Chest X raypainless procedure
Bronchoscopy
o
AtSO4
Anticholinergic mimics SNR
Decreases saliva dry mouth
o
NPO 6 to 8 hours
o
Local anesthesia check gag reflex before feeding
ABG
Hyperventilation decreased CO2 increased blood pH respiratory alkalosis
o
Hypoventilation increased CO2 decreased blood pH respiratory acidosis
o
Diarrhea decreased HCO3 decreased blood pH metabolic acidosis
o
Vomiting gastric content decreased HCL increased blood pH metabolic alkalosis
o
Vomiting blood decreased O2 anaerobic metabolism formation of lactic acid
decreased blood pH metabolic acidosis
o
Blood pH normal 7.35 to 7.45 If increased alkalosis; If decreased acidosis
o
Partial CO2 normal 35 to 45 If increased Respiratory Acidosis; if decreased Respiratory
Alkalosis
o
Partial HCO3 normal 22 to 26 If increased Metabolic alkalosis; If decreased metabolic
acidosis
Cancer of the larynxCS, alcohol and over usage of voice (choir member)
o
A - nterior neck mass
o
B – urning sensation with hot beverages / Bad breath
o
C - hange in the voice (hoarseness)
o
D – ysphagia/dyspnea
Chronic Obstructive Pulmonary Disease
o
Chronic Bronchitis
Blue bloater
Excessive mucus production
o
Asthma
Periods of bronchospasm and bronchoconstriction
o
Emphysema
Disequilibrium of elastase and antielastase
Pink puffer
o
Manifestations
ALTERATION IN
•
LOC decreased O2
•
Thoracic anatomy over distention of alveoli TD = APD barrel chest
•
Skino
Temperature cool clammy skin
o
Color pale to cyanotic
•
ABG Respiratory acidosis Increased CO2
B – reathing difficulty, purse lip expiration >inhalation removal of excess CO2
(diet low CHO)
C – ough (mucus production); Chronic hypoxia (2 to 3 lpm of O2 therapy, decreased O2
demand by rest and SFF) clubbing of the fingers and decreased TP to the kidneys
causing polycythemia
D– ecreased Metabolism
•
Anorexia weight loss (high calorie diet) fatigue weakness
Bronchodilators
o
Theophylline and aminophylline
Primary effect stimulates beta 2 receptors smooth muscle relaxation
bronchodilation
Side effect stimulates beta 1 receptors increases cardiac rate need not to notify
the physician
Adverse effect hypotension monitor BP sign of toxicity
Evaluation check breath sounds
Acute Respiratory Distress Syndrome
o
Causes
A – spiration
R– espiratory trauma (embolism)
•
fracture embolism ARDS
Drug toxicity (ASA)
Sepsis and shock
•
Vomiting, bleeding, dehydration hypovolemia shock ARDS
o
Syndrome
Severe hypoxia
Bilateral infiltrates
Dyspnea
Bilateral infiltrates
Dyspnea
Pulmonary embolism
o
Restlessness earliest sign
Water Seal System
o
Drainage Bottle→ marked the level every shift
o
Water seal bottle
Presence of fluctuation→ normal
Absence of fluctuation→ lungs are fully expanded→ assess first patient (X ray→
confirm) OR presence of obstruction
Intermittent bubbling→ normal
•
Absent→ obstruction
•
Continuous→ leakage
o
Suction Control→ continuous bubbling→ normal
Risk factors for cardiovascular disorders
o
R– ace non modifiable
o
I– ncreased blood pressure modifiable
o
S– tress SNR increased BP and CR, vasoconstriction modifiable
o
K– nowing sedentary life style modifiable
o
F– at foods atherosclerosis modifiable
o
A– lcohol (modifiable) / Age above 40 (non modifiable)
o
C– igarette smoking vasoconstriction (nicotine) modifiable / Contraceptive pills clotting
of blood thrombus formation
o
T– ype A behavior (modifiable) competitiveness, perfectionist high stress level
o
O– besity
o
R– esult of DM lipolysis increased fatty acids atherosclerosis
o
S – exgender males > female (before menopausal because estrogen decreases PVR)
after menopausal female eversible}[inverted T wave] Injury [elevated ST segment]> male
Decreased TP in heart Ischemia (Angina) {r necrosis (MI) {irreversible}[pathologic Q
wave/permanent in the ECG]
Eating a heavy meal, strenuous exercise, sex, exposure to cold Decreased blood flow (heart)
decreased TP (heart) decreased O2 (heart) anaerobic respiration production of lactic acid
PAINmanagement decreased O2 demand by rest and SFF
An g i n a
o
Pain relieved by rest and NTG
o
NTGVasodilation orthostatic hypotension move gradually Monitor BP
Store in a dark and amber container
Effective tingling sensation no need to notify physician
Maximum of 3 tablets with 5 minute interval
MI
o
Pain relieved by Morphine SO4
Narcotic analgesic
Can cause respiratory depression monitor RR and O2 saturation
Antidote narcan
Cardioversionsynchronous
Defibrillation uns y nc hronous
Buerger’s diseaseCS vasoconstriction stop CS common in men
Raynaud’s stress and cold vasoconstriction common in female
Congestive heart failure
Left sided pulmonary
Dyspnea
Crackles
Polycythemia due to decrease O2 to the kidneys
Clubbing of the fingers due to prolonged hypoxia
Orthopnea
o
Right sided systemic
Hepatomegaly
Distended neck veins
Edema
Portal hypertension
Distended neck veins
Edema
Portal hypertension
Ascites weight gain
Varicose veins
o
Digoxin
Cardiac glycoside
Positive inotrophic effect increased strength of myocardial contraction
Negative chronotrophic effect decreased cardiac rate monitor CR never give if
CR below 60 bpm
Adverse effect
•
V – omitting
•
A– norexia
•
N – ausea
•
D – iarrhea
•
A– bdominal pain
•
REMEMBER: earliest GI; late halo vision
•
Antidote Digibind
--------------------------------------------------------------------------------------------------------------
Decreased RBC→ Activity in tolerance, Fatigue, provide rest, Anemia
Decreased Platelets→ Prone to bleeding, avoid parenteral injection, apply pressure on injection
site, high risk for injury
Decreased WBC→ prone to infection, reverse isolation
Increased WBC→ presence of infection
Increased WBC→ presence of infection
-------------------------------------------------------------------------------------------------------------------------------------------------------------------
First Day/Newly diagnosed→ Knowledge deficit
First Day/Newly diagnosed→ Knowledge deficit
Diuretic
o
D– iet high K diet except aldactone
o
I – input and Output expected increased output
o
U – ndesirable effect electrolyte imbalance (K)
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