Medical Surgical Nursing Review Notes

// MEDICAL SURGICAL NURSING REVIEW NOTES
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b. Cor Pulmonale (right ventricular hypertrophy)
C. Diagnostic Procedure
ABG analysis reveals PO
2
decrease (hypoxemia), PCO
2
increase, pH decrease
Bronchial Asthma
Reversible inflammatory lung condition due to hypersensitivity to allergens leading to narrowing of smaller
airways
A. Predisposing Factors (Depending on Types)
1. Extrinsic Asthma ( Atopic/ Allergic )
Causes
a. Pollen
b. Dust
c. Fumes
d. Smoke
e. Gases
f. Danders
g. Furs
h. Lints
2. Intrinsic Asthma (Non atopic/Non allergic)
2. Intrinsic Asthma (Non atopic/Non allergic)
Causes
a. Hereditary
b. Drugs (aspirin, penicillin, beta blocker)
c. Foods (seafoods, eggs, milk, chocolates, chicken
d. Food additives (nitrates)
e. Sudden change in temperature, air pressure and humidity
f. Physical and emotional stress
3. Mixed Type

90 95%
B. Signs and Symptoms
1. Cough that is non productive
2. Dyspnea
3. Wheezing on expiration
4. Cyanosis
5. Mild Stress/apprehension
6. Tachycardia, palpitations
7. Diaphoresis
1. Pulmonary Function Test
- Incentive spirometer reveals decrease vital lung capacity
2. ABG analysis PO 2 decrease
- Before ABG test for positive Allens Test, apply direct pressure to ulnar and radial artery to determine
presence of collateral circulation
D. Nursing Management
1. Enforce CBR
2. Oxygen inhalation, with low inflow of 2 3 L/min
3. Administer medications as ordered
a. Bronchodilators given via inhalation or metered dose inhalaer or MDI for 5 minutes
b. Steroids decrease inflammation

c. Mucomysts (acetylceisteine)
d. Mucolytics/expectorants
e. Anti histamine
4. Force fluids
5. Semi fowlers position
6. Nebulize and suction when needed
7. Provide client health teachings and discharge planning concerning
a. Avoidance of precipitating factor
b. Prevent complications
- Emphysema
- Status Asthmaticus (give drug of choice)
- Epinephrine
- Steroids
- Bronchodilators
c. Regular adherence to medications to prevent development of status asthmaticus
d. Importance of follow up care
BRONCHIECTASIS
Abnormal permanent dilation of bronchus leading to destruction of muscular and elastic tissues of alveoli
A. Predisposing Factors
1. Recurrent lower respiratory tract infections
2. Chest trauma
3. Congenital defects
4. Related to presence of tumor
1. Productive cough
2. Dyspnea
3. Cyanosis
4. Anorexia and generalized body malaise
5. Hemoptysis (only COPD with sign)
1. ABG PO 2 decrease
2. Bronchoscopy direct visualization of bronchus using fiberscope
Nursing Management PRE Bronchoscopy
1. Secure inform consent and explain procedure to client
2. Maintain NPO 6 8 hours prior to procedure
3. Monitor vital signs and breath sound
3. Monitor vital signs and breath sound
POST Bronchoscopy
1. Feeding initiated upon return of gag reflex
2. Avoid talking, coughing and smoking, may cause irritation
3. Monitor for signs of gross
4. Monitor for signs of laryngeal spasm prepare tracheostomy set
D. Treatment
1. Surgery (pneumonectomy , 1 lung is removed and position on affected side)
2. Segmental Wedge Lobectomy (promote re expansion of lungs)
- Unaffected lobectomy facilitate drainage

EMPHYSEMA
Irreversible terminal stage of COPD characterized by
a. Inelasticity of alveoli
b. Air trapping
c. Maldistribution of gases
d. Over distention of thoracic cavity (barrel chest)
A. Predisposing Factors
1. Smoking
2. Air pollution
3. Allergy
4. High risk: elderly
5. Hereditary it involves deficiency of ALPHA-1 ANTI TRYPSIN (needed to form Elastase, for recoil of
alveoli)
1. Productive cough
2. Dyspnea at rest
3. Prolong expiratory grunt
4. Anorexia and generalized body malaise
5. Resonance to hyperresonance
6. Decrease tactile fremitus
7. Decrease or diminished breath sounds
8. Rales or ronchi
9. Bronchial wheezing
9. Bronchial wheezing
10. Barrel chest
11. Flaring of alai nares
12. Purse lip breathing to eliminates excess CO 2 (compensatory mechanism)
1. Pulmonary Function Test reveals decrease vital lung capacity
2. ABG analysis reveals
a. Panlobular/ centrilobular
- Decrease PO 2 (hypoxemia leading to chronic bronchitis, Blue Bloaters )
- Decrease ph
- Increase PCO 2
- Respiratory acidosis
b. Panacinar/ centriacinar
- Increase PO 2 (hyperaxemia, Pink Puffers )
- Decrease PCO 2
- Increase ph
- Respiratory alkalosis
1. Enforce CBR
2. Administer oxygen inhalation via low inflow
3. Administer medications as ordered
a. Bronchodilators
b. Steroids

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