Adult Health Exam 2

If the patient is not getting enough oxygen what can happen?

-O2 sat over 90% is sufficient -hypoxia may occur -hypoxia may lead to tissue damage -hypoxia may cause renal damage

bilirubin metabolism

-formed from heme of lysed RBC's- fat soluble: circulate bound to albumin -released to liver cells --> modified to H2O soluble form --> most to bile --> feces -some is reabsorbed at the ileum, excreted in urine -provides color for both urine and feces -jaundice is buildup of bilirubin; usually liver problem

J.G., a 75-year-old woman, is scheduled to have exploratory surgery tomorrow for a bowel obstruction.She has a history of type 2 diabetes. 1. Have students identify J.G.'s risk factors for deficient nutrition. 2. What special considerations should be taken related to her diabetes?

1.

D.T. is an 88 year old woman who lives alone. She has been feeling weaker over past 2 days. Last night became confused and disoriented. Her housekeeper notified her daughter who brought D.T. to the clinic. She reports coughing over the past 3 days. She has a hx of mild HF that is treated medically but no other significant health disorders. She last saw her HCP 4 months ago. 1. What are D.T's risk factors for pneumonia? 2. What type of pneumonia is D.T. likely exhibiting?

1. Age, limited mobility, chronic heart failure 2. CAP because there is no mention of hospitalization or long-term care facility residency within the last 2 weeks; she last saw her HCP 4 months ago.

1. What is the likely cause of this exacerbation? 2. What would you anticipate in regard to treatment? 3. What is G.S. at risk for with exacerbation?

1. Bacterial or viral infection 2. Short-acting bronchodilator Inhaled corticosteroid Possible antibiotic 3. Acute respiratory failure

M.Z. is a 28 yr old male who arrives to the ED following a high-speed MVA. He is complaining severe chest pain rating at a 10. You notice his breathing is labored, part of his chest wall is moving in the opposite direction of the remainder when he breathes. MZ's BP is 96/50, HR 126, RR 36, T 37, Ox 88% on 4L of O2. Alert & Oriented, no open wounds. 1. How would you classify MZ's trauma? 2. Base on his presentation & mechanism of injury, what type of injury would you suspect MZ to have? 3. What potential life-threatening complication of a potential pneumothorax would you need to assess? 4. What would you look for? 5. Nursing priorities

1. Blunt Trauma (occurs when the chest is struck) 2. Pneumothorax (caused by air entering pleural cavity), fractured ribs with flail chest 3. Tension pneumothorax (both respiratory & cardiovascular systems affected, if the tension in the pleural space is not relieved, the patient is likely to die from inadequate cardiac output or severe hypoxemia. 4. dyspnea, marked tachycardia, tracheal deviation, decreased or absent breath sounds on the affected side, neck vein distention, cyanosis, and profuse diaphoresis 5. Administer 02, IV, remove clothing to assess, cover chest wound, place pt. in semi-fowlers or injured side

J.G. is currently NPO with an NG tube placed for bowel decompression. She will remain NPO for a period of time postoperatively.Her provider orders parenteral nutrition. 1. Discuss the benefits of central vs. peripheral parenteral nutrition for J.G. 2. Why would J.G. begin her parenteral nutrition before her surgery?

1. Central solutions are hypertonic. Large central vein can handle high glucose content ranging from 20% to 50%. Peripheral solutions less hypertonic. Peripheral vein can handle glucose up to 20% 2. Short-term nutritional support Protein and caloric requirements not high Risk of central catheter too great Supplement inadequate oral intake

1. What manifestations of pneumonia is D.T. displaying? 2. For what other manifestations would you assess D.T.? 3. What diagnostic tests would you expect the nurse practitioner in the clinic to order?

1. Cough, weakness, confusion 2. Shaking chills; dyspnea; tachypnea; pleuritic chest pain; green, yellow, or rust-colored sputum; rhonchi and rales; bronchial breath sounds; egophony; ↑ fremitus; dullness to percussion if pleural effusion present; nonspecific manifestations including diaphoresis, anorexia, myalgias, headache, and abdominal pain 3. Chest x-ray, sputum for gram stain and culture and sensitivity, CBC with differential, electrolytes, brain natriuretic peptide (BNP)

K. L., a 21-year-old female, comes into your clinic for her routine check-up. She states that she has joined a gym and exercises 3 times/wk.She asks for guidance with her diet to enhance her healthy lifestyle. K.L.'s diet history indicates that she eats 3 meals/day, including fast food regularly. Her favorite snacks are chips, grapes, and ice cream.

1. Discuss diet concerns related to fast food and her snack choices: She may be exceeding 35% of calories from fat in her daily intake She is consuming a large amount of saturated fat 2. Ways to improve K.L.'s daily dietary intake, as well as eating pattern: Grocery shop weekly for healthier foods that are easy to prepare Identify fast food choices that might be healthier 3. Identify healthier snack foods that K.L. could be encouraged to eat: Explore other fruits besides grapes that she likes Popcorn instead of chips Fruit pops or low-fat frozen treats instead of ice cream

S.C. is now ready for discharge. 1. What other patient teaching should you do with him? 2. What can you do to help ensure that he continues medications after discharge?

1. Emphasize the importance of complying with his medication regimen. Teach him how to minimize exposure to close contacts. He should open windows and ventilate rooms in which he is living. Until his sputum is negative for AFB, he should sleep alone, spend as much time as possible outdoors, and minimize time in close proximity with other people and on public transportation. Emphasize importance of treatment compliance. 2. teaching and counseling, reminder systems, incentives or rewards, contracts and DOT. Because of his history and the fact that S.C. is living in a shelter, the Department of Health should provide DOT.

S.C. is a 57 year old chinese man who was transported from a homeless shelter for having respiratory symptoms. He has a history of IV drug use & is HIV positive. He has been coughing regularly & producing mucopurulent sputum. 1. What risk factors does S.C. have for TB? 2. What diagnostic tests would you expect the HCP to order for SC?

1. Homeless, IV-drug user, resident of shelter, poverty, immunosuppression (HIV) 2. Tuberculin skin-test (TST), interferon-γ release assay (IGRA), chest x-ray, sputum culture and sensitivity, sputum for AFB

• S.C.'s chest x-ray and sputum smear for AFB confirm the TB diagnosis. 1. What treatment would you expect the health care provider to order for S.C.? 2. Do you think S.C. needs to stay in the hospital at this point?

1. Treatment consists of four-drug therapy regimen of Isoniazid, rifampin (Rifadin), pyrazinamide (PZA), and ethambutol. 2. Although most people do not need hospitalization , S.C.'s history and living situation do not provide adequate support to ensure compliance. S.C. should stay in the hospital for at least a few days in order to allow social services time to identify available support and make necessary arrangements.

A patient is admitted to the emergency department with a severe exacerbation of asthma. Which finding is of most concern to the nurse? 1. Unable to speak and sweating profusely 2. PaO2 of 80 mm Hg and PaCO2 of 50 mm Hg 3. Presence of inspiratory and expiratory wheezing 4. Peak expiratory flow rate at 60% of personal best

1. Unable to speak and sweating profusely

The nurse reviews the arterial blood gases of a patient. Which result would indicate the patient has later stage COPD? 1. pH 7.32, PaCO2 58 mm Hg, PaO2 60 mm Hg, HCO3 30 mEq/L 2. pH 7.30, PaCO2 45 mm Hg, PaO2 55 mm Hg, HCO3 18 mEq/L 3. pH 7.40, PaCO2 40 mm Hg, PaO2 70 mm Hg, HCO3 25 mEq/L 4. pH 7.52, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 35 mEq/L

1. pH 7.32, PaCO2 58 mm Hg, PaO2 60 mm Hg, HCO3 30 mEq/L

J.B. is a 62 yr old man who was diagnosed with lung cancer 2 weeks ago. He smoked 2 packs of cigarettes per day for past 40 yrs. He works as a chemical engineer in the plastics industry. He comes to the ED because he feels like he "just can't breathe right". On arrival he tells you he has small-cell lung carcinoma. 1. What factors in J.B.'s hx increase his risk for lung cancer? 2. What other factors might you question JB? 3. How does the prognosis for this type of lung cancer compare to other types of lung cancer? 4. Where would JB's cancer metastasize to? 5. Clinical manifestations to assess 6. Diagnostic testings

1. smoking, exposure to chemicals on job site 2. exposure to other carinogens such as asbestos, radon, radiation 3. very rapid, Accounts for about 20% of lung cancers. Most malignant form of lung cancer. Spreads early via lymphatics and bloodstream; frequent metastasis to brain. Associated with endocrine disturbances. Chemotherapy mainstay of treatment but overall poor prognosis. Radiation is used as adjuvant therapy as well as palliative measure. 4. lung cancers metastasize primarily by direct extension and via the blood and lymph system. The common sites for metastasis are the liver, brain, bones, lymph nodes, and adrenal glands. 5. The clinical manifestations of lung cancer are usually nonspecific and appear late in the disease process. Symptoms may be masked by a chronic cough attributed to smoking or smoking-related lung disease. Manifestations depend on the type of primary lung cancer, its location, and metastatic spread. 6. CXR, CT, Sputum, lung biopsy, pleural fluid analysis

D.S. is a 45-year-old woman who is being hospitalized for shortness of breath and respiratory distress. Findings on admission include T 98.3° F , P 104, R 30 Blood pressure 150/72 SaO2 88%. Height 5 ft 5 in, Weight 320 pounds, History of hypertension, type 2 diabetes, COPD, obesity. She states that she's "tired of being like this". In what range does D.S.'s BMI fall?

53.2- extremely obese

Intrinsic factor

A substance produced by the mucosa of the stomach and intestines that is essential for the absorption of vitamin B12.

G.S., a 77-year-old man, comes to the hospital complaining of shortness of breath, morning cough, and swelling in his lower extremities. He has difficulty breathing when he walks short distances, such as to the bathroom. G.S. states that he sleeps in a recliner to make it easier to breathe. He feels his shoes are tight at the end of the day. He is placed on oxygen at 2 L/minute via nasal cannula. 1. What clinical manifestations does GS have?

A chronic intermittent cough usually occurs in the morning and may or may not be productive of small amounts of sticky mucus. These symptoms can occur many years before actual airflow limitation. Wheezing, chest tightness, Characteristically underweight with anorexia Chronic fatigue Paroxysmal coughing may be so severe that patient faints or fractures ribs

Based on E.P.'s assessment findings, develop a discharge care plan. Include teaching for him and his wife. Identify community services that would be of benefit to him.

Frequent small meals Identify favorite high-calorie foods that he can easily ingest, such as ice cream Oral nutritional supplements Community services might include home health nursing, Meals on Wheels

D.S. is noted to have an apple-type body shape. What do you know about body shape in relation to obesity problems and what other problems is she likely to have related to her weight?

Abdominal obesity is probably the most dangerous of all, and applebody shape is considered at the highest risk for health issues compared to the other body types. Larger waists can mean higher risk of heart disease

After discharge instructions for a patient who has had bariatric surgery for treatment of obesity, the nurse determines that additional teaching is needed when the patient says: A. "I shouldn't eat concentrated sweets." B. "I can eat small, frequent meals throughout the day." C. "I should drink several glasses of fluids with my meals." D. "I will need to have a cobalamin injection once a month."

Answer: C "I should drink several glasses of fluids with my meals."

A patient is admitted to a medical unit with a diagnosis of malnutrition. The student nurse asks the nurse assigned to this patient about the relationship between drugs and nutrition. What is the most appropriate response for the nurse to make? A. "Foods alter the absorption or bioavailability of all drugs." B. "If the patient skips a meal, drugs may not be taken." C. "Some drugs increase the requirements for essential nutrients." D. "Drugs should be taken with food to prevent GI irritation."

Answer: C "Some drugs increase the requirements for essential nutrients."

An important factor associated with both short-term and long-term weight-loss success is A. Higher initial body mass index. B. Simultaneous smoking cessation. C. A strong desire to improve appearance. D. Fewer dieting attempts in the past year.

Answer: C A strong desire to improve appearance.

A patient's ABG results include the following: pH 7.32, PaO2 84 mm Hg, PaCO2 49 mm Hg, and SaO2 84%. For what should the nurse assess the patient? a. tetany b. tachypnea c. pleural friction rub d. kussmaul respirations

Answer: B Rationale: The arterial blood gas analysis indicates respiratory acidosis. Tachypnea is defined as a rapid respiratory rate and indicates respiratory distress. Tetany occurs in metabolic alkalosis. A pleural friction rub is a creaking or grating sound heard during auscultation of the lungs and indicates inflamed pleural surfaces that are rubbing together. Kussmaul respirations are commonly seen in metabolic acidosis and are abnormally deep, very rapid sighing respirations.

The nurse teaches a patient about safe and successful weight loss. Which statement, if made by the patient, would indicate an understanding of the instructions? A. "I will keep a diary of daily weights to chart my weight loss." B. "I plan to lose 4 pounds a week until I have lost my goal of 60 pounds." C. "I should not exercise more than what is needed because increased activity increases the appetite." D. "I plan to join a behavior-modification group to make permanent changes necessary for weight control."

Answer: D "I plan to join a behavior-modification group to make permanent changes necessary for weight control."

The nurse would interpret an induration of 5 mm resulting from tuberculin skin testing as a positive finding in which patient? a. a patient with a history of illegal IV drug use b. a patient with diabetes and end-stage kidney disease c. a patient who immigrated from india 3 months ago d. a patient who is HIV infected

Answer: D Rationale: Induration of 5 mm in an HIV-infected person is considered a positive reaction.

The health care provider orders a 10% fat emulsion solution to be given to a critically ill patient who is currently receiving peripheral parenteral nutrition. Which assessment finding would alert the nurse to a systemic problem related to lipid administration? A. The onset of vomiting and fever B. Retention of fluid with peripheral edema C. A random capillary blood glucose level of 148 mg/dL D. Redness, tenderness, and exudate at the catheter insertion site

Answer: D Redness, tenderness, and exudate at the catheter insertion site

DF's d-dimer is positive, Spiral CT scan confirms the diagnosis of pulmonary emboli. What treatment measures would you expect to implement for D.F.?

Anticoagulation therapy (either LMWH or unfractionated heparin), thrombolytics if severe, oxygen therapy. Vasopressors and fluids if becomes hypotensive. Inferior vena cava filter if patient has multiple lower extremity DVT - to prevent embolization to lungs.

J.W., a 69-year-old male, is admitted to the hospital with an exacerbation of COPD. He is 5'11" and 146 pounds. His wife reports that he has had difficulty eating due to his shortness of breath and has lost 7 pounds since his last doctor's appointment. J.W. comes in to the clinic for a follow-up appointment 2 weeks after discharge from the hospital. He has lost another 3 pounds and his doctor discusses enteral nutrition options to supplement his intake.

Ask students what additional assessment data should be gathered: Vital signs, food history for at least the last 3 days, ability to swallow. What is the best option for J.W. for enteral nutrition? Gastrostomy tube feedings could be administered intermittently, or cycled during the night. This would allow him to eat normally, but obtain needed calories to maintain weight and metabolic processes. Nasogastric feedings would be uncomfortable, obstruct his ability to eat comfortably, and also may be contraindicated due to his esophageal cancer. A jejunostomy tube is not necessary, as he displays no aspiration risk.

For which patients is the most important for the nurse to refer to a dietitian for a complete nutritional assessment? A. A 38-yr-old with diabetes who is undergoing laser eye surgery B. A 55-yr-old with a history of alcohol use disorder who is hospitalized with a fractured femur from a fall C. A 24-yr-old who has been taking a burst of corticosteroid therapy for 1 week for treatment of an asthma exacerbation D. A 45-yr-old hospitalized with nausea and abdominal pain who has had no oral intake and only IV fluids of D5 ½ NS for 6 days

B. 55 year old with a history of alcohol use disorder who is hospitalized with a fractured femur from a fall.

A 56 year old normally healthy patient at the clinic is diagnosed with bacterial community-acquired pneumonia. Before treatment is prescribed, the nurse asks the patient about an allergy to: A. Amoxicillin B. Erythromycin C. Sulfonamides D. Cephalosporins

B. Erythromycin Outpatient drug therapy options for a healthy person with community-acquired pneumonia will be consist of macrolides (erythromycin) or doxycycline. If the patient is allergic to macrolides, doxycycline would be prescribed.

How do air get into my lungs?

CO2 binds to water to form carbonic acid

You perform a focused assessment on DF. Her BP 100/64, HR 110, RR 24, T 37. She has bibasilar crackles. Her breathing appears labored. She is somewhat restless and in obvious distress. 1. What clinical manifestations of P.E. does DF demonstrate? 2. What diagnostic tests would you expect to teach DF about?

Chest pain, dyspnea, tachycardia, tachypnea, restlessness, crackles 2. Serum D-dimer levels, spiral CT scan, chest x-ray, ECG, troponin, b-natriuretic peptide (BNP). If cannot have contrast media for spiral CT scan, then would expect patient to have a ventilation-perfusion (V/Q) scan.

food high in protein

Complete proteins: Eggs Fish Meats Milk and milk products Poultry Incomplete proteins: Grains Legumes Nuts Seeds

(Ch. 26) 24 hours after a patient had a tracheostomy, the tube is accidentally dislodged after a coughing episode. Which action should the nurse take first? A. Call the HCP B. Place the obturator in the tracheostomy tube C. Position the patient in a semi-fowler's position D. Grasp the retention sutures to spread the tracheostomy opening

D. Grasp the retention sutures to spread the tracheostomy opening

The nurse obtains a drug history from a patient with ascites and elevated aspartate and alanine aminotransferase levels. The nurse is most concerned if the patient makes which statement? A. Occasionally I will use Benadryl for my allergies." B. "Sometimes probiotics can make me feel bloated." C. "I add flaxseed powder to my cereal every morning." D. "I take acetaminophen 4 to 5 times a day for back pain."

D. I take acetaminophen 4 to 5 times a day for back pain

The nurse is caring for a patient with pneumonia. If a pleural effusion is developing, the nurse would expect which finding? a. barrel-shaped chest b. paradoxical respirations c. hyperresonance on percussion d. localized decreased breath sounds

D. localized decreased breath sounds Clinical manifestations of pleural effusion include diminished breath sounds over the affected area, decreased movement of the chest on the affected side, dullness to percussion, dyspnea, cough, and occasional sharp and nonradiating chest pain that is worse on inhalation.

Two major consequences of obesity are due to

Increase in fat mass Production of adipokines Contribute to insulin resistance and atherosclerosis Disrupt immune factors and predispose to certain cancers

COPD

Inspection: Barrel chest, cyanosis, tripod position, use of accessory muscles Palpation: decreased movement Percussion: hyperresonant or dull Auscultation: Crackles, wheezes, distant breath sounds

Atelectasis

Inspection: no change unless involves entire lobe Palpation: if small, no change, if large, decrease movement, decreased fremitus Percussion: dull over affected area Auscultation: Fine crackles, may disappear with deep breaths

Asthma Exacerbation

Inspection: prolonged expiration, tripod position, pursed lip Palpation: decreased movement Percussion: Hyper resonance Auscultation: Wheezes, decrease breath sounds, ominous sign (severely decreased air movement)

J.W. comes to the outpatient surgery unit for placement of a gastrostomy tube. What will you need to teach him and his wife for discharge?

J.W. and his wife will need to be taught how to: Check for tube position, length of exposed tube When to start feedings (usually 24-48 hours after tube placement) Check for tube placement Proper positioning for feedings: head elevated at least 30 degrees Check for residual feeding Check for tube patency Complications of feedings: vomiting, diarrhea, constipation, dehydration Complications of the tube: skin irritation and dislodgement How to administer tube feedings at the prescribed schedule

D.T.'s CXR shows consolidation in her left lower lobe, consistent with pneumonia. WBC is 17,000 with an increased number of bands. Electrolytes are within normal limits. Sputum Gram stain shows gram + diplococci and many WBCs. Because of her age & altered mentation, the HCP admits her to the hospital. On admission, D.T. has bronchial breath sounds with dullness of left lower lobe & egophony. Her O2 is 87%. What is your priority of care for D.T.?

Monitor pulse oximetry and provide oxygen therapy as needed. Begin antibiotics as soon as possible; individualize rest and activity to D.T.'s tolerance. Maintain fall precautions to prevent injury. Administer analgesics PRN to relieve the chest pain and antipyretics such as aspirin or acetaminophen for significantly elevated temperature. Maintain adequate hydration while monitoring for any heart failure. Maintain adequate nutrition with high caloric, small, frequent meals.

DF is a 74 yr old female who arrives in the ED with complaints of chest pain and shortness of breath. DF was recently discharged from rehab after undergoing bilateral knee replacements. She if 5'2 & weights 158lb. Her past hx is negative except for mitral regurgitation & HF. What risk factors does DF have for development of pulmonary embolism?

Obesity, orthopedic surgery, immobility, dehydration, heart failure. Risk factors for PE include immobility or reduced mobility, surgery within the last 3 months (especially pelvic and lower extremity surgery), history of DVT, malignancy, obesity, oral contraceptives, hormone therapy, cigarette smoking, prolonged air travel, heart failure, pregnancy, and clotting disorders.

1. What is the primary nursing management for S.C.? 2. What hygiene measures can you teach him to minimize transmission?

Place him in airborne isolation and begin drug therapy as ordered. Cover his nose and mouth with paper tissue every time he coughs, sneezes, or produces sputum. The tissues should be thrown into a paper bag and disposed of with the trash or flushed down the toilet. Emphasize careful hand washing after handling sputum and soiled tissues. If he needs to be out of the negative-pressure room, the patient must wear a standard isolation mask to prevent exposure to others. Minimize prolonged visitation to other parts of the hospital.

If D.S. wants to have bariatric surgery, what risks does the surgery pose?

Postanesthesia problems due to her weight and pain following surgery. There will need to be psychologic support as well as medical follow up.

Valsvalve Maneuver

Pressure exerted to expel feces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway.

What is the rationale for taking corticosteroids?

Reduce bronchial hyperresponsiveness Decrease mucous production Are taken on a fixed schedule Suppress inflammatory response Inhaled form is used in long-term control Systemic form to control exacerbations and manage persistent asthma

D.F. is started on a continuous IV drip of unfractionated heparin at 1000 units/hour. Drip will be titrated to therapeutic level using aPTT levels drawn every 6 hours. What nursing interventions would be appropriate in the care of D.F.?

Semi-Fowler's position, maintain IV access, titrate oxygen therapy to maintain adequate oxygen saturation, frequent assessment of patient's respiratory and cardiovascular status, monitor aPTT laboratory results and titrate heparin as needed, provide emotional support and reassurance, provide patient education retreatments and long-term anticoagulation.

After major surgery, a patient receives parenteral nutrition. If the patient develops refeeding syndrome, the nurse would expect which finding? Blood glucose level of 148 mg/dL Serum potassium level of 5.7 mEq/L Serum phosphate level of 1.9 mg/dL White blood cell count of 15.6 x 103/μL

Serum phosphate level of 1.9 mg/dL Refeeding syndrome is characterized by fluid retention and electrolyte imbalances (hypophosphatemia, hypokalemia, hypomagnesemia). Hypophosphatemia is the hallmark of refeeding syndrome and is associated with serious outcomes, including cardiac dysrhythmias, respiratory arrest, and neurologic disturbances (e.g., paresthesia).

What are signs of partial airway obstruction?

Snoring, gurgling, noisy Inspiratory: stridor * Expiratory: wheeze * Crackles Cyanosis *

E.P., an 84-year-old man, was admitted with complications from esophageal cancer. He is being discharged from the hospital with a secondary diagnosis of malnutrition. He lives with his wife, who is 82 years old. They have no other family in town. Discuss contributing factors

Socioeconomic factors—food insecurity Safety net programs, Contributions from relatives, friends Government and local programs Physical illnesses- surgery, injury, hospitalization Undernutrition, GI disease Symptoms interfere with normal food consumption and metabolism May restrict intake out of fear

What important teaching should you provide to D.T. and family?

Teach the importance of rest and fluids while recovering, the importance of finishing the antibiotics, and food or drug interactions with the prescribed antibiotic, avoidance of alcohol and smoking, importance of follow-up chest x-ray, information about yearly influenza vaccinations, and signs and symptoms to watch for in the future.

J.G. is recovering from a small bowel resection. She has advanced to a regular diet, but is taking in only small amounts of food. She will be discharged to home tomorrow, where she lives with her husband.

Teaching: Administration of parenteral nutrition, Dressing care, Solution and supplies storage Referrals: Social services to assess home environment and financial concerns, Home IV therapy for supplies, parenteral nutrition solution, Home health nursing for home follow-through

Obesity can cause what type of complications?

Type 2 diabetes- Excess weight makes drug treatment less effective: Hyperinsulinemia, Insulin resistance, Glucose intolerance CVD-Increased LDLs, High triglycerides , Decreased HDLs Sleep apnea Snoring and hypoventilation, obesity hypoventilation syndrome, reduced chest wall compliance, increased work of breathing, Decreased total lung capacity, Weight loss can improve lung function Osteoarthritis, Cancer

J.G. has a peripherally inserted central catheter placed in her left arm for administration of parenteral nutrition. She is receiving a 3-part solution containing lipids. What nursing assessment needs to be done?

Vital signs every 4 to 8 hours Daily weights Blood glucose Check initially every 4 to 6 hours Infusion pump must be used Need to periodically check volume infused Monitor lab values: Electrolytes BUN CBC Liver enzymes Dressing changes Site observation key Refeeding syndrome

Body Mass Index (BMI)

Weight (kg)/Height (m2) Underweight = BMI less than 18.5 kg/m2 Normal = BMI 18.5 to 24.9 kg/m2 Overweight = BMI 25 to 29.9 kg/m2 Obese = BMI greater than 30 kg/m2 Extremely obese = BMI greater than or equal to 40 kg/m2

Nutritional therapy for Patients with COPD

Weight loss is a predictor of a poor prognosis and increased frequency of COPD exacerbations. Malnutrition in COPD patients is multifactorial including increased inflammatory mediators, increased metabolic rate due to the ventilatory effort, and lack of appetite. Other factors that contribute to malnutrition in COPD include altered taste caused by chronic mouth breathing, excessive sputum, fatigue, anxiety, depression, increased energy needs, numerous infections, and side effects of polypharmacy. To decrease dyspnea and conserve energy Rest at least 30 minutes before eating Avoid exercise for 1 hour before and after eating Use bronchodilator

What is distal to the bronchioles that is a defense mechanism?

alveoli macrophages

How does pneumonia spread to the lungs?

aspiration, lymphatic spread, and inhalation of microbes

Lower respiratory

bronchi, bronchioles, alveolar ducts, alveoli

What is an abnormal finding of a lung assessment?

bronchial breath sounds in the lower lung field

Stridor

continuous musical or crowing sound of constant pithc. result of partial obstruction of larynx or trachea Etiology: Croup, epiglottis, vocal cord edema after extubation foreign body

Wheezes

continuous, high-pitched squeak or musical sound caused by rapid vibration of bronchial walls. First evident on expiration but possibly evident on inspiration as obstruction of airway increases. May be audible without stethoscope. Etiology: Bronchospasm (caused by asthma), airway obstruction, COPD

What signs indicate that O2 therapy is working?

cough is productive, yellow sputum, lungs clear, 96% on Room Air

Pleural Friction Rub

creaking or grating sound from roughened, inflamed surfaces of the pleura rubbing together, evident during inspiration, expiration, or both and no change with coughing; usually uncomfortable, especially on deep inspiration. Etiology: pleurisy, pneumonia, pulmonary infarct

What is the priority assessment for a patient who has just undergone a posterior epistaxis packing?

check O2 saturation

If a patient's O2 sat drops from 95% to 85% , what is the first thing the nurse should do?

check the position of the probe

GI effects of aging

dental caries, decrease taste buds, decrease sense of smell, less saliva, delayed emptying of esophagus, constipation, inability to taste, decreased HCI, liver size decrease, gallbladder disease, risk for decreased food intake, inability to obtain food Oral cavity Digestion/motility Endocrine system Musculoskeletal system Vision and hearing

What are teachings to give for a patient with CAP (community acquired pneumonia)

good hand hygiene, avoid people with a cold or the flu, vaccinations, dispose sputum

What are age related factors that affects respiratory system?

decrease residual volume decrease lung base sounds increase posterior/anterior diameter decrease force of cough decrease formation of cilia

What are some findings when palpating the chest?

decrease tactile fremitus, limited chest expansion, trachea deviation

Coarse crackles

louder, discontinuous, low-pitched sounds caused by air passing through airway intermittently occluded by mucus, unstable bronchial wall. May be heard on inspiration, expiration, or both. Similar sound to blowing through straw under water. Etiology: excess fluid within the lungs, heart failure, pulmonary edema, pneumonia with severe congestion, COPD

Percussion of Chest area

lung tissue- resonant flat over heavy muscles and bones liver- dullness stomach- tympany

Upper Respiratory

nose, mouth, pharynx, epiglottis, larynx, and trachea

Vegans are at risk for

pernicious anemia (B12), lack of vitamin B12 (cobalamin) S&S- Weakness Paresthesia Impaired though process Tissue Hypoxia Sore tongue NauseaVomiting Anorexia

Pleural effusion

pg. 469

What are the early signs of hypoxia?

restlessness and apprehension

Fine Crackles

short, discontinuous, high-pitched sounds heard just before the end of inspiration. Result of rapid equalization of gas pressure when collapsed alveoli or terminal bronchioles suddenly snap open. Similar sound to that made by rolling hair between fingers Etiology: interstitial edema (early pulmonary edema), alveoli filling (pneumonia), loss of lung volume (atelectasis), early phase HF

Brochophony, whispered pectoriloquy

spoken or whispered syllable more distinct than normal on auscultation etiology: pneumonia