Nurs-300: Exam 2

Order: Acetaminophen 400 mg PO q6h. Child weighs 32 kg. Safe range: 10-15 mg/kg/dose. What is the safe dose range for this patient? What is the safe dose range for this patient? Is this safe?

320-480 mg/dose, Yes it is safe

Order: Ibuprofen 200 mg PO. The patient weighs 25 kg. Safe range: 5-10 mg/kg/dose. What is the safe dose range for this patient? Is this safe?

125-250 mg/dose, Yes it is safe

Order: Morphine 6 mg IV q4h. This patient weighs 80 kg. Safe range: 0.05-0.1 mg/kg/dose. What is the safe dose range for this patient? Is this safe?

4-8 mg/dose, Yes it is safe

Order: Digoxin 0.125 mg PO daily. Child weighs 20 kg. Safe range: 0.01-0.02 mg/kg/day. What is the safe dose range for this patient? Is this safe?

0.2-0.4 mg/day, No it is below safe range

22 lb; Safe: 25-50 mg/kg/day divided BID; Order: Amoxicillin 300 mg PO BID. What is the safe range? Is it safe?

125-250 mg/dose, No it is not safe

44 lb; Safe: 50-100 mg/kg/day divided every 8 hr; Order: Cefazolin 750 mg IV every 8 hr. What is the safe range? Is it safe?

333.3-666.7 mg/dose; No it is not safe

What carries oxygen in the body?

plasma and red blood cells

97% of oxygen is carried by __ in the form of __

red blood cells, oxyhemoglobin

Other than oxygen (oxyhemoglobin) what else does hemoglobin carry ?

carbon dioxide in the form of carboxyhemoglobin

What must occur between the circulating blood and tissue cells?

internal respiration

What is the normal WBC range?

5,000-10,000 /mm3

What is the normal range for hemoglobin?

12-18 g/dL

What is the normal hemoglobin range for women?

12-16 g/dL

What is the normal hemoglobin range for men?

14-18 g/dL

What is the normal hematocrit range for women?

37-47%

What is the normal hematocrit range for men?

42-52%

What is the normal platelet count range?

150,000-450,000/mm3

What are factors that affect cardiopulmonary functioning and oxygenation?

level of health (renal, cardiac, muscular, anemia), medications, developmental considerations, lifestyle/culture, environment, psychological health, social determinants

What is the normal respiratory rate range for infants (birth-1 year)?

30-60 breaths/min

What is the normal respiratory rate range for early childhood (1-5 years)?

20-40 breaths/min

What is the normal respiratory range for late childhood (6-12 years)?

15-25 breaths/min

What is the normal respiratory range for adolescent and adult (18+ years)?

12-20 breaths/min

What is the normal respiratory pattern for infants (birth-1 year)?

abdominal breathing, irregular in rate and depth

What is the normal respiratory pattern for early childhood (1-5 yrs)?

abdominal breathing, irregular

What is the normal respiratory pattern for late childhood (6-12 years)?

thoracic breathing, regular

What is the normal respiratory pattern for adolescent and adults (18+ years)?

thoracic, regular

What is the normal shape of thorax for infants (birth-1 yr)?

round

What is the normal shape of thorax for early childhood (1-5 years)?

elliptical

What is the normal shape of thorax for late childhood (6-12 years)?

elliptical

What is the normal shape of thorax for adolescent and adult (18+ years)

elliptical or barrel-shaped

In infants, lungs are transformed from:

fluid filled structures to air filled organs

Why is ‘surfactant’ important to infants?

24-36 weeks of gestation it prevents lung collapse in newborn

the infants chest is __, airways are __, and __ is a potential problem

small, short, aspiration

What is an infant’s respiratory rate and activity like?

rapid, primarily abnormal

The first 3 months of an infant’s life what typically occurs?

periods of apnea, periodic breathing (less than 20 sec, usually 10 secs or less). >20 secs or frequent apnea is abnormal

What are toddler/preschool age eustachian tubes, bronchi, and bronchioles like?

elongated and less angular

At what stage of life does the immune system begin to protect against most infections?

by the end of late childhood

What sicknesses are most common in toddler/preschool aged children and for those in school settings?

Colds and upper respiratory infections (URI), otis media (ear infection) bronchitis, pneumonia

What are some respiratory considerations and concerns with school age-adolescents?

asthma, environmental allergies, respiratory infections

What are some school aged-adolescents considerations?

belief of invulnerability, hard to teach, peers strongly influence

What are some considerations for young and middle aged adults?

unhealthy diet, lack of exercise, stress, smoking/vaping, substance abuse

In older adults: boney landmarks are more __ due to __

prominent, loss of subcutaneous fat

What type of back problem is prominent in older adults and what’s it look like?

Kyphosis, appearance of leaning forward

What may result in increased anterior/posterior diameter especially in older adults?

barrel chest

in older adults: tissues and airways become more __ and diaphragm moves __

rigid, less efficiently

What disease are older adults most at risk for?

pneumonia

What are some structural and functional changes in older adults?

decreased ciliary action, decreased muscle strength, atherosclerosis in arteries

What is the purpose of the ‘allen test’?

a quick bedside check to see of blood flows properly through radial and ulnar arteries in wrist

What is the normal outcome from allen test and what does it mean?

normal color comes back to hand within 5-15 seconds, meaning one artery is healthy enough to supply blood to hand alone

When are Allen tests most commonly used?

before an arterial stick

What are some cardiac biomarkers?

total creatine kinase (CK total), creatine kinase-MB (CKMB), Troponin I

What is in a complete blood count (CBC)?

hemoglobin (hgb) and hematocrit (hct).

What does blood carry?

o2, co2, nutrients, waste

What does ECG, EKG measure?

electrical currents in heart

What are sputum collection indications?

cytology to identify cancer; c/s to grow and identify microorganisms and the antibiotics effective against them

How soon can you get a sputum culture and sensitivity (C/S) back?

24-72 hrs

What is acid fast bacillus (AFB) and how often do you collect?

sputum to test for a type of bacteria that causes TB, 3 morning collections

What are sputum collection considerations?

best in morning, wait 1-2 hrs post eating, perform CPT, sterile specimen container, label, lab slip, biohazard bag

What PPE should be used for sputum collection?

gown, gloves, mask, goggles

What are thoracentesis considerations?

base line data, monitor pt during procedure, informed consent, pt sitting up right

is bronchoscopy done under anesthesia?

yes

Nursing consideration for bronchoscopy?

informed consent and assessment prior to procedure, gag relfex returns before giving any fluids (aspiration risk) post op

Spiral CT

less invasive, faster scan, accurate

What do we assess prior to IV contrast?

kidney function, allergies, medications, pregnancy status

How may pt feel during IV contrast injection (for CT)?

warm and flushed

What should you do after CT scan& Iv contrast?

hydrate either by mouth or via IV

What would you use chest x-ray (CXR) for?

screen, diagnose, evaluate changes- pneumonia, trauma-fractures, confirmation of tube placement, ETT, or trach, NG tube

What is the hypothesis/clinical problem for airway management?

ineffective airway clearance/retained secretions, impaired gas exchange/hypoxia, ineffective breathing pattern/labored breathing/dyspnea, infection, risk for aspiration

What are some actions/interventions, health promotion for airway management?

healthy lifestyle choices/behavior, exercise/nutrition, vaccinations, teaching about pollution free environment, reducing anxiety, maintaining good nutrition, promoting comfort, proper breathing, promoting/controlling coughing, chest physiotherapy, oxygen needs with meds

What are airway clearance manifestations or data expected?

mucosal secretions build up or aspiration pf emesis can obstruct client’s airway, hydration and cough, deep breath helps client maintain a patent airway

What are nursing interventions that mobilize secretions and maintain airway patency?

assist with coughing, hydration, positioning, humidification, nebulizer treatments, chest physiotherapy, suctioning

How do you promote proper breathing?

deep breathing, using incentive spirometry, pursed lip breathing, diaphragmatic breathing

How do you use incentive spirometer?

inhale fully into it, noting how much volume is achieved upon inspiration

You are caring for a patient who is 12 hours status post cholecystectomy. The patient order reads, “Incentive spirometry 10 times per hour while awake.” What is the rationale for incentive spirometry? How would you teach a patient to use an incentive spirometer?

rationale: to expand lungs, improve lung function, prevent complications like pneumonia or atelectasis Teach: pt sit upright, exhale completely and seal lips, inhale slowly, hold breath 3-5s, breathe out and rest, cough

What are ‘crackles’ sometimes heard in breath sounds?

intermittent sounds occurring when air moves through airways that contain fluid

What can ‘crackles’ be classified as?

fine, medium, coarse

What are "‘wheezes” sometimes heard in breath sounds?

continuous sounds heard on expiration and sometimes inspiration as air passes through airways constricted by swelling, secretions, or tumors, louder over chest/back

What can ‘wheezes’ be classified as?

sibilant or sonorous

What is ‘stridor’ sometimes heard in breath sounds?

noisy breathing that occurs due to obstructed airflow through a narrowed airway

What is ‘rhonchi’ sometimes heard in breath sounds?

continuous gurgling or bubbling sounds typically heard during both inhalation and exhalation

What are other things besides crackles, wheezes, rales, pleural rub, stridor, and rhonchi that can be found in breath sounds?

diminished/decreased, absent, unequal chest expansion, cough (productive/nonproductive)

What are ‘rales’ sometimes heard in breath sounds?

soft bubbling, crackling, end of inspiration

What is ‘pleural' rub’ sometimes heard in breath sounds?

leathery sound, symmetrical

What are early signs of Hypoxia?

tachypnea, tachycardia, hypertension, diaphoresis, pale skin, restlessness, anxiety, confusion, agitation, unexplained fatigue, dyspnea, exertion, use of accessory muscles

What are late signs of hypoxia?

lethargic, hard to arouse, stupor, cyanosis, cold/clammy skin, increased accessory muscle use, bradypnea, bradycardia, hypotension, cardiac dysrhythmias

What is a normal pH?

7.35-7.45

What is a normal CO2 level?

35-45 mmHg (lungs)

What is a normal HCO3 level?

22-26 mEq/L (kidneys)

What is a normal PO2 level?

80-100 mmHg

When is the best time of day to do a sputum collection?

morning, wait 1-2 hrs after eating,

What is a Thoracentesis?

diagnostic; removing fluid or air from the pleural space

What is the purpose of chest physiotherapy (CPT)?

loosens and mobilizes thick respiratory secretions, moves mucus into larger airways for coughing or suctioning, used for patients unable to clear secretions

What are nursing considerations when using chest physiotherapy (CPT)?

perform 1 hour before or 2 hours after meals, best at bedtime, give bronchodilator/nebulizer first if prescribed, provide tissues, emesis basin, use cupped hands or percussion device

What are three components of chest physiotherapy (CPT)?

percussion, vibration, postural drainage

What is percussion in CPT?

rhythmic clapping with cupped hands, breaks up mucus

What is vibration in CPT?

gentle shaking during exhalation, moves secretions toward larger airways

What is postural drainage in CPT?

uses gravity and positioning to drain specific lung segments

When would you NOT perform CPT?

pregnancy, rib, chest, neck, or head injury, increased intracranial pressure (ICP), recent abdominal surgery, pulmonary embolism, bleeding disorders, osteoporosis

What does continuous positive airway pressure (CPAP) do for a patient?

keeps airways open with continuous positive pressure, improves oxygenation, prevents airway collapse (especially during sleep)

What are some indications for need for CPAP?

obstructive sleep apnea (OSA), COPD, heart failure/pulmonary edema, acute hypoxic respiratory failure