Nursing Study Guide Block 4 Final

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Study Guide for the Final Exam

Here are the rules: please do not call me or email me questions about the study guide. I will answer questions about the study guide during the brief review before the exam itself. You cannot memorize the answers to the questions and do well on the exam- the questions are meant to stimulate thinking, not to be answers. Please remember to review the chapters on shock and MODS as there are questions on this content.

1. There are several ABG questions; remember these also include oxygen numbers so be prepared to determine oxygenation in addition to acid base

PH: 7.35- 7.45

PCO2: 35-45
HCO3: 22-26

O2: 94-100

2. Review the care of the patient with pneumonia, including applicable nursing diagnoses and measureable outcomes Restrictive respiratory disorder: decreased lung expansion- low PaO2, decreased lung compliance, normal to low P/Q ration, shunt, respiratory alkalosis (blowing off co2, more bicarbonate) increased RR, TV smaller. SOB/cough, dyspnea=how many words can they say in one breath chest pain, fatigue, wt. loss, lung crackles,

care: HOB 30deg, fluids to clear secretions, tidal volume--normal breathing 500mL

Nursing dx: impaired gas exchange, ineffective breathing pattern, acute pain

Outcomes: maintains adequate alveolar oxygen-carbon dioxide exchange, clears lungs of fluids and exudates. Demonstrates effective RR, rhythm, and depth of respirations. Reports control of pain following relief measures.

3. Review the treatment for TB (look in Lewis), including medications, length of treatment, evaluation of treatment plan, who is most likely to get TB infection, and side effects of the medications Medications: aggressive TB treatment: four drugs for 6 months, (INH, rifampin [Rifadin], pyrazinamide [PZA], and ethambutol) Newer: rifamycins, rifubin, rifapentine, first line for special situations Length of treatment: 6 months- 1 Year

Evaluation of treatment plan: resolution of the disease, normal pulmonary function, absence of any complication, no transmission of TB, Most likely to contract: Asians have the highest TB rate, followed by Hawaiians and pacific islanders. African Americans are the highest rate inside the US. (45%) Higher rates of TB infections with patients with HIV infections Side effects of meds: alcohol increases hepatotoxicity of INH, monitor liver function. PZA may not be included in initial phase (due to liver disease or pregnancy)

4. Review the care of a patient with lung surgery, including chest tube management To keep lung inflated & Drain fluid from interpleural space

How do you know if collapsed lung: Blood gases, Chest X-ray, Vital signs, Color

Air leaks – bubbling in water chamber: check your tubes for air leak & make sure they’re always free of kinks. Don’t milk the chest tube (unless ordered). Continued bubbling = pneumothorax not resolved yet,

Constant vigorous bubbling = air leak in system
Should see tidaling if not attached to suction
>100cc/hr. of drainage = call doc
Determine if working correctly by:
Monitor output, pain, breath sounds, assess patient breathing, auscultate, ABG, pulse ox (SPO2), skin/mucous membrane coloring, and respiratory effort Chest tube pain is common- give pain meds >7/10

5. Review heart failure: right-sided (acute and chronic), left- sided (acute and chronic), pulmonary edema, cardiomyopathy and management of the patients; remember to review the hemodynamic changes (and values) associated with right and left sided failure RIGHT SIDED HF: (FLUID RETENTION): Corpulmonale, systemic edema, neck vein distention, weight gain, fluid retention, Risk: COPD, hypoxia (pulmonary HTN), causes pulmonary vasoconstriction. CVP = increased; PVR = increased; SVR = increased; wedge = increased; contractility =...
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