COPD or Surgery
What would education would be for a COPD patient?
including which medication could be harmful?
medication management, pursed lip breathing, immunizations, lifestyle changes (like quitting smoking), and managing exacerbations and help manage symptoms by resting in between activities to help with energy conservation
harmful- Non selective beta blockers like propranolol and atenolol
Empyema vs pneumonia
Empyema -pus accumulates in the pleural space, the area between the lungs and the chest wall.
pneumonia-infection in any area or lobe of lung
pneumothorax vs atelectasis
pneumothorax-air leaks into the pleural space, putting pressure on the lung and causing it to collapse- trauma, cancer, spontaneous
atelectasis-Collapsed (alveoli) in the lungs-Post-operative atelectasis often develops within 24-48 hours of surgery
What is a concern for a pt dx with Leukemia and a neutropenia count of 2,000? (Normal 5,000-10,000)
infection- what measures to take as a RN?
what medication is commonly used for tb?
side effects?
Rifamin
orange body fluids and as with most medications n/v
Non invasive intervention to avoid PE post surgery
walking
Your patient has a chest tube that is continuously bubbling, what is the next action?
check for a leak or obstruction in tubing
What are the symptoms of PE and how to dx?
chest pain, dyspnea, tachycardia
dx -dimer blood tests, chest X-rays, CT pulmonary angiography (CTPA), ventilation-perfusion (V/Q) scans, and sometimes pulmonary angiography.
What is thrombocytopenia
low number of platelets in the blood.
symptoms- Easy bruising, Blood in urine or stool, petechiae
diagnosis- CBC, blood smear, bone marrow test
Treatment- underlying cause
how to diagnosis Tb?
Quantiferon Gold (QFT-Gold) - reliable and relatively quick blood test
other tests may include lung and sputum cultures
Give 5 facts about ABG
normal levels?
pt assessment prior?
what is it looking for?
pH 7.35 and 7.45 (PaO2) between 80 and 100 mmHg (PaCO2) between 35 and 45 mmHg (HCO3) level between 22 and 26 mEq/L
Allens test
blood levels related to oxygenation
Why do a blood or sputum culture?
Describe why and how to prepare a pt for thoracentesis.
why-to diagnose or treat a pleural effusion IE congestive heart failure (most common cause of pleural effusion), infections, cancer, and autoimmune diseases
how- consent, have pt sit over bedside table leaning over and not talk
Type of Precaution for and what PPE-
contact
droplet
airborne
contact- touching involved, skin infections, gloves and/or mask
droplet- Larger respiratory droplets, flu, surgical mask
airborne- suspended in air, TB and chickenpox, N95
and what would you do if the pt walked into the ED and you were in triage?
risks -weakened immune systems, close contact with infected individuals, living in crowded or unsanitary conditions, and travel to areas with high TB rates.
persistent cough lasting three weeks or longer, chest pain, hemoptysis, fatigue, weight loss, loss of appetite, fever, and night sweats
put a mask on! and negative pressure room considered
Teach how to use an incentive spirometer.
Sit the patient upright — 90 degrees is ideal for full lung expansion. 2️⃣ Instruct them to exhale normally 3️⃣ Place mouth around the mouthpiece and inhale slowly & deeply 4️⃣ Hold the breath for 3–5 seconds, then exhale 5️⃣ Repeat 10 times every hour while awake
First noninvasive intervention if course lungs sounds are heard
cough to clear secretions
what is the best explanation of pleurisy?
a- collapsed lung only in one lobe
b-infection of fluid in the lower lobes of the lung
c-inflammation of lung and chest cavity lining causing dull chest pain, especially when still
d-inflammation of lung and chest cavity lining causing sharp chest pain, especially when breathing
d-inflammation of lung and chest cavity lining causing sharp chest pain, especially when breathing
what is the treatment for chemotherapy induced anemia?
EPOGEN belongs to a class of medications called erythropoiesis-stimulating agents (ESAs). These agents work by mimicking the action of erythropoietin, a hormone produced naturally by the kidneys. Also used in kidney failure- risks include clots, MI
Describe the action and teachings about an antiviral for a pt with AIDS.
antivirals do not kill the virus but suppress its reproduction to other cells
take routinely (do not miss a dose- consistency is key)
What to watch for post laryngectomy
give the different oxygen delivery types and specific considerations
nasal canula - 1- 6L (consider humidified- no petroleum)
Venturi- 2L-15L TIP COLOR SPECIFIC TO LEVEL
Non rebreather- 12-15% (not a good choice for pt vomiting)
High flow- up to 60L
what is the first intervention for an asthmatic pt that is wheezing and dyspneic ?
give beta 2 adrenergic agonist (albuterol)
what are the expected side effects?
lab levels to assess for a pt getting chemotherapy and why.
platelets- thrombocytopenia (150,000 to 450,000 platelets per microliter of blood) bleeding
hemoglobin- low H/H (adult males, 13.5 to 17.5 g/dL, and for adult females, it's 12.0 to 15.5 g/dL )
WBC- leukopenia (below 4,000 cells per microliter of blood) risk for infectin
Maslow
vs
ADPIE
MASLOW- physiological, safety, love and belonging, esteem, and self-actualization
ADPIE: Assessment, Diagnosis, Planning, Implementation, and Evaluation
Least invasive first unless critical ABC involved