...Case Study for Respiratory Disorders #2 Scenario A.W., a 52-year-old woman disabled from severe emphysema, was walking at a mall when she suddenly grabbed her right side and gasped, “Oh, something just popped.” A.W. whispered to her walking companion, “I can’t get any air.” Her companion yelled for someone to call 911 and helped her to the nearest bench. By the time the rescue unit arrived, A.W. was stuporous and in severe respiratory distress. She was intubated, an IV of lactated Ringer’s (LR) to KVO (keep vein open) was started, and she was transported to the nearest emergency department (ED). On arrival at the ED, the physician auscultates muffled heart tones, no breath sounds on the right, and faint sounds on the left. A.W. is stuporous, tachycardic, and cyanotic. The paramedics inform the physician that it was difï¬cult to ventilate A.W. A STAT portable chest x-ray (CXR) and arterial blood gases (ABGs) are obtained. A.W. has an 80% pneumothorax on the right, and her ABGs on 100% oxygen are pH 7.18, PaCO2 92 mm Hg, PaO2 32 mm Hg, HCO3 27 mmol/L, base excess (BE) -5 mmol/L, SaO2 53%. 1) Given the diagnosis of pneumothorax, explain why the paramedic had difï¬culty ventilating A.W. The paramedics couldn’t ventilate C.W. because the pleural space is full of air, which then forces pressure on the lungs which doesn’t allow the lungs to inflate when air is inhaled in. 2) Interpret A.W.’s ABGs. [c] PH 7.18 acidotic PaCO2 92 mm Hg PaO2 32 HCO3 27 Respiratory Acidosis ...
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...Top of Form The ABCDE approach Underlying principles The approach to all deteriorating or critically ill patients is the same. The underlying principles are: Use the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach to assess and treat the patient. Do a complete initial assessment and re-assess regularly. Treat life-threatening problems before moving to the next part of assessment. Assess the effects of treatment. Recognise when you will need extra help. Call for appropriate help early. Use all members of the team. This enables interventions (e.g. assessment, attaching monitors, intravenous access), to be undertaken simultaneously. Communicate effectively - use the Situation, Background, Assessment, Recommendation (SBAR) or Reason, Story, Vital signs, Plan (RSVP) approach. The aim of the initial treatment is to keep the patient alive, and achieve some clinical improvement. This will buy time for further treatment and making a diagnosis. Remember – it can take a few minutes for treatments to work, so wait a short while before reassessing the patient after an intervention. First steps Ensure personal safety. Wear apron and gloves as appropriate. First look at the patient in general to see if the patient appears unwell. If the patient is awake, ask “How are you?”. If the patient appears unconscious or has collapsed, shake him and ask “Are you alright?” If he responds normally he has a patent airway, is breathing...
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...NRSG240 Final Test note CARDIAC NURSING 4 AMI 4 Definition (3marks)- very detailed needed. 4 Clinical manifestations of AMI. (5marks) 4 Nursing Interventions and Rationale for Managing a patient with Acute Chest pain(6marks) 4 and Ineffective Tissue perfusion (6marks) 5 Acute chest Pain 오류! 책갈피가 정의되어 있지 않습니다. 1. PQRST questions to evaluate MI- intensity, location, radiation, duration, precipitation & alleviating factors, in order to accurately evaluate, treat and prevent further ischaemia. 오류! 책갈피가 정의되어 있지 않습니다. 2. Semi-Fowler’s position & O2 therapy 2L via Hudson Mask in order to increase oxygenation of myocardial tissue & prevent further ischaemia. 오류! 책갈피가 정의되어 있지 않습니다. 3. Administer medications- Morphin (normally 2.5-5mg) & anginine 600mcg (given every five minutes; maximum 3 tablets in order to relieve/prevent pain & ischemia to decrease anxiety & cardiac workload. 오류! 책갈피가 정의되어 있지 않습니다. 4. 12-lead ECG & monitor in order to check hypotension & bradycardia, which may lead to hypoperfusion. 오류! 책갈피가 정의되어 있지 않습니다. Ineffective tissue perfusion 오류! 책갈피가 정의되어 있지 않습니다. 1. Monitor vital signs (Hourly) and saturation oxygen to determine baseline and ongoing change. 오류! 책갈피가 정의되어 있지 않습니다. 2. Administer oxygen by Hudson’s mask (6-10L/min) and monitor the effectiveness to increase oxygenation of myocardial tissue and prevent further ischaemia. 오류! 책갈피가 정의되어 있지 않습니다. 3. Monitor respiratory status for sysptoms of heart failure to maintain appropriate levels of oxygenation...
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...Ackowledgement First of all, I would like to praise ALLAH THE ALL MIGHTHY. His will, I will not be able to complete the assignment. I would like to express my gratitute to all who gave me the possibility to complete this assignment. I want to thank the Dean of Nursing Faculty, I for giving the support, encouragement towards compliting the assignment. I deeply indebted to my tutor who gave an idea and suggestion and encouragement, helped me at the time of writing the assignment. My colleagues from Nursing Faculty who supported me in my assignment work. I thank them for all their support, help, interest and valuable hints. Last but not least, I would like to thank my family especially my husband whose patient love enable me to complete this work. Table of Content | | |Page No. | |1. |Introduction |1 – 2 | |2. |Clinical Assessment |3 – 6 | |3. |Management Related To Head Injury |7 - 8 | |4. |Immediate Care And Management Of Patient ...
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...PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE Nursing Assessment 1. Part of Nursing Process 2. Nurses use physical assessment skills to: a) Obtain baseline data and expand the data base from which subsequent phases of the nursing process can evolve b) To identify and manage a variety of patient problems (actual and potential) c) Evaluate the effectiveness of nursing care d) Enhance the nurse-patient relationship e) Make clinical judgments Gathering Data Subjective data - Said by the client (S) Objective data - Observed by the nurse (O) Document: SOAPIER Assessment Techniques: The order of techniques is as follows (Inspect – Palpation – Percussion - Auscultation) except for the abdomen which is Inspect – Auscultation – Percuss – Palpate. A. Inspection – critical observation *always first* 1. Take time to “observe” with eyes, ears, nose (all senses) 2. Use good lighting 3. Look at color, shape, symmetry, position 4. Observe for odors from skin, breath, wound 5. Develop and use nursing instincts 6. Inspection is done alone and in combination with other assessment techniques B. Palpation – light and deep touch 1. Back of hand (dorsal aspect) to assess skin temperature 2. Fingers to assess texture, moisture, areas of tenderness 3. Assess size, shape, and consistency of lesions and organs 4. Deep = 5-8 cm (2-3”) deep; Light = 1 cm deep C. Percussion – sounds produced by striking body surface 1. Produces different notes depending on underlying mass (dull...
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...|CognitiveLevel||3rd Ed. Page References| |Recall|Application|Analysis|Totals|| I. PATIENT DATA EVALUATION AND RECOMMENDATIONS|11|14|1|26|| A. Review Data in the Patient Record|4|||4|| 1. Patient history e.g.,• present illness• admission notes• respiratory care orders• medication history• progress notes• diagnoses• DNR status• patient education (previous)|||||pp 33, 82, 47| 2. Physical examination relative to the cardiopulmonary system e.g., vitalsigns, physical findings|||||pp 33-35, 35-45, 47, 151-153, 153-155, 155-156, 156-158, 158-163, 175-177| 3. Laboratory data e.g.,• CBC• electrolytes• coagulation studies• culture and sensitivities• sputum Gram stain|||||pp 45-47| 4. Pulmonary function results|||||pp 47, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197| 5. Blood gas results|||||pp 47, 124-126, 126-127, 127-128, 151-153, 153-155, 156-158, 158-163| 6. Imaging studies e.g.,• radiograph• CT• MRI|||||pp 33-45, 47, 151-153, 175-177| 7. Monitoring data|||||| a. fluid balance|||||pp 139-140| b. pulmonary mechanics e.g., maximum inspiratory pressure, vitalcapacity|||||pp 47, 139, 191-194, 194-196| c. respiratory e.g.,• rate• tidal and minute volume• I:E|||||pp 47, 139, 191-194, 194-196| d. pulmonary compliance, airways resistance, work of breathing|||||pp 47, 137-139, 141-143| e. noninvasive e.g.,• pulse oximetry• VD/VT• capnography• transcutaneous O2 / CO2|||||pp 20-21, 47, 137-139, 167-172, 172-175| 8. Cardiac monitoring|||||pp 35-45, 158-163| a. ECG data results...
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...Chapter 51. Enhancing Patient Safety in Nursing Education Through Patient Simulation Carol Fowler Durham, Kathryn R. Alden Background The alarming rise in morbidity and mortality among hospitalized patients throughout the United States heightens concerns about professional competency.1 Nurses and other health care professionals are under increased scrutiny to provide safe, effective care. Likewise, nursing education programs are faced with increased pressure to produce graduates who are capable of providing safe patient care. Toward that end, nursing education programs develop curricula, hire qualified faculty, and select learning experiences for students in an effort to train and graduate competent, effective nurses. The instructional strategies utilized in both didactic and clinical components of nursing education courses are highly influential in determining critical thinking and clinical decisionmaking ability as well as in developing the psychomotor skill performance of new graduates. Of course, it is unrealistic to think that graduates of nursing education programs have received all the training they need when they depart the doors of academia. Orientation programs for new graduates and continuing education for nurses are essential tools to help practitioners improve their knowledge, skills, and expertise so that quality patient care is provided and outcomes are optimized while errors are minimized. Ongoing evaluation of nursing competence is necessary...
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...A kid with Hepatitis A can return to school 1 week within the onset of jaundice. 2. After a patient has dialysis they may have a slight fever...this is normal due to the fact that the dialysis solution is warmed by the machine. 3. Hyperkalemia presents on an EKG as tall peaked T-waves 4. The antidote for Mag Sulfate toxicity is ---Calcium Gluconate 5. Impetigo is a CONTAGEOUS skin disorder and the person needs to wash ALL linens and dishes seperate from the family. They also need to wash their hands frequently and avoid contact. positive sweat test. indicative of cystic fibrosis 1. Herbs: Black Cohosh is used to treat menopausal symptoms. When taken with an antihypertensive, it may cause hypotension. Licorice can increase potassium loss and may cause dig toxicity. 2. With acute appendicitis, expect to see pain first then nausea and vomiting. With gastroenitis, you will see nausea and vomiting first then pain. 3. If a patient is allergic to latex, they should avoid apricots, cherries, grapes, kiwi, passion fruit, bananas, avocados, chestnuts, tomatoes and peaches. 4. Do not elevate the stump after an AKA after the first 24 hours, as this may cause flexion contracture. 5. Beta Blockers and ACEI are less effective in African Americans than Caucasians. 1. for the myelogram postop positions. water based dye (lighter) bed elevated. oil based dye heavier bed flat. 2.autonomic dysreflexia- elevated bed first....then check foley...
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...NCSBN ON-LINE REVIEW 1.A client has been hospitalized after an automobile accident. A full leg cast was applied in the emergency room. reason for the nurse to elevate the casted leg is to A) Promote the client's comfort B) Reduce the drying time C) Decrease irritation to the skin D) Improve venous return The most important D: Improve venous return. Elevating the leg both improves venous return and reduces swelling. Client comfort will be improved as well. 2. The nurse is reviewing with a client how to collect a clean catch urine specimen. What is the appropriate sequence to teach the client? A) B) C) D) Clean the meatus, begin voiding, then catch urine stream Void a little, clean the meatus, then collect specimen Clean the meatus, then urinate into container Void continuously and catch some of the urine A: Clean the meatus, begin voiding, then catch urine stream. A clean catch urine is difficult to obtain and requires clear directions. Instructing the client to carefully clean the meatus, then void naturally with a steady stream prevents surface bacteria from contaminating the urine specimen. As starting and stopping flow can be difficult, once the client begins voiding it’s best to just slip the container into the stream. Other responses do not reflect correct technique 3. Following change-of-shift report on an orthopedic unit, which client should the nurse see first? A) B) C) D) 16 year-old who had an open reduction of a fractured wrist 10 hours ago 20 year-old...
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...publisher. No patent liability is assumed with respect to the use of the information contained herein. Although every precaution has been taken in the preparation of this book, the publisher and author assume no responsibility for errors or omissions. Nor is any liability assumed for damages resulting from the use of the information contained herein. ISBN-13:978-0-7897-2706-9 ISBN-10: 0-7897-3706-x Library of Congress Cataloging-in-Publication Data Rinehart, Wilda. NCLEX-PN exam cram / Wilda Rinehart, Diann Sloan, Clara Hurd. -- 2nd ed. p. cm. ISBN 978-0-7897-3706-9 (pbk. w/cd) 1. Practical nursing--Examinations, questions, etc. 2. Nursing--Examinations, questions, etc. 3. National Council Licensure Examination for Practical/Vocational Nurses--Study guides. I. Sloan, Diann. II. Hurd, Clara. III. Title. RT62.R55 2008 610.73'076--dc22 2008000133 Printed in the United States of America First Printing: February 2008 Trademarks All terms mentioned in this book that are known to be trademarks or service marks have been appropriately capitalized. Pearson Education cannot attest to the accuracy of this information. Use of a term in this book should not be regarded as affecting the validity of any trademark or service mark. Warning and Disclaimer Every effort has been made to make this book as complete and as accurate as possible, but no warranty or fitness is implied. The information provided is on an “as is” basis. The...
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...INSTRUCTOR GUIDE Human Anatomy & Physiology Laboratory Manual MAIN VERSION, Eighth Edition Update CAT VERSION, Ninth Edition Update FETAL PIG VERSION, Ninth Edition Update ELAINE N. MARIEB, R.N., Ph.D Holyoke Community College SUSAN T. BAXLEY, M.A. Troy University, Montgomery Campus NANCY G. KINCAID, Ph.D Troy University, Montgomery Campus PhysioEx™ Exercises authored by Peter Z. Zao, North Idaho College Timothy Stabler, Indiana University Northwest Lori Smith, American River College Greta Peterson, Middlesex Community College Andrew Lokuta, University of Wisconsin—Madison San Francisco • Boston • New York Cape Town • Hong Kong • London • Madrid • Mexico City Montreal • Munich • Paris • Singapore • Sydney • Tokyo • Toronto Editor-in-Chief: Serina Beauparlant Project Editor: Sabrina Larson PhysioEx Project Editor: Erik Fortier Editorial Assistant: Nicole Graziano Managing Editor: Wendy Earl Production Editor: Leslie Austin Composition: Cecelia G. Morales Cover Design: Riezebos Holzbaur Design Group Senior Manufacturing Buyer: Stacey Weinberger Marketing Manager: Gordon Lee Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings, 1301 Sansome St., San Francisco, CA 94111. All rights reserved. Manufactured in the United States of America. This publication is protected by Copyright and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means...
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