NUR301 Exam 1

Oxygenation

The physiological process of supplying oxygen to cells and tissues to maintain cellular function.

Ventilation

The mechanical movement of air into and out of the lungs to facilitate gas exchange.

Perfusion

Passage of blood through systemic or localized blood vessels to deliver oxygen and nutrients to tissues and remove metabolic waste.

Bronchoscopy

Probe stuck down throat. ‘Flexible’ is for diagnostic viewing, ‘rigid’ is for removing foreign bodies. NPO for 6-8 hours, no aspiration. Remove oral prostheses. Assess for gag reflex afterwards.

Obstructive Sleep Apnea

Repetitive airway collapse during sleep. Can use Continuous Positive Airway Pressure (CPAP), continuous positive pressure. Lifestyle changes, avoid supine position.

Atelectasis

Collapsed alveoli. Get the patient moving, breathing deeply, coughing, and expanding the lungs.

Pneumonia

Community-acquired, hospital-acquired (48+hours after admission), ventilator-associated (48+hours of ventilation), aspiration pneumonia, bacterial, viral, fungal. Treat the underlying condition: antibiotics, antifungal. Supply oxygen. Breathing techniques, incentive spirometry, suctioning.

Tuberculosis

Persistent and productive cough, sometimes with blood. Fever, night sweats, fatigue, weight loss, loss of appetite, chest pain.

Assess respiratory status, vital signs, recent travel. CXR and TB test.

Airborne precautions. Weeks of antibiotic therapy.

Tracheostomy

Stoma in the neck into the trachea.

‘Cuffed’ is used to help manage aspiration risk, seals.

‘Fenestrated’ has an opening that allows for speech.

Monitor secretions, skin integrity, oxygen, quality of breathing.

Pleural Effusions

Buildup of fluid in the pleural space between the lungs and chest wall.

Dyspnea (SOB), decreased breath sounds, nonproductive cough, other respiratory stuff.

Treat underlying cause, bacterial, HF, PE, or… treated with thoracentesis (removal of fluid), important to monitor for pneumothorax.

Pneumothorax

Air in the pleural space, causes partial or complete collapse of the lung.

Primary spontaneous —> without obvious cause.

Secondary spontaneous —> without obvious cause, underlying respiratory condition.

Trauma induced, by an injury.

Sudden chest pain and SOB, tachycardia, tachypnea. Monitor vitals and for respiratory status.

Needle decompression, chest tube insertion, surgical intervention.

Chest Tubes

Removes air or fluid with fluid-sealed suction. Frequently assess vitals and respiratory status. Monitor qualities of drainage. Tidaling is the normal rise and fall of water in chamber with breathing. Continuous bubbling is a sign of a leak.

Pulmonary Embolisms

When a blood clot (usually DVT) becomes lodged in a pulmonary artery. Sudden SOB, tachycardia, tachypnea, pleuritic chest pain. Airway, Breathing, Circulation. Also monitor vitals, will probably be on clot buster/anticoags.

COPD

Target SPO2 is often 88-92%. SOB, chronic cough, sputum, wheezing, fatigue.

Emphysema —> pink puffer.

Chronic Bronchitis —> blue bloater.

Airborne Precautions

TB, Measles, Chickpox.

N95, negative pressure room.

Droplet Precautions

Influenza, meningitis.

Surgical Mask

Contact Precautions

C. Diff, MRSA.

Gown and Gloves.

Neutropenic Precautions

For patients with weak immune systems.

Hand washing, gloves, mask, no sick visitors.

Cardiac Output

The amount of blood the heart pumps per minute (Stroke Volume and Heart Rate).

Low cardiac output has fast heart rate, low BP, weak pulse, pale skin, decreased urine output, SOB.

Cardiac Biomarkers

Biomarkers measure damage to the heart. Elevated biomarkers indicate injury, the higher the greater the injury. The primary biomarker is troponin.

Cardiac Diagnostic Tests

(Noninvasives:) ECG: Checks heart rhythm

Echocardiogram: Checks heart structure and function

Stress test: Tests for heart function

CXR: Looks at heart and lungs

(Invasives:) Cardiac catheterization: checks coronary arteries.

Coronary angiography: uses contrast to see blocked arteries. Uses dye.

Coronary Artery Disease and Angina

CAD is the buildup of plaque in the coronary arteries. Angina is when not enough oxygen is delivered to the heart. Plaque buildup obstructs oxygen delivery, causes Angina.

Treatment includes PCI/Angioplasty, placing a stent. CABG, bypassing coronary arteries.

Myocardial Infarction

Blockage of coronary artery preventing the heart from getting enough oxygen, heart muscle dies. Chest pressure/pain radiating to arm, jaw, neck or back. Woman and older adults may be atypical symptoms.

Heparin

Check PTT and compare to hospital protocol. Too low —> increase heparin, too high —> decrease/hold heparin.

Low PTT indicates that blood is clotting too easily. High PTT indicates that blood is being prevented from clotting.

Cardiomyopathy

Dilated: When the heart becomes enlarged and weak, which leads to poor pumping.

Hypertrophic: When the heart muscle becomes too thick, making it hard to fill properly.

Restrictive: When the heart becomes stiff, also making it hard to fill.

SOB, fatigue, swelling, edema, chest pain, etc. ACE inhibitors, ARBs, Beta-Blockers, diuretics.

Treat the underlying cause, reduce sodium, heart transplant.

Heart Failure

When the heart can’t pump enough blood, blood backs up and fluid builds up.

Left sided: Fluid backs up into the lungs. SOB, crackles, coughing, orthopnea.

Right sided: Fluid backs up into the body. Edema, JVD, weight gain, Ascites.

Daily weights are important! ACE inhibitors, ARBs, diuretics. Oxygen/ventilation if needed.

Atherosclerosis

Fat/plaque buildup within the arteries. This constricts blood flow and creates risk for clot formation, especially if the vessel ruptures.

Caused by high cholesterol and bloob pressure, smoking, obesity, diabetes, inactivity, etc.

May present as chest pain, leg pain with walking, shortness of breath, and more.

Aneurysms

Weakening of the artery wall, causing it to bulge/enlarge, creating a risk of rupturing.

Risk factors include high blood pressure, smoking, atherosclerosis, older age, etc.

Chest or upper back pain, dyspnea, cough, hoarse voice, difficulty swallowing. Control BP, stop smoking, manage cholesterol, surgical repair and stents are available.

Third Spacing

When fluid moves out of the bloodstream into other bodily spaces. It becomes inaccessible and unusable to the body, lowering the overall circulating blood volume.

Edema/swelling, weight gain, low blood pressure, decreased urine output.

Treat the root cause. Diuretics.

Hypervolemia (Fluid Volume Excess)

Edema, weight gain, SOB, JVD, high BP, crackles in the lungs.

Daily weights, I&Os, Lung sounds, edema, HR and BP.

Treat underlying cause, administer Diuretics, fluid and sodium restriction

Hypovolemia (Fluid Volume Deficit)

Thirst, dry mouth, weakness, dizziness, low BP, fast HR, decreased urine, weight loss.

Assess daily weight, I&O, BP and HR, skin, urine quantity and color, capillary refill.

IV Fluids, oral fluids, treat the underlying cause (vomiting, diarrhea, etc).

Intravenous Fluids

Isotonic: used for fluid loss, dehydration, and low blood pressure.

Hypotonic: used for cell dehydration and high sodium levels.

Hypertonic: used for severely low sodium and fluid shifts.

Metabolic Acidosis

Low pH, low HCO3. Diarrhea, diabetic ketoacidosis, kidney failure. Confusion, weakness, abnormal breathing. Treat the cause!

Metabolic Alkalosis

High ph, high HCO3. Vomiting, NG suction, diuretics. Weakness, confusion, and muscle cramps. Replace fluids and electrolytes.

Respiratory Acidosis

Low pH, high CO2. COPD, airway obstruction, and respiratory depression. Slow/shallow breathing with headache.

Improve ventilation and provide oxygen as ordered.

Respiratory Alkalosis

High pH and low CO2. Anxiety, hyperventilation, pain and fever. Fast breathing, dizziness, and tingling.

Treat the cause and slow down breathing.

Potassium

3.5-5.0

Hypokalemia: Often caused by diuretics, vomiting diarrhea. Causes muscle cramps, fatigue, weakness, and dysrhythmias. Treated by providing potassium

Hyperkalemia: Caused by kidney failure, ACE inhibitors, and over supplementation. Causes muscle weakness, dangerous dysrhythmias. Treated with IV calcium, insulin and glucose.