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Medical Surgical Nursing Notes I

Chest X ray painless procedure Bronchoscopy o AtSO4 Anticholinergic mimics SNR Decreases saliva dry mouth o NPO 6 to 8 hours o Local anesthesia check gag reflex before feeding ABG o Hyperventilation decreased CO2 increased blood pH respiratory alkalosis o Hypoventilation increased CO2 decreased blood pH respiratory acidosis o Diarrhea decreased HCO3 decreased blood pH metabolic acidosis o Vomiting gastric content decreased HCL increased blood pH metabolic alkalosis o Vomiting blood decreased O2 anaerobic metabolism formation of lactic acid decreased blood pH metabolic acidosis o Blood pH normal 7.35 to 7.45 If increased alkalosis; If decreased acidosis o Partial CO2 normal 35 to 45 If increased Respiratory Acidosis; if decreased Respiratory Alkalosis o Partial HCO3 normal 22 to 26 If increased Metabolic alkalosis; If decreased metabolic acidosis Cancer of the larynx CS, alcohol and over usage of voice (choir member) o A - nterior neck mass o B urning sensation with hot beverages / Bad breath

o C - hange in the voice (hoarseness) o D ysphagia/dyspnea Chronic Obstructive Pulmonary Disease o Chronic Bronchitis Blue bloater Excessive mucus production o Asthma Periods of bronchospasm and bronchoconstriction o Emphysema Disequilibrium of elastase and antielastase Pink puffer o Manifestations A LTERATION IN LOC decreased O2 Thoracic anatomy over distention of alveoli TD = APD barrel chest Skin o Temperature cool clammy skin o Color pale to cyanotic ABG Respiratory acidosis Increased CO2 B reathing difficulty, purse lip expiration > inhalation removal of excess CO2 (diet low CHO)

C ough (mucus production); Chronic hypoxia (2 to 3 lpm of O2 therapy, decreased O2 demand by rest and SFF) clubbing of the fingers and decreased TP to the kidneys causing polycythemia D ecreased Metabolism Anorexia weight loss (high calorie diet) fatigue weakness Bronchodilators o Theophylline and aminophylline Primary effect stimulates beta 2 receptors smooth muscle relaxation bronchodilation Side effect stimulates beta 1 receptors increases cardiac rate need not to notify the physician Adverse effect hypotension monitor BP sign of toxicity Evaluation check breath sounds Acute Respiratory Distress Syndrome o Causes A spiration R espiratory trauma (embolism) fracture embolism ARDS D rug toxicity (ASA) S epsis and shock Vomiting, bleeding, dehydration hypovolemia shock ARDS o Syndrome Severe hypoxia Bilateral infiltrates


Pulmonary embolism o Restlessness earliest

Water Seal System o Drainage Bottle marked the level every shift o Water seal bottle Presence of fluctuation normal Absence of fluctuation lungs are fully expanded assess first patient (X ray confirm) OR presence of obstruction Intermittent bubbling normal Absent obstruction Continuous leakage o Suction Control continuous bubbling normal