NUR215 Exam 3: Medication Administration, Gas Exchange and Oxygenation, Elimination (Part I: Urinary), & Client Education

Polypharmacy

use of multiple medications

What information makes a medication order/prescription from a provider complete?

date and time ordered, name of meds, strength, route, frequency, signature from provider

TACTIS

therapeutic effect, action, contraindications, toxic effects, interventions, safe dose

Rights of med administration

right medication, dose, client, route, time, documentation

What are the three checks?

remove from storage, take out of packaging, at bedside (compare to EMAR)

When is medication reconciliation performed

admission, transitions of care, discharge

Enteral types

oral, tube

Topical types

transdermal, ophthalmic, otic, nasal, intravaginal, rectal, inhaled

Parenteral types

ID, Subq, IM, IV

Intradermal needle

Intradermal angle

5-10 degrees

Subcutaneous needle

Subcutaneous angle

45-90 degrees

Intramuscular needle

Intramuscular angle

90 degrees

Intravenous needle

Intravenous angle

25 degrees

Blood flow route

heart, arteries, capillaries, veins, heart

Pulmonary circulation

flow of blood from the heart to the lungs and back to the heart

Respiratory upper airway anatomy

pharynx and larynx

Respiratory lower airway anatomy

trachea, bronchi, bronchioles, alveoli

Inspiration

diaphragm down, thoracic cavity increase

Expiration

diaphragm up, thoracic cavity decrease

Ventilation

moving gases in and out of lungs/alveoli

Diffusion

moving respiratory gases from one area to another by concentration gradients

Perfusion

ability of cardiovascular system to pump oxygenated blood to tissues and return deoxygenated blood to heart

Work of Breathing

effort required to expand and contract the lungs

Increased work of breathing

breathing faster, not enough oxygen

Increased WOB signs

accessory muscle use, increased RR and HR, diaphoresis, nasal flaring

Lung volumes

lung compliance and airway resistance

Lung compliance

ability of lungs to distend or expand

Diastole

rest, mitral and tricuspid valves permit flow to those relaxed ventricles

Systole

AV valves are closed, hear S1, semilunar valves closing - S2

Cardiovascular structure and function

myocardial pump, myocardial blood flow, systemic circulation, coronary artery circulation

Cardiac output

volume of blood pumped by the heart per minute

Stroke volume

amount of blood ejected from the heart in one contraction

Calculating cardiac output

CO = SV x HR

Normal stroke volume

50-75 mL/contraction

Preload

volume of blood in ventricles at end of diastole

Clients w decreased preload

dehydration, hypovolemia, hemorrhage, hypotensive

Clients w increased preload

hypervolemia (too much fluid), heart failure

Afterload

amount of resistance to ejection of blood from the ventricle

Clients w increased afterload

hypertension, coronary artery disease (blockage/clot)

Contractility

ability of heart to squeeze blood from the ventricles

The conduction systems

SA node, AV node, bundle of His, Purkinje network

P wave

atrial depolarization (contraction)

What does the P wave represent

SA node

QRS Complex

ventricular depolarization (contraction)

T wave

ventricular repolarization (getting ready to contract)

Cardiopulmonary risk factors

sedentary lifestyle, smoking, high BMI, diet high saturated fat, heroin abuse

S1 (lub)

closure of AV valves

S2 (dub)

closure of aortic and pulmonic valves

Respiratory acidosis

low pH, high CO2, hypoventilation

Respiratory acidosis S&S

confusion, fatigue, lethargy, SOB

Respiratory acidosis interventions

improve lung function, mechanical ventilation

Respiratory alkalosis

high pH, low CO2, hyperventilation

Respiratory alkalosis S&S

dizziness, muscle spasms, irritability, nausea

Respiratory alkalosis interventions

regulate o2, reduce anxiety, rebreathing

Hypoxemia

deficient amount of oxygen in the blood

Hypoxemia S&S

dyspnea, wheezing, cyanosis, tachycardia

At risk for hypoxemia

COPD, asthma, pneumonia, heart failure, sleep apnea, COVID-19

Hypoxia

deficiency in the amount of oxygen reaching the tissues

Hypoxia S&S

restless, agitated, dizzy, confusion, cyanosis

At risk for hypoxia

those affecting the heart, lungs, and blood (COPD, emphysema or asthma)

Right-sided heart failure S&S

dependent edema, distended jugular veins, GI distress, enlarged organs, weight gain

Left-sided heart failure S&S

pulmonary congestion, tachypnea, orthopnea, cyanosis (respiratory)

Nasal cannula

low concentrations of oxygen through two prongs that rest in nostrils

When to use nasal cannula

chronic illnesses (COPD, Emphysema)

Simple mask

low concentrations of oxygen, little higher than cannula, fits over a client's nose and mouth

When to use simple mask

low blood oxygen levels (chest pain, dizziness, or minor hemorrhages)

Non-rebreather mask

higher levels of oxygen

When to use non-rebreather mask

emergency, require additional oxygen (smoke inhalation, carbon monoxide poisoning, or trauma)

Partial rebreather mask

two-way valves instead of one-way, rebreathe small amount of outside air

When to use partial rebreather mask

need extra oxygen (smoke inhalation, trauma, or carbon monoxide poisoning)

Venturi mask

regulate percentage of oxygen (only one that does this)

When to use venturi mask

risk of hypercapnia, COPD

Oral suctioning

removal of secretions from the mouth

Nasal suctioning

clearing nasal passages to improve breathing

Nasopharyngeal suctioning

removing secretions from the throat through a nasally inserted catheter

Nasotracheal suctioning

removal of secretions from the trachea through a nasally inserted catheter; sterile technique

Oropharyngeal suctioning

removing secretions from the throat through an orally inserted catheter (clean not sterile)

Productive cough

sputum

Non-effective cough

cannot clear airway

Chronic lung disease assessment findings

increased respiratory rate, fatigue, adventitious lung sounds, accessory muscle use

Never suction for an

effective cough and can clear airway

When should you suction using NTS

non effective cough

Emphysema patient looks like

tripod position, barrel chest

How blood flows through the heart

1.Right Atrium (deoxygenated blood from body)

2.Right Ventricle (pushes deoxygenated blood to lungs)

3.Left Atrium (now oxygenated blood from the lungs)

4.Left ventricle (pushes oxygenated blood to aortas, then to rest of the body)

Patients who have a problem diffusing

atelectasis, postoperative, immobile (not taking deep breaths), smokers (can develop COPD)

Structure responsible responsible for returning oxygenated blood to heart

Cognitive learning

knowledge/thinking

Affective learning

emotions/feelings

Psychomotor learning

action/doing

Urine is produced in the

kidneys

Ureters

attached to each kidney, carries urinary waste to bladder

Bladder

holds urine, holds about 2 cups, once full receptors tell brain to empty

Urethra

where urine passes out body

Nephrons

functional unit of kidney, removes waste from blood, role in fluid/electrolyte balance

Production of urine factors

diet, breathing, sweating, meds

Clear urine

too much water