Respiratory
Pneumonia management may include what?
1. antibiotics
2. supplemental o2
3. Turning and repositioning in at risk patients
4. Pursed lip breathing
Interpret this ABG
pH 7.35
CO2 67
HCO3 30
FULLY COMPENSATED RESPIRATORY ACIDOSIS
The pH is now normal. The deviation likely moved up. CO2 is significantly elevated. Bicarb moved to compensate.
What are some reasons a patient can develop Hyperkalemia?
1. Kidney Problem
2. ACE Inhibitors
3. Hemolysis (Make sure you can think of which diseases/injuries can cause this)
4. Certain foods, salt substitutes
sickle cell, trauma
4. Acidosis
Are we missing any more?
Symptoms of a DVT are?
When caring for a patient with congestive heart failure, what is something important for the nurse to teach the patient regarding diet and over the counter drugs?
Limit the use of NSAIDS (worsen HTN, promote fluid retention).
Limit Salt intake
What are some ways to diagnose Tuberculosis?
1. Chest X-ray
2. Sputum Culture (AFB)
3. Mantoux skin test
4. Gold top (quantiFERON blood test)
Interpret this ABG
pH 7.19
CO2 40
HCO3 - 18
A dehydrated patient will likely have which lab abnormalities
Sodium ____
Urine Specific Gravity ____
BUN _____
Elevated
Elevated
Elevated!!!
Know the normal values
Complications of unmanaged/untreated HTN are?
1. Renal Failure
2.Heart Failure
3. Aneurysms
4. Stroke
unilateral leg pain,
erythema
swelling
+ homan's sign
What precautions should the nurse advocate for with a patient who presents to the hospital with a complaint of fever, night sweats, weight loss, hemoptysis?
1. Airborne/Droplet
TB patients need to be put in isolation to minimize spread of disease.
What are some causes of Acidosis?
Hypoxemia
DKA
Toxicity/OD
Can you name others?
A patient has been taking Spironolactone for the past 3 months. What complication should the nurse anticipate?
Hyperkalemia
A 64 year old male presents to the ER with a complaint of chest pain. What are some important diagnostic tests the nurse should anticipate?
ECG
Cardiac Troponin I
Hypertensive Emergency.
1 37 year old M presents to the ER with a c/o productive cough (green phlegm) x 3 days. The patient has the following VS
T - 101.9
RR - 20
O2 93%
BP 118/76
What is the likely cause of the patient's symptoms?
Pneumonia
Difference between CAP and HAP??
Symptoms of hypernatremia include?
A patient taking Loop Diuretics may develop
Hypotension
Dehydration
A patient who develops chest pain at rest and is not relieved with 3 doses of Nitroglycerin has likely developed ________________ and needs to _____
Unstable Angina/ACS
Call 911
If Hypertension goes unmanaged for years what will likely happen?
1. Renal Dx
2. CHF
3. Stroke
Having the patient use Incentive Spirometry, cough, managing their pain, ambulating after surgery or during hospitalization are good ways nurses help patient prevent getting ______
Pneumonia
Central pontine myelinolysis is a complication from
correcting hyponatremia too quickly
A patient with Hyperkalemia received Kayexalate. How does this medication work?
As the resin passes along the intestine or is retained in the colon after administration by enema, the sodium ions are partially released and are replaced by potassium ions. For the most part, this action occurs in the large intestine, which excretes potassium ions to a greater degree than does the small intestine.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/011287s022lbl.pdf
A 45 year old Female with epigastric pain, nausea, and vomiting should be assessed with ________ to r/o_______ as these symptoms are called _____________
ECG
STEMI!!!
Atypical MI symptoms/Anginal Equivalents
DVT prophylaxis management is with _____________
Sub Q Lovenox (enoxaparin)
SubQ Heparin
Nursing diagnosis associated with a patient with pneumonia include ....
Ineffective airway clearance
Impaired Tissue Perfusion
Activity Intolerance
Know the implications and reasoning behind these
A patient given Spironolactone and Metoprolol for heart failure is expected to have
a. normal K, HR 67
b. Hyper K, HR 90
c. Hypo K, HR 59
d. Hyper Na, HR 100
A
A patient with a serum sodium of 173mg/dl who is symptomatic would likely develop what medical problem? What would be the appropriate intervention?
Pt has Hypernatremia
Can develop Seizures
Need to administer Hypotonic saline (0.45 NS or water)
What is the difference between hypertension and hypertensive Emergency?
Hypertensive Emergency shows evidence of end organ damage
1. Renal - Elevated BUN/Creatinine
2. Cardiac - ECG changes/BNP/Troponin leak
Risk factors for developing a DVT is
1. Prolonged immobility
2. Smoking
3. Hip or prolonged surgery