Med-Surg - Respiration, Fluid and Electrolytes, ABG - NCLEX/HESI case study

omalizumab, life-threatening effect?

"My lips and tongue are swollen." antiinflammatory and monoclonal antibody used for long-term control of asthma. Anaphylactic

The therapeutic serum level range of theophylline

10 to 20 mg/mL (40 to 79 mcmol/L). Check daily

silicosis, s/s? 1.Fatigue 2.Malaise 3.Anorexia 4.Weight gain 5.Dyspnea at rest

123 chronic lung fibrosis. It is characterized by nodule formation between alveoli leading to fibrosis. Malaise, extreme fatigue, anorexia, weight loss, and dyspnea on exertion (not at rest) would occur in a client with silicosis. Additional manifestations include reduced lung volume and upper lobe fibrosis.

tuberculin skin test should return to the clinic for the results in how long?

48 to 72 hours

TB test positive, Which action by the nurse has the highest priority? Contact the primary health care provider (PHCP). Call the radiology department for a chest radiographic study to be done.

A. The PHCP will prescribe a chest x-ray & sputum culture

A client with a fat embolus is experiencing respiratory distress. The nurse plans?

Administration of oxygen, intubation, and mechanical ventilation with positive end-expiratory pressure Respiratory failure is the most common cause of death after fat embolus.

hematoma at the ABG puncture site on the next day

Apply a warm compress. enhances the absorption of blood in the hematoma.

After ABG been draw, what should nurse do

Applying pressure to the puncture site by applying a 2 × 2 gauze for 5 minutes A cold (not warm) compress would aid in limiting blood flow. dependent position, Wrong, clot.

The client with a history of lung disease is at risk for developing respiratory acidosis. The nurse asks this client about which symptoms that are characteristic of this disorder? "Do you have shallow breathing?" "Do you have a headache or become confused?" "Do you feel dizzy or have tingling sensations?"

B hypoxia A is wrong cause compensation

codeine sulfate for a client with a nonproductive cough to suppress the cough reflex. side effect?

Constipation opioid analgesic, a frequent side effect is constipation. drowsiness, nausea, and vomiting also

pt receiving nasal oxygen and notes: pH of 7.38 (7.38), Paco2 of 38 mm Hg (38 mm Hg), Pao2 of 86 mm Hg (86 mm Hg), and HCO3 of 23 mEq/L (23 mmol/L). What action should the nurse take?

Continue monitoring the client. Not Discontinue the oxygen.

Why is it so much easier to breathe out than in?

Exhalation, muscles relax

thoracentesis to relieve a tension pneumothorax that resulted from rib fractures. T or F "I will lie on the affected side for an hour." "I will notify you if I feel a crackling sensation in my chest."

F T turned onto the unaffected side for 1 hour to facilitate lung expansion Subcutaneous emphysema (crepitus) may follow this procedure because air in the pleural cavity leaks into subcutaneous tissues.

pharyngitis pt education

Foods that are highly seasoned are irritating to the throat and should be completely avoided. consume cool clear fluids, ice chips, or ice pops to soothe the painful throat. Citrus products, milk and milk products should be avoided eat bland foods and drink 2000 to 3000 mL of fluid daily

pt at risk for respiratory acidosis. s/s the nurse should assess?

Headache, restlessness, and confusion

early stages of disseminated intravascular coagulation (DIC). Med?

Heparin

Diuretics, Na?

Hyponatremia

acidosis, s/s?

In both respiratory and metabolic acidosis, the central nervous system (CNS) is depressed. Headache, lethargy, weakness, and confusion develop, leading eventually to coma and death. seizures and hyperactivity would not be noted.

Postural drainage. position is chosen that will use gravity to help drain secretions from which primary areas?

Lobes place the head lower than the affected lung segments. often is done in conjunction with chest percussion.

fractured rib, pain with ins/expiration?

Pain, especially with inspiration

foods that are high in magnesium

Peas and cauliflower

HIV pt TB test 7mm

Positive. larger than 5mm is positive

pt receive isoniazid, doctor will add which med?

Pyridoxine = Vitamin B6 Clients receiving isoniazid can develop neuropathy, and the agent of choice to help prevent this adverse effect is pyridoxine

hyperphosphatemia

Renal insufficiency, hypoparathyroidism, and tumor lysis syndrome

The nurse knows that if Guillain-Barré syndrome is severe, the client will be at risk for which acid-base imbalance?

Respiratory acidosis Guillain-Barré is a neuromuscular disorder in which the client may experience weakening or paralysis of the muscles used for respiration.

pulmonary sarcoidosis, early sign of exacerbation

Shortness of breath (dyspnea) and Dry cough Later: night sweats, fever, weight loss, and skin nodules.

hypokalemia fall precaution

T

Guaifenesin, pt education?

Take the tablet with a full glass of water. expectorant

pleurisy, it is painful to inhale. Why?

The inflamed pleurae cannot glide against each other as they normally do. Not: nerve endings especially sensitive

Hypocalcemia S/S

The most common manifestations of hypocalcemia are caused by overstimulation of the nerves and muscles tetany and the presence of Chvostek's sign. Calcium is needed by the heart for contraction. When the serum calcium level is decreased, cardiac contractility is decreased and the client will experience hypotension. prolonged QT and ST intervals

pneumothorax pt notes continuous bubbling in the water seal chamber of the client's closed chest drainage system.

There is an air leak somewhere in the system water-seal chamber is fluctuating: observe pt's respirations, normal. water-seal chamber fluctuating stopped: obstrction in tubing, check kinks, change position and cough.

diphenhydramine

antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities that require mental acuity. should be taken with food or milk. oral rinses, sugarless gum, or hard candy may be used to minimize dry mouth.

foods that are high in potassium

avocado, bananas, cantaloupe, carrots, fish, mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, and tomatoes.

carbon monoxide blood report reveals a level of 12%. s/s?

between 11% and 20%: flushing, headache, decreased visual activity, decreased cerebral functioning, and slight breathlessness; 21% to 40%: nausea, vomiting, dizziness, tinnitus, vertigo, confusion, drowsiness, pale to reddish-purple skin, and tachycardia; 41% to 60% result in seizure and coma; higher than 60% result in death.

high potassium causes

bleeding or hemorrhage, tissue breakdown, blood transfusions, ingestion of potassium in medications, and failure to restrict dietary potassium.

most problems of metabolic alkalosis are related to increased stimulation of what systems?

cardiac, nervous, and neuromuscular systems

Toxoplasmosis

caused by the ingestion of cysts from contaminated cat feces.

Histoplasmosis

caused by the inhalation of spores from bat or bird droppings. This disease cannot be transmitted from 1 person to another. opportunistic fungal infection that can occur in the client with AIDS. begins as a respiratory infection, can progress to disseminated infection. Typical s/s: fever, dyspnea, cough, and weight loss. Enlargement of the lymph nodes, liver, and spleen may occur as well.

Carboplatin (Paraplatin) side effects

chemo Lost of taste, ringing in ears, N/V

pursed lip breathing

close the mouth and breathe in through the nose. purses the lips and breathes out slowly through the mouth, without puffing the cheeks. at least twice the amount of time breathing out than in. should use the abdominal muscles to assist in squeezing out all of the air. never hold the breath.

Chest physiotherapy

consists of percussion, vibration, and postural drainage.

Left lung lobectomy pt, suction-control chamber is bubbling continuously

continue to monitor. It's normal.

benign prostatic hyperplasia, inability to void. Ask which med did pt take?

decongestants BPH, urinary retention be triggered by certain medications: decongestants, anticholinergics(-ium), and antidepressants. Diuretics increase urine output.

common clinical manifestation of pulmonary embolism?

dyspnea, and chest pain. (tachypnea, tachycardia)

draining fistulas, fluid? frequent wound irrigations

fluid volume deficit. fluid volume excess.

pt with ileostomy/colostomy, fluid imbalance?

fluid volume deficit. large intestine plays an important role in helping absorb water from food waste.

TB home care instructions

follow the medication regimen exactly as prescribed and always have a supply of the medication on hand. Side and adverse effects After 2 to 3 weeks of medication therapy, it is unlikely that the client will infect anyone. Activities should be resumed gradually. a well-balanced diet that is rich in iron, protein, and vitamin C to promote healing and prevent recurrence of infection. Respiratory isolation is not necessary because family members already have been exposed. thorough hand washing, to cover the mouth and nose when coughing or sneezing, and to put used tissues into plastic bags. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. When the results of 3 sputum cultures are negative, the client is no longer considered infectious and can usually return to former employment.

Risk factor for COPD

genetics!!! cigarette smoking, environmental factors, and Alpha-1 antitrypsin (AAT) deficiency.

hyperaldosteronism, Cushing's syndrome, taking corticosteroids. Na?

hypernatremia

incentive spirometer

inhales slowly, with a constant flow through the unit (not deep and quick). The breath should be held for 2 to 3 seconds before exhaling slowly.

orange fluid secretion

isoniazid, rifampin

5% dextrose in 0.225% saline (D5W 1/4 NS)

isotonic

initial nursing action of bloody nose?

loosen clothing around the neck to prevent pressure on the carotid artery. assisted to a sitting position with the head tilted slightly forward, and pressure should be applied to the nares by pinching the nose toward the septum for 10 minutes. Ice packs can be applied to the nose and forehead. If these actions are not successful, an ice collar may be applied, along with a topical vasoconstrictive medication. The primary health care provider also may prescribe packing of the nostrils. The client should be provided with an emesis basin and should be instructed not to swallow blood so as to reduce the risk of nausea and vomiting.

Hypophosphatemia causes

malnutrition or starvation use of aluminum hydroxide-based or magnesium-based antacids

Excess alcohol ingestion and salicylate toxicity; Fentanyl, acid-base imbalance?

metabolic acidosis respiratory acidosis, an opioid

Lyme disease

multisystem infection that results from a bite by a tick that is usually carried by several species of deer.

pH 7.45

normal

suspected opioid overdose has received a dose of naloxone hydrochloride. The client subsequently becomes restless, starts to vomit, and complains of abdominal cramping. The blood pressure increases from 110/72 mm Hg to 160/86 mm Hg. why?

opioid withdrawal. Resuscitation equipment at bedside increased temperature and blood pressure, abdominal cramping, vomiting, and restlessness. Time of onset may be anywhere from a few minutes to a few hours

assessment findings in chronic sinusitis.

persistent purulent nasal discharge, a chronic cough due to nasal discharge, anosmia (loss of smell), nasal stuffiness, and headache that is worse on arising after sleep.

Silicosis findings?

reduced lung volume, and fibrosis on chest x-ray some decreases in vital capacity and total lung volume. This disease is restricted to the respiratory system only.

isoniazid, pt education

report signs and symptoms of hepatitis immediately, which include yellow skin and sclera.

TB initial s/s TB advanced s/s

slight morning cough, fatigue, lethargy, and low-grade fever. Chest pain, Labored breathing

triggers for an asthma attack?

specific allergens; cold air, dry air, or fine airborne particles; microorganisms; and aspirin and other NSAIDs. exercise, upper respiratory illness

Echinacea Garlic

stimulates immune system, for common cold decrease cholesterol, BP. anticoagulant.

first dose of albuterol should monitor which side effect?

tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache.

early s/s of acute respiratory distress syndrome (ARDS).

tachypnea and dyspnea Breath sounds in the early stages of ARDS usually are clear. Blood-tinged frothy sputum would be a later sign after the development of pulmonary edema.

alkalosis s/s

tingling and numbness of the fingers, restlessness, and tetany caused by irritability of the central nervous system (CNS).

theophylline

xanthine/methylxanthine bronchodilator. Before a serum level of the medication is drawn, pt need to avoid food contain xanthine, such as colas, coffee, or chocolate