final study lpn 120

Neutrophils

- elevate with infections, protect body from infection Left shift: occurs with elevated immature neutrophils (AKA bands); probable bacterial infection

Lymphocytes

- increase with viral infections and allergic conditions, Right shift: viral

interventions for a patient with fluid overload.

1.Assess vital signs, including oxygen saturation by pulse oximetry (SpO2), every 4 hours unless severity requires more frequent assessment. 2. Monitor for elevated blood pressure, increased pulse rate and volume (especially bounding pulse), and elevated temperature. Auscultate breath sounds and heart sounds at least every 4 hours, noting adventitious, decreased, or absent breath sounds and muffling of S1and S2. 3. Assess the abdomen for ascites and the extremities and dependent body sites (such as the sacrum) for edema. 4. Monitor urine output every 2 to 3 hours, or evenly hourly if inadequate urine excretion is suspected

Sodium (Na+) ions

135 -145 mEq/L major extracellular positive ions (cations)

Platelets (thrombocytes)

150,000 to 400,000/mm3 one of the formed elements in the blood that is responsible for aiding in the clotting process

NPO

Any type of endoscopy, such as barium enema and colonoscopy • Cardiac catheterization • Any computed tomography with contrast medium or dye • Any scope procedures that require conscious sedation or general anesthesia • Any test reflecting glucose levels, such as glucose tolerance test, fasting blood glucose, and hemoglobin A1c • Lung and brain scans if contrast medium is used • Cholesterol and lipid tests

After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must: A. Monitor fluctuations in the water-seal chamber B. Clamp the chest tube once every shift C. Encourage coughing and deep breathing D. Milk the chest tube every 2 hours

C. Encourage coughing and deep breathing Explanation: When caring for a patient who is recovering from a pneumonectomy, the nurse should encourage coughing and deep breathing to prevent pneumonia in the unaffected lung. Because the lung has been removed, the water-seal chamber should display no fluctuations. Reinflation is not the purpose of chest tube. Chest tube milking is controversial and should be done only to remove blood clots that obstruct the flow of drainage.

Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude? A. The system is functioning normally B. The client has a pneumothorax C. The system has an air leak D. The chest tube is obstructed

C. The system has an air leak Explanation: Constant bubbling in the chamber indicates an air leak and requires immediate intervention. The client with a pneumothorax will have intermittent bubbling in the water-seal chamber. Clients without a pneumothorax should have no evidence of bubbling in the chamber. If the tube is obstructed, the nurse should notice that the fluid has stopped fluctuating in the water-seal chamber.

For a patient with advance chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? A. Encouraging the patient to drink three glasses of fluid daily B. Keeping the patient in semi-fowler's position C. Using a high-flow venturi mask to deliver oxygen as prescribe D. Administering a sedative, as prescribe

C. Using a high-flow venturi mask to deliver oxygen as prescribed Explanation: The patient with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily would not affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Patients with COPD and respiratory distress should be places in high-Fowler's position and should not receive sedatives or other drugs that may further depress the respiratory center.

may be done to evaluate liver, kidney, pancreas function (See box 25-2, p.544)

CBC

Chloride 97 - 107 mEq/dL

Essential for the body's metabolism (process of turning food into energy) Helps maintain body's acid-base balance Important for gastric acid production Works in conjuntion with other electrolytes With sodium to regulate fluid balance gastric acid question on test!

When, for some reason, the body is unable to maintain fluid and electrolyte balance, normal fluid-moving processes are impaired. One of the possible results of this imbalance is third-spacing of fluids, meaning the fluids are shifted to areas where they can no longer contribute to fluid and electrolyte

For example, when excessive fluid has moved into the interstitial space, which often occurs with severe congestive heart failure, edema results. Another example includes liver diseases that result in increased blood pressure in the portal circulation,or the circulation that supplies the liver with blood. The fluid is forced out of the circulation and into the peritoneal cavity , where it is no longer available for use by the body

s/s fluid overload:

Increased respiratory rate, shortness of breath with exertion, or labored respirations • Sudden onset of coughing • Jugular vein distention • Increased blood pressure, pulse pressure, or central venous pressure • Full, bounding pulse • Edema of extremities or dependent areas, such as sacrum • Auscultation of rales or wheezes, and muffled or distant heart sounds • Weight gain • Increased urine production in an attempt to rid body of excess fluid • Pink or frothy sputum • Decreased oxygen saturation level • Anxiety or fear that is unexplainable by the patient • Ascites (distention of the abdomen due to fluid collection in the peritoneal cavity)

The effects of third-spacing include the following: •

Lowering the volume of the blood, thereby lowering the blood pressure • Increasing the volume of fluid in the interstitial spaces, thereby possibly causing excessive edema, which can result in compression of nerve endings, capillaries, and cells • Lowering the solute concentration of the interstitial fluid, thereby causing excessive amounts of water to move into the cells, resulting in overhydration and possible rupture of the cells, better known as cellular death

Potassium (K+) 3.5 - 5.3 mEq/L

Major intracellular cation Controls intracellular fluid volume (98% in ICF) Irritant at the neuromuscular junction (2% in ECF) Changes in levels affects muscle contraction and relaxation (think of heart contractility and rhythm) Necessary for protein synthesis

hypothalmus function

The most important factor determining water intake is thirst. The hypothalamus in the brain receives information from osmoreceptors,which are receptors that are able to detect when there is an elevated concentration of solutes in the blood, increasing the blood's osmolality,or plasma concentration. Increased osmolality results in low fluid levels. When the hypothalamus detects these conditions, it stimulates thirst. However, if there is too much fluid or if there is a problem with the osmoreceptors, the body will not stimulate thirst

pulmonary function tests (PFTs)

Used to diagnose obstructive or restrictive lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma.

peak flow meter

a handheld device often used to test those with asthma to measure how quickly the patient can expel air

pt teaching

alleviate the patient's anxiety and increase compliance It is generally helpful to provide the patient with a written pamphlet or brochure about the procedure. If written consent must be obtained to perform the procedure, be certain that all patient teaching is completed before the consent is signed. ask about shellfish, iodine or contrast medium

Bronchoscopy procedure

bronchi visualized through fiberoptic tube. Can be used to diagnose, biopsy, specimen collection, or assess changes, suction mucous plug, lavage lungs, or remove foreign objects

Basophils

contain large amts of histamine; elevate in anaphylactic reactions

tuberculin skin tests (TB test)

diagnostic test for exposure to tuberculosis bacteria by applying chemical agent (Tine or Mantoux tests) under surface of skin and evaluating site for reaction

This third-spacing of fluid results

in edema and ascites, a large collection of fluid within the peritoneal cavity. The effects of third-spacing include the following:

Hypochloremia what can you do?

increase in dietary sodium chloride to intravenous infusion of IV fluids, such as 0.9% sodium chloride or 0.45% sodium chloride.

Lymphocytes

increase with viral infections and allergic conditions, Right shift: elevated lymphocytes;

Monocytes/Macrophages

levels rise as second line defense in bacterial infections

left shift

occurs with elevated immature neutrophils (AKA bands); probable bacterial infection

chest x-ray

radiographic image of the thoracic cavity

bronchoscopy

visual examination of the bronchi

WBC

—4.5 to 11.1 mm3

Eosinophils

—elevate with allergic reactions and parasite infections

RBC

—male : 5.21 to 5.81 mm3 female: 3.91 to 5.31 mm3

Hgb

—male: 13.2-17.4 g/dL female: 11.7-16.1 g/dL

Hct

—male: 38-52mL/dL female: 33-46 mL/dL