NUR 195
Final Exam Outline
ATI Chapters 15, 17-36, 38, 46-52, 56-61, 67-74,
82-83
H&C Chapters 20-31, 39-48, 51, 53-55, 60-61, 67
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1. Respiratory Assessment and Care Modalities
a. Respiratory Assessment
• Health History- Past Health, Social, and Family History
i. Physical Assessment
General Appearance
• Clubbing
• Cyanosis Upper Respiratory Structures
• Nose and Sinuses
• Trachea
Lower Respiratory Structures and Breathing
• Positioning
• Thoracic Inspection
• Thoracic Auscultation
• Anterior/Posterior
Wheeze
1. Lung Sounds
• Asthma & COPD
• Narrowing of Airway
Coarse Crackles
• PNA & Pulmonary Edema
ii. Diagnostics
PFT
PFT= Pulmonary Function Tests
Determine Lung Function and Breathing Difficulties
ABG’
Arterial Blood Gases (ABG)
Reports the Status of Oxygenation and Acid-Base Balance in the Blood
pH
PaO2
• Amount of H+
• Partial pressure of oxygen
PaCO2
• Partial pressure of carbon dioxide
HCO -
• Concentration of bicarbonate
SaO2
• Percentage of oxygen bound to HgB as compared to the total amount that can be carried
Bronchoscopy
Directly Examine Larynx, Trachea, Bronchi
Indications
• Visualize and Biopsy Tissue
• Visualize Inflammation or Strictures
• Aspirate Secretions, Sputum or Lung Abscesses
• Removal of Foreign Bodies
Considerations
• Pt is sedated and given anesthetic
• NPO 4-8 hours before exam
• ADAT after procedure when gag/cough reflex is present
Thoracentesis
Aspiration of Fluid from the Pleural Space
• Pleural Fluid Lubricates the Movement of the Lungs in the Thorax Indications
Sputum Cultures
• Empyema
• Pneumonia
• Best collected in the morning before the patient has had anything to eat or drink Use a sterile container
X- Ray
Patient Education=Contraindicated in pregnancy
• Patient needs to take a deep breath and HOLD it
Patient Preparation= Gown and take off jewelry/metal
• May use lead shield over thyroid, ovaries, and testicles
• Nurse should observe the three principles of time, distance, and shielding
CT
Patient Education= Contraindicated in allergy, pregnancy, morbid obesity
Patient Preparation= Must remain supine, sit still; NPO for 4 hours prior if contrast needed
MRI
Patient Education=Uses magnet and radiofrequency instead of radiation
• May also use contrast
• More detailed images
• Contraindicated in morbid obesity, claustrophobia, confusion/agitation, implanted metal
a. Some medical devices are okay Patient Preparation=Remove all metal, must lay flat and still
• OFFER EAR PLUGS
Pulse Ox
Noninvasive
• Measures oxygen saturation of hemoglobin
• Sensor can be placed on finger, forehead, earlobe, nare, lip, bridge of nose
Chest Tubes
2. Fluoroscopy
a. Patient Education
b. Patient Preparation
Water Seal=Allow excess air/fluid to exit pleural space with exhalation and stops air from entering with inhalation
c. Sterile Water at Bedside
3. Tidaling= expected
Bubbling=Air Leak in System
Indications=Pneumothorax
• Hemothorax
• Pulmonary Empyema
Complications=Air Leaks
• Do not d/c with air leak Accidental Disconnection
• Keep Sterile Water at Bedside
• Keep Occlusive Dressing at Bedside Tension Pneumothorax
• Clamped/Kinked Tubing
Removal=Pain Medication 30 Min Before
• Remove Sutures
• Patient will Valsalva
• Apply Airtight, Sterile Petroleum Jelly Gauze Dressing
• Obtain Chest X-Ray
• Monitor Wound Drainage
b. Oxygen Modalities
i. Nasal Cannula _1-6_ L
ii. Simple Mask 5-8_ L
iii. Venturi Mask _4-10_ L
iv. Nonrebreather 10-15_ L
CPAP- Continuous Positive Airway Pressure (CPAP)
• Sleep Apnea
Requires Leak-Proof Mask
BiPap Bi-level Positive Airway Pressure (BiPAP)
• COPD or Ventilatory Assistance
• Requires Leak-Proof Mask
v. Mechanical Ventilation Breathes for patient
Hypoxemia Hypoventilation Respiratory failure Compromised airway
Respiratory distress with confusion
Increased work of breathing not relieved by other interventions
Controlled hyperventilation
vi. High Flow Nasal Cannula
c. Treatments
i. Incentive Spirometer
1. Patient Education Sit upright in a chair or in bed.
2. Put the mouthpiece in your mouth and close your lips tightly around it.
3. Breathe in (inhale) slowly through your mouth as deeply as you can.
4. Try to get the piston as high as you can, while keeping the indicator between the arrows.
Tracheostomy Surgical procedure
• Complications
• Can occur early or late (years after removal)
Small Volume Nebulizer
Indications
• Asthma attack
• SOB Nursing Management
• Smoking when it is working Albuterol is most common drug used in SVN [Show Less]