Class notes NURS 324 Lewis's Medical-Surgical Nursing

1. Respiratory Problems
a. Asthma
 Assessment
 Symptoms: Dyspnea, wheezing, chest tightness, cough (often worse at night or early
morning).
 Physical Examination: Prolonged expiration, use of accessory muscles, decreased
oxygen saturation during exacerbations.
 Diagnostics:
 Peak Expiratory Flow Rate (PEFR): Decreased during an attack.
 Pulmonary Function Tests: FEV1/FVC ratio decreased.
 Allergy Testing: To identify triggers.
 Management
 Medications:
 Rescue Inhalers: Short-acting beta-agonists (e.g., albuterol).
 Controller Medications: Inhaled corticosteroids (e.g., fluticasone), leukotriene
modifiers (e.g., montelukast).
 Severe Exacerbations: IV corticosteroids, oxygen therapy, and magnesium
sulfate.
 Patient Education:
 Proper inhaler technique.
 Trigger avoidance (e.g., allergens, smoke, stress).
 Monitoring symptoms using a peak flow meter.


b. Tracheostomy
 Management
 Regular stoma care: Cleaning and ensuring the area remains free of infection.
 Assess for complications: Tube dislodgment, infection, tracheal stenosis.
 Humidified air to prevent mucus plugging.
 Suctioning
 Indications: Excessive secretions, respiratory distress, audible gurgling.
 Procedure:
 Use sterile technique.
 Limit suctioning to 10-15 seconds per pass to prevent hypoxia.
 Monitor oxygen saturation and heart rate.


c. Chronic Obstructive Pulmonary Disease (COPD)
 Vaccines
 Annual influenza vaccine.
 Pneumococcal vaccine (e.g., PCV13, PPSV23).

,  Patient Education
 Smoking cessation is critical.
 Energy conservation techniques.
 Adequate hydration (to thin secretions).
 Avoiding respiratory irritants (e.g., pollution, dust).
 Postural Drainage
 Positioning to facilitate mucus drainage from different lung segments.
 Often used in conjunction with percussion or vibration.
 Pursed-Lip Breathing
 Technique: Inhale through the nose, exhale slowly through pursed lips.
 Benefits: Reduces air trapping and dyspnea, improves oxygenation.
 Management/Nursing Care
 Medications:
 Bronchodilators: Beta-agonists (e.g., salmeterol) and anticholinergics (e.g.,
tiotropium).
 Inhaled corticosteroids for exacerbations.
 Oxygen Therapy: Target oxygen saturation 88-92% to prevent CO2 retention.
 Monitor for signs of exacerbation: Increased dyspnea, sputum changes, fever.


d. Tuberculosis (TB)
 Risk Factors/Transmission
 Risk Factors: HIV infection, crowded living conditions, malnutrition, healthcare
exposure.
 Transmission: Airborne droplets. TB spreads when an infected person coughs, sneezes,
or talks.
 Medications
 Isoniazid (INH): Monitor for hepatotoxicity and peripheral neuropathy (prevent with
pyridoxine).
 Rifampin: Common side effects include orange discoloration of bodily fluids and
hepatotoxicity.


e. Pulmonary Embolism (PE)
 Management
 Immediate Actions: Administer oxygen, elevate the head of the bed.
 Monitor vital signs, especially for signs of shock or hypoxia.
 Treatment
 Anticoagulants: Heparin (IV) initially, followed by oral warfarin or DOACs (e.g.,
rivaroxaban).
 Thrombolytics: For massive PE with hemodynamic instability.

,  Preventive Measures: Early ambulation, compression stockings, prophylactic
anticoagulation for high-risk patients.


f. Pneumonia
 Types
 Community-Acquired (CAP): Acquired outside hospital settings.
 Hospital-Acquired (HAP): Onset ≥48 hours after hospital admission.
 Aspiration Pneumonia: Inhalation of food, liquid, or gastric contents.
 Risk Factors
 Advanced age, chronic diseases (e.g., diabetes, COPD).
 Immunosuppression (e.g., HIV, chemotherapy).
 Smoking, prolonged immobility, recent surgery or intubation.

2. Fluids and Electrolytes


a. Arterial Blood Gas (ABG)
 Interpretation of ABG Results
 Key Components:
 pH: Normal range 7.35–7.45.
 PaCO₂: Normal range 35–45 mmHg (respiratory component).
 HCO₃⁻: Normal range 22–26 mEq/L (metabolic component).
 PaO₂: Normal range 80–100 mmHg (oxygenation status).
 O₂ Saturation: Normal >95%.
 Acid-Base Imbalances:
 Respiratory Acidosis: ↓ pH, ↑ PaCO₂ (e.g., COPD, hypoventilation).
 Respiratory Alkalosis: ↑ pH, ↓ PaCO₂ (e.g., hyperventilation).
 Metabolic Acidosis: ↓ pH, ↓ HCO₃⁻ (e.g., ketoacidosis, renal failure).
 Metabolic Alkalosis: ↑ pH, ↑ HCO₃⁻ (e.g., vomiting, excessive antacid use).
 Assessment/Clinical Manifestations
 Respiratory Acidosis: Confusion, drowsiness, headache, hypoventilation.
 Respiratory Alkalosis: Dizziness, tingling, tachypnea.
 Metabolic Acidosis: Kussmaul respirations, hypotension, confusion.
 Metabolic Alkalosis: Nausea, muscle cramps, slow breathing.


b. Dehydration
 Clinical Manifestations
 Thirst, dry mucous membranes, decreased urine output.
 Tachycardia, hypotension, increased hematocrit, and BUN.
 Severe: Altered mental status, hypovolemic shock.