infants in a series of four doses and is recommended for patients at increased risk of developing pneumonia. This includes all adults over 65 years of age, those with chronic illnesses or who are immunocompromised (such as HIV/AIDS), any adult who smokes or has asthma, and those living in special environments such as nursing homes or long-term care facilities 13. What are the different oxygen devices? What liters per minute do they require? - Nasal cannula: 1-6 L/min - Oxygen Mask: partial rebreather mask = 6-10 L/min; nonrebreather mask = minimum of 10 L/min; Venturi mask = 4-12 L/min 14. Which ones are used for oxygen support, which ones are used for oxygen and ventilation support? 15. What is the purpose of percussion? - Percussion detects the presence of abnormal fluid or air in the lungs. It also determines diaphragmatic excursion. 16. What is the importance of an incentive spirometer? - encourages voluntary deep breathing by providing visual feedback to patients about inspiratory volume. It promotes deep breathing and prevents or treats atelectasis in the postoperative patient.- How do we use it? 17. Why is it important (respiratory focus) for patients to: - Stay hydrated - Cough & deep breathe - Stay mobile 18. Describe the nursing diagnoses that you would expect for a patient with COPD. CH 45: Urinary Elimination 19. What is the function of the following: -urine is produced in the nephron - Kidneys: remove waste products from the blood and play a major role in the regulation of fluid and electrolyte balance. - Ureters: carries urinary waste to the bladder. - Bladder: a hollow, distensible, muscular organ that holds urine. - Urethra: Urine travels from the bladder through the urethra and passes to the outside of the body through the urethral meatus. 20. What hormone comes from the kidneys and stimulates production of RBCs? - Erythropoietin, produced by the kidneys, stimulates red blood cell production and maturation in bone marrow. 21. How does renin increase your blood volume and blood pressure? - Renin functions as an enzyme to convert angiotensinogen (a substance synthesized by the liver) into angiotensin I. Angiotensin I is converted to angiotensin II in the lungs. Angiotensin II causes vasoconstriction and stimulates aldosterone release from the adrenal cortex. Aldosterone causes retention of water, which increases blood volume. The kidneys also produce prostaglandin E2 and prostacyclin, which help maintain renal blood flow through vasodilation. These mechanisms increase arterial blood pressure and renal blood flow. 22. Describe the symptoms of cystitis (UTI). - urgency, frequency, incontinence, suprapubic tenderness; and foul-smelling cloudy urine. - How do symptoms differ across the lifespan?  Older adults may experience a change in mental status called delirium. In some cases, there will be obvious blood in the urine (hematuria). If infection spreads to the upper urinary tract (pyelonephritis), patients may also experience fever, chills, diaphoresis, and flank pain. 23. What are possible causes of a UTI? – - Risk for a UTI increases in the presence of an indwelling catheter, any instrumentation of the urinary tract, urinary retention, urinary and fecal incontinence, and poor perineal hygiene practices. 24. What foods increase the acidity of the urine, decreasing the risk of UTI’s? - Cranberry juice and vitamin C 25. Describe the symptoms of pyelonephritis. - Systemic symptoms (fever, fatigue, malaise, & dull flank pain), hematuria, painful urination (dysuria), frequency, and urgency. 26. Describe ways a patient could get a UTI in the hospital. - Catheter-associated UTIs (CAUTIs) are an ongoing problem for hospitals because they are associated with increased hospitalizations, increased morbidity and mortality, longer hospital stays, and increased hospital costs 27. Describe the clinical manifestations of urinary retention. - patient may void small amounts of urine 2 to 3 times an hour with no real relief. - Acute or rapid-onset urinary retention stretches the bladder, causing feelings of pressure, discomfort/pain, tenderness over the symphysis pubis, restlessness, and sometimes diaphoresis. - Chronic urinary retention has a slow, gradual onset; patient experiences a decrease in voiding volumes, straining to void, frequency, urgency, incontinence, and sensations of incomplete emptying 28. If a patient has a foley, how would you obtain a sterile specimen? - collect a specimen by using sterile aseptic technique through the special sampling port - found on the side of the catheter. Never collect the specimen from the drainage bag. - Clamp the tubing below the port, allowing fresh, uncontaminated urine to collect in the tube. After wiping the port with an antimicrobial swab, insert a sterile syringe hub and withdraw at least 3 to 5 mL of urine (check agency policy). - Using sterile aseptic technique, transfer the urine to a sterile container - Patients with a urinary diversion need to have the stoma catheterized to obtain an accurate specimen.