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Medical Surgical Nursing

Medical Surgical Nursing

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Published by api-3853350
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Published by: api-3853350 on Oct 19, 2008
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\ue000Chest X ray \ue001painless procedure
\ue000Bronchoscopy
o
AtSO4
\ue002Anticholinergic \ue001 mimics SNR
\ue002Decreases saliva \ue001dry mouth
o
NPO 6 to 8 hours
o
Local anesthesia\ue001 check gag reflex before feeding
\ue000ABGo
Hyperventilation\ue001 decreased CO2\ue001 increased blood pH\ue001 respiratory
alkalosis
o
Hypoventilation\ue001 increased CO2\ue001 decreased blood pH\ue001 respiratory
acidosis
o
Diarrhea\ue001 decreased HCO3\ue001 decreased blood pH\ue001 metabolic
acidosis
o
Vomiting gastric content\ue001 decreased HCL\ue001 increased blood pH\ue001
metabolic alkalosis
o
Vomiting blood\ue001 decreased O2\ue001 anaerobic metabolism\ue001 formation of
lactic acid\ue001 decreased blood pH\ue001 metabolic acidosis
o
Blood pH\ue001 normal 7.35 to 7.45\ue001 If increased\ue001 alkalosis; If decreased
\ue001acidosis
o
Partial CO2\ue001 normal 35 to 45\ue001 If increased Respiratory Acidosis; if
decreased Respiratory Alkalosis
o
Partial HCO3\ue001 normal 22 to 26\ue001 If increased Metabolic alkalosis; If
decreased metabolic acidosis
\ue000Cancer of the larynx \ue001CS, alcohol and over usage of voice (choir member)
o
A - nterior neck mass
o
B \u2013 urning sensation with hot beverages / Bad breath
o
C - hange in the voice (hoarseness)
o
D \u2013 ysphagia/dyspnea
\ue000Chronic Obstructive Pulmonary Disease
o
Chronic Bronchitis
\ue002Blue bloater
\ue002Excessive mucus production
o
Asthma
\ue002Periods of bronchospasm and bronchoconstriction
o
Emphysema
\ue002Disequilibrium of elastase and antielastase
\ue002Pink puffer
o
Manifestations
\ue002A \u2013 LTERATION IN
\u2022
LOC\ue001 decreased O2
\u2022
Thoracic anatomy\ue001 over distention of alveoli\ue001 TD =
APD\ue001 barrel chest
\u2022
Skino
Temperature\ue001 cool clammy skin
o
Color\ue001 pale to cyanotic
\u2022
ABG\ue001 Respiratory acidosis\ue001 Increased CO2
\ue002B\u2013 reathing \ue001 difficulty, purse lip \ue001expir ation> inha lat ion \ue001
removal of excess CO2 (diet low CHO)
\ue002C \u2013 ough (mucus production); Chronic hypoxia (2 to 3 lpm of O2
therapy, decreased O2 demand by rest and SFF)\ue001 clubbing of the
fingers and decreased TP to the kidneys causing polycythemia
\ue002D \u2013 ecreased Metabolism
\u2022
Anorexia\ue001 weight loss (high calorie diet)\ue001 fatigue\ue001
weakness
\ue000Bronchodilators
o
Theophylline and aminophylline
\ue002Primary effect \ue001stimulates beta 2 receptors \ue001smooth muscle
relaxation\ue001 bronchodilation
\ue002Side effect \ue001stimulates beta 1 receptors \ue001increases cardiac rate
\ue001need not to notify the physician
\ue002Adverse effect \ue001h y po ten sio n \ue001 monitor BP \ue001 sign of toxicity
\ue002Evaluation \ue001 check breath sounds
\ue000Acute Respiratory Distress Syndrome
o
Causes
\ue002A \u2013 spiration
\ue002R\u2013 espiratory trauma (embolism)
\u2022
fracture\ue001 embolism\ue001 ARDS
\ue002D\u2013 rug toxicity (ASA)
\ue002S \u2013 epsis and shock
\u2022
Vomiting, bleeding, dehydration\ue001 hypovolemia\ue001 shock
\ue001 ARD S
o
Syndrome

\ue002Severe hypoxia
\ue002Bilateral infiltrates
\ue002Dyspnea

\ue000Pulmonary embolism
o
Restlessness\ue001 earliest
\ue000Water Seal System
o
Drainage Bottle\u2192 marked the level every shift
o
Water seal bottle
\ue002Presence of fluctuation\u2192 normal
\ue002Absence of fluctuation\u2192 lungs are fully expanded\u2192 assess first
patient (X ray\u2192 confirm) OR presence of obstruction
\ue002Intermittent bubbling\u2192 normal
\u2022
Absent\u2192 obstruction
\u2022
Continuous\u2192 leakage
o
Suction Control\u2192 continuous bubbling\u2192 normal
\ue000Risk factors for cardiovascular disorders
o
R \u2013 ace\ue001 non modifiable
o
I \u2013 ncresed blood pressure\ue001 modifiable
o
S \u2013 tress\ue001 SNR\ue001 increased BP and CR, vasoconstriction\ue001 modifiable
o
K \u2013 nowing sedentary life style\ue001 modifiable
o
F \u2013 at foods\ue001 atherosclerosis\ue001 modifiable
o
A \u2013 lcohol (modifiable) / Age\ue001 above 40 (non modifiable)
o
C \u2013 igarette smoking\ue001 vasoconstriction (nicotine)\ue001 modifiable /
Contraceptive pills\ue001 clotting of blood\ue001 thrombus formation
o
T \u2013 ype A behavior (modifiable)\ue001 competitiveness, perfectionist\ue001 high
stress level
o
O\u2013 besity
o
R\u2013 esult of DM\ue001 lipolysis\ue001 increased fatty acids\ue001 atherosclerosis
o
S \u2013 ex\ue001gender\ue001 males > female (before menopausal because estrogen
decreases PVR) after menopausal femaleeversib le}[inverted T wave]\ue001
Injury [elevated ST segment]\ue001> male
\ue000Decreased TP in heart \ue001 Ischemia (Angina){r necrosis (MI)
{irreversible}[pathologic Q wave/permanent in the ECG]
\ue000Eating a heavy meal, strenuous exercise, sex, exposure to cold \ue001D ecr eas ed
blood flow (heart)\ue001 decreased TP (heart)\ue001 decreased O2 (heart)\ue001 anaerobic
respiration\ue001 production of lactic acid\ue001 PAIN\ue001 management decreased O2
demand by rest and SFF
\ue000 Ang ina
o
Pain relieved by rest and NTG
o
NTG\ue002Vasodilation \ue001 orthostatic hypotention \ue001 move gradually \ue001
Monitor BP
\ue002Store in a dark and amber container
\ue002Effective \ue001tingling sensation \ue001no need to notify physician

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