July 2012 nle tips ms


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July 2012 nle tips ms

  1. 1. WHAT YOU SHOULD KNOW BEFORE THE PNLE JULY  2012  PNLE  PEARLS  OF  SUCCESS    PART  6:  MEDICAL  AND  SURGICAL  HEALTH  NURSING    PERIOPERATIVE  NURSING       E.  The  Surgical  Team  A.     Major   Types   of   Pathologic   Process   Requiring   Surgical    Intervention  (OPET)   Surgeon  • Obstruction   –   impairment   to   the   flow   of   vital   fluids   • Performance   of   the   operative   procedure   according   to   the   (blood,urine,CSF,bile)   needs  of  the  patients.  • Perforation  –  rupture  of  an  organ.   • The   primary   decision   maker   regarding   surgical   technique   to  • Erosion  –  wearing  off  of  a  surface  or  membrane.   use  during  the  procedure.  • Tumors  –  abnormal  new  growths.   Assistant  Surgeon     • Assists   with   retracting,   hemostasis,   suturing   and   any   other  B.    Classification  of  Surgical  Procedure   tasks   requested   by   the   surgeon   to   facilitate   speed   while     maintaining  quality  during  the  procedure.  According  to  PURPOSE:   Anesthesiologist  • Diagnostic   –   to   establish   the   presence   of   a   disease   condition.   (   • Selects   the   anesthesia,   administers   it,   intubates   the   client   if   e.g  biopsy  )   necessary,   manages   technical   problems   related   to   the  • Exploratory  –  to  determine  the  extent  of  disease  condition  (  e.g   administration   of   anesthetic   agents,   and   supervises   the   client’s   Ex-­‐Lap  )   condition  throughout  the  surgical  procedure.  • Curative  –  to  treat  the  disease  condition.   Scrub  Nurse              *    Ablative  –  removal  of  an  organ   • Assists  with  the  preparation  of  the  room.              *  Constructive  –  repair  of  congenitally   • Scrubs,   gowns   and   gloves   self   and   other   members   of   the                                                                        defective  organ.   surgical  team.              *  Reconstructive  –  repair  of  damage  organ   • Prepares   the   instrument   table   and   organizes   sterile   equipment  • Palliative   –   to   relieve   distressing   sign   and   symptoms,   not   for  functional  use.   necessarily  to  cure  the  disease.   • Assists  with  the  drapping  procedure.     • Passes   instruments   to   the   surgeon   and   assistants   by  According  to  URGENCY   anticipating  their  need.     • Counts  sponges,  needles  and  instruments.   • Monitor  practices  of  aseptic  technique  in  self  and  others.   Classification   Indication  for   Examples   • Keeps  track  of  irrigations  used  for  calculations  of  blood  loss   Surgery   Circulating  Nurse  Emergent  –  patient     -­‐  severe   • Responsible  and  accountable  for  all  activities  occurring  during  requires  immediate   Without  delay   bleeding   a   surgical   procedure   including   the   management   of   personnel  attention,  life  threatening   -­‐  gunshot/  stab   equipment,   supplies   and   the   environment   during   a   surgical  condition.   wounds   procedure.   -­‐  Fractured  skull   • Ensure  all  equipment  is  working  properly.  Urgent  /  Imperative  –   Within  24  to  30   -­‐   kidney   /   • Guarantees  sterility  of  instruments  and  supplies.  patient  requires  prompt   hours   ureteral  stones   • Monitor  the  room  and  team  members  for  breaks  in  the  sterile  attention.   technique.  Required  –  patient   Plan  within  a   -­‐  cataract   • Handles  specimens.  needs  to  have  surgery.   few  weeks  or   -­‐  thyroid  d/o   • Coordinates   activities   with   other   departments,   such   as   months   radiology  and  pathology.  Elective  –  patient  should   Failure  to  have   -­‐  repair  of  scar  have  surgery.   surgery  not   -­‐  vaginal  repair     catastrophic   F.    Principles  of  Surgical  Asepsis    Optional  –  patient’s   Personal   -­‐  cosmetic   Ø Sterile   object   remains   sterile   only   when   touched   by   another  decision.   preference   surgery   sterile  object     Ø Only sterile objects may be placed on a sterile fieldC.  Preoperative  Meds.  5A’s   Ø A  sterile  object  or  field  out  of  range  of  vision  or  an  object  held  Anxiolitics  (Tranquilizers  &  Sedatives)   below  a  person’s  waist  is  contaminated                *  Diazepam  (  Valium  )   Ø When   a   sterile   surface   comes   in   contact   with   a   wet,              *  Lorazepam  (  Ativan  )   contaminated   surface,   the   sterile   object   or   field   becomes              *  Diphenhydramine   contaminated  by  capillary  action  Analgesics   Ø Fluid  flows  in  the  direction  of  gravity              *  Nalbuphine  (  Nubain  )   Ø The   edges   of   a   sterile   field   or   container   are   considered   to   be  Anticholinergics   contaminated  (1  inch)              *  Atropine  Sulfate    Anti-­‐Ulcer  (Proton  Pump  Inhibitors)   G.  PACU/RR  Care              *  Omeprazole  (  Losec  )                *  Famotidine   ü Maintaining  a  Patent  Airway  Antibiotics   ü Assessing  Status  of  Circulatory  System     ü Maintaining  Adequate  Respiratory  Function  D.  Preoperative  Teachings   ü Assessing  Thermoregulatory  Status   Ø Incentive Spirometry ü Maintaining  Adequate  Fluid  Volume   Ø Diaphragmatic Breathing ü Minimizing  Complications  of  Skin  Impairment   Ø Coughing ü Maintaining  Safety   Ø Turning ü Promoting  Comfort   Ø Foot and Leg exercise  • Teaching should be done morning/afternoon before the day of surgery  • Best Method: Return Demonstration  POSSIBLE  TOPICS  ON  MEDICAL  AND  SURGICAL  HEALTH  NURSING  FOR  THE  UPCOMING  JULY  2012  PNLE  *Patterned  on  the  previous  board  exams  from  December  2006  –  December  2011…  the  purpose  of  this  note  is  to  GUIDE  students  on  the  possible  topics  that  might  be  part  of  the  upcoming  July  2012  PNLE  
  2. 2. WHAT YOU SHOULD KNOW BEFORE THE PNLE JULY  2012  PNLE  PEARLS  OF  SUCCESS    PART  6:  MEDICAL  AND  SURGICAL  HEALTH  NURSING       Intestinal   • NGT  insertion  as  needed  H.    Parameter  for  Discharge  from  PACU/RR   Obstruction   • Administered  IVF  as  ordered     (  3rd-­‐5th  day  postop)   • Prepare  for  possible  surgery  • Activity.  Able  to  obey  commands   Constipation   • Adequate  hydration  • Respiratory.  Easy,  noiseless  breathing   • High  fiber  diet  • Circulation.  BP  within  20mmHg  of  preop  level   • Encourage  early  ambulation  • Consciousness.  Responsive   Paralytic  Ileus   • Encourage  early  ambulation  • Color.  Pinkish  skin  and  mucus  membrane   WOUND       Wound  Infection   • Keep  wound  clean  and  dry  I.  Post  Operative  Complications   • Surgical  aseptic  technique     when  changing  dressing   Problem   Nursing  Intervention   • Antibiotic  therapy     Wound  Dehiscence    RESPIRATORY     • Apply  abdominal  binders  Pneumonia   • Deep  breathing  exercises     • Encourage  high  protein  diet     • Coughing  exercise   and  Vit.C  intake     • Early  ambulation   • Keep  in  bed  rest  Atelectasis   • Deep  breathing  exercises   Wound  Evisceration   • Semi-­‐Fowlers,  bend  knees  to     • Coughing  exercise   relieve  tension  on  the   • Early  ambulation   abdominal  muscles  Pulmonary   • Turning   • Splinting  on  coughing  Embolism   • Ambulation   • Cover  exposed  organ  with   • Anti  embolic  stockings   sterile  ,  moist  saline  dressing   • Reassure,  keep  him/her  quite   • Compression  devises   and  relaxed   • Prevent  massaging  the  lower   • Prepare  for  surgery  and  repair   extremities   of  wound  CIRCULATION      Hypovolemia   • Fluid  and  blood  replacement    Hemorrhage   • Fluid  and  blood  replacement   ONCOLOGY  NURSING   • Vit.k  and  hemostat     • Ligation  of  bleeders   A.  Benign  VS  Malignant  Neoplasm   • Pressure  dressing    Thrombophlebitis   • Early  ambulation   Characteristic   Benign  Neoplasm   Malignant  Neoplasm     • Anti  embolic  stocking   Speed  Growth   Grows  slowly   Usually  grows  rapidly     • Encourage  leg  exercise   Usually  continues   Tends  to  grow  relentlessly     • Hydrate  adequately   to  grow  throughout   throughout  life     • Avoid  any  restricting  devices   life  unless       that  impaired  circulation   surgically  removed     • Avoid  massage  on  the  calf  of   Mode  of   Grows  by  enlarging   Grows  by  infiltrating     the  leg   Growth   and  expanding   surrounding  tissues     • Initiate  anticoagulant  therapy   Always  remains   May  remain  localized  (in  URINARY     localized;  never   situ)  but  usually  infiltrates  Urinary  Retention   • Monitor  I  &  O   infiltrates   other  tissues   • Interventions  to  facilitate   surrounding     voiding   tissues   • Urinary  Catheterization  as   Capsule   Almost  always   Never  contained  within  a   needed   contained  within  a   capsule  Urinary   • Monitor  I  &  O   fibrous  capsule   Absence  of  capsule  allows  Incontinence   Capsule   neoplastic  cells  to  invade  Urinary  Tract   • Adequate  fluid  intake   advantageous   surrounding  tissues  Infection   • Early  ambulation   because   Surgical  removal  of  tumor     encapsulated   difficult   • Aseptic  catheterization  as   tumor  can  be   needed   removed  surgically   • Good  perineal  hygiene   Cell   Usually  well   Usually  poorly  GASTRO-­‐INTESTINAL     characteristics   differentiated   differentiated  Nausea  and   • IV  fluids  until  peristalsis      Vomiting   returns   Recurrence   Unusual  when   Common  following  surgery   • Progressive  diet  (  clear  liquid   surgically  removed   because  tumor  cells  spread   then  full  fluids,  soft  then   into  surrounding  tissues   regular  diet)   Metastasis   Never  occur   Very  common   • Anti  emetics  as  ordered   Effect  of   Not  harmful  to  host   Always  harmful  to  host  Hiccups   • NGT  insertion  as  needed   Neoplasm   unless  located  in   Causes  disfigurement,   • Hold  breath  while  taking  a   area  where  it   disrupted  organ  function,   large  swallow  of  water   compresses  tissue   nutritional  imbalances   • Breath  in  and  out  on  a  paper   or  obstructs  vital   May  result  in  ulcerations,   bag   organs   sepsis,  perforations,     • Anti  emetics  as  ordered  POSSIBLE  TOPICS  ON  MEDICAL  AND  SURGICAL  HEALTH  NURSING  FOR  THE  UPCOMING  JULY  2012  PNLE  *Patterned  on  the  previous  board  exams  from  December  2006  –  December  2011…  the  purpose  of  this  note  is  to  GUIDE  students  on  the  possible  topics  that  might  be  part  of  the  upcoming  July  2012  PNLE  
  3. 3. WHAT YOU SHOULD KNOW BEFORE THE PNLE JULY  2012  PNLE  PEARLS  OF  SUCCESS    PART  6:  MEDICAL  AND  SURGICAL  HEALTH  NURSING    Prognosis   Very  good   Depends  on  cell  type  and   Client  Education   Tumor  generally   speed  of  diagnosis   ü Avoid close contact with others until treatment is completed removed  surgically   Poor  prognosis  if  cells  are   ü Maintain daily activities unless contraindicated, allowing for extra poorly  differentiated  and   rest periods as needed evidence  of  metastatic   ü Maintain balanced diet spread  exists   ü Maintain fluid intake ensure adequate hydration (2-3 liters/day) Good  prognosis  indicated  if   ü If implant is temporary, maintain bedrest to avoid dislodging the cells  still  resemble  normal   implant. cells  and  there  is  no   ü Excreted body fluids may be radioactive; double-flush toilets after evidence  of  metastasis   use   ü Radiation therapy may lead to bone marrow suppression    B.  Recommendations  of  the  American  Cancer  Society  for  Early   Nursing  Management  Cancer  Detection   ü Exposure to small amounts of radiation is possible during close1.  For  detection  of  breast  cancer   contact with persons receiving internal radiation: understand the ü Beginning at age 20, routinely perform monthly breast self- principles of protection from exposure to radiation: time, distance, examination   and shielding ü Women  ages  20-­‐39  should  have  breast  examination  by  a   Ø Time: minimize time spent in close proximity to the healthcare  provider  every  3  years   radiation source; a common standard is to limit contact time ü Women  age  40    and  older  should  have  a  yearly  mammogram   to 30 minutes total per 8-hour shift; and  breast  self-­‐examination  by  a  healthcare  provider   Ø Distance: maintain the maximum distance 6 feet possible from the radiation source             Ø Shielding: use lead shields and other precautions to reduce  2.  For  detection  of  colon  and  rectal  cancer   exposure to radiation ü All persons age 50 and older should have a yearly fecal occult ü Place client in private room blood test   ü Instruct visitors to maintain at least a distance of 6 feet from the ü Digital  rectal  examination  and  flexible  sigmoidoscopy  should   client and limit visitors to 10-30 minutes be  done  every  5  years   ü Ensure proper handling and disposal of body fluids, assuring the ü Colonoscopy  with  barium  enema  should  be  done  every  10   containers are marked appropriately years   ü Ensure proper handling of bed linens and clothing       ü In the event of a dislodged implant, use long-handled forceps and3.  For  detection  of  uterine  cancer   place the implant into a lead container; never directly touch the ü Yearly papanicolao (Pap) smear for sexually active females and implant any female over age 18   ü Do not allow pregnant woman to come into any contact with ü At  menopause,  high-­‐risk  women  should  have  an  endometrial   radiation tissue  sample   ü If working routinely near radiation sources, wear a monitoring           device to measure exposure4.  For  detection  of  prostate  cancer   ü Educate client in all safety measures ü At age 50, have a yearly digital rectal examination   ü At  age  50,  have  a  yearly  prostate-­‐specific  antigen  (PSA)  test E.  External  Radiation  Therapy  (Teletheraphy)         Ø The radiation oncologist marks specific locations for radiationC.    American  Cancer  Society’s  seven  warning  signs  of  cancer   treatment using a semipermanent type of ink(uses  acronym  CAUTION  US):   Ø Treatment  is  usually  given  15-­‐30  minutes  per  day,  5  day  per     1.  Change  in  bowel  or  bladder  habits   week,  for  2-­‐7  weeks     2.  A  sore  that  does  not  heal   Ø The  client  does  not  pose  a  risk  for  radiation  exposure  to  other     3.  Unusual  bleeding  or  discharge   people     4.  Thickening  or  lump  in  breast  or  elsewhere       5.  Indigestions  or  difficulty  in  swallowing   Side  Effects     6.  Obvious  change  in  wart  or  mole   § Tissue damage to target area (erythema, sloughing, hemorrhage)                      7.  Nagging  cough  or  hoarseness   §  Ulcerations  of  oral  mucous  membranes     §  GIT  effects  such  as  nausea,  vomiting,  and  diarrhea                    8.  Unexplained  Anemia   § Immunosuppression                    9.  Sudden  loss  of  weight          Client  Education    D.    Internal  Radiation  Therapy  (Brachytheraphy)   ü Wash the marked area of the skin with plain water only and pat   skin dry; do not use soaps, deodorants, lotions, perfumes, powdersSources  of  Internal  Radiation   or medications on the site during the duration of the treatment; doü Implanted into affected tissue or body cavity not wash off the treatment site marksü Ingested as a solution ü Avoid  rubbing,  scratching,  or  scrubbing  the  treatment  site;  do  ü Injected as a solution into the bloodstream or body cavity not  apply  extreme  temperatures  (Heat  or  Cold)  to  the  ü Introduced through a catheter into the tumor treatment  site  ;  if  shaving,  use  only  an  electric  razor   ü Wear  soft,  loose-­‐fitting  over  the  treatment  areaSide  Effects     ü Protect  skin  from  sun  exposure  during  the  treatment  and  for  at   § Fatigue least  1  year  after  the  treatment  is  completed;  when  going   § Anorexia outdoors,  use  sun-­‐blocking    agents  with  sun  protector  factor   § Immunosuppression (SPF)  of  at  least  15 § Other side effects similar to external radiation ü Maintain  proper  rest,  diet,  and  fluid  intake  as  essential  to       promoting  health  and  repair  of  normal  tissues        POSSIBLE  TOPICS  ON  MEDICAL  AND  SURGICAL  HEALTH  NURSING  FOR  THE  UPCOMING  JULY  2012  PNLE  *Patterned  on  the  previous  board  exams  from  December  2006  –  December  2011…  the  purpose  of  this  note  is  to  GUIDE  students  on  the  possible  topics  that  might  be  part  of  the  upcoming  July  2012  PNLE  
  4. 4. WHAT YOU SHOULD KNOW BEFORE THE PNLE JULY  2012  PNLE  PEARLS  OF  SUCCESS    PART  6:  MEDICAL  AND  SURGICAL  HEALTH  NURSING    Nursing  Management     Cardiac  Action  Potential  ü Monitor for adverse side effects of radiation Ø Depolarization/Contraction/Systole  -­‐  electrical  activation  of  ü  Monitor  for  significant  decreases  in  white  blood  cell  counts   a   cell   caused   by   the   influx   of   sodium   into   the   cell   while   and  platelet  counts potassium  exits  the  cell  ü Client  teaching  (refer  to  later  sections  for  management  of   Ø Repolarization/Resting/Diastole   -­‐   return   of   the   cell   to   the   immunosuppression,  thrombocytopenia   resting   state   caused   by   re-­‐entry   of   potassium   into   the   cell     while  sodium  exits      CARDIOVASCULAR  NURSING   D.  Cardiac  Catheterization  (  Coronary  Angiography  /     Arteriography  )  A.    Heart  Circulation   Ø Insertion  of  a  catheter  into  the  heart  and  surrounding  vessels   Ø Is  an  invasive  procedure  during  which  physician  injects  dye   into  coronary  arteries  and  immediately  takes  a  series  of  x-­‐ray   films  to  assess  the  structures  of  the  arteries   Pretest:  Ensure  Consent,  assess  for  allergy  to  seafood  and   iodine,  NPO,  document  weight  and  height,  baseline  VS,  blood   tests  and  document  the  peripheral  pulses   Intra-­‐test:  inform  patient  of  a  fluttery  feeling  as  the  catheter   passes  through  the  heart;  inform  the  patient  that  a  feeling  of   warmth  and  metallic  taste  may  occur  when  dye  is   administered   Post-­‐test:  Monitor  VS  and  cardiac  rhythm   Ø Monitor  peripheral  pulses,  color  and  warmth  and  sensation  of   the  extremity  distal  to  insertion  site     Ø Maintain  sandbag  to  the  insertion  site  if  required  to  maintain   pressure   Ø Monitor  for  bleeding  and  hematoma  formation       E.    Coronary  Arterial  Diseases     ANGINA     Coronary  artery  bypass   PECTORIS   Levine’s  Sign:   surgery     initial  sign  that   Ø Greater and lesser 4  E’s  of   shows  the  hand   saphenous veins are Angina   clutching  the  chest   commonly used for     Pectoris     bypass graft proceduresB.    Heart  Sound     Chest  pain:       ü Excessive characterized  by   Percutaneuos   Ø Tricuspid  valve  (lub)  -­‐  RT  5th  intercostal,  medial   physical sharp  stabbing   Transluminal  Coronary   Ø Mitral  valve  (lub)  -­‐  LT  5th  intercostal,  lateral   exertion pain  located  at  sub   Angioplasty  (PTCA)   Ø Aortic  semilunar  valve  (dub)  -­‐  RT  2nd  intercostal   ü Exposure to sterna  usually   Ø Mechanical dilation of Ø Pulmonary  semilunar  valve  (dub)  -­‐  LT  2nd  intercostals   cold radiates  from  neck,   the coronary vessel wall   environment back,  arms,   by compresing theS1    -­‐  due  to  closure  of  the  AV(mitral/tricuspid)  valves   ü Extreme shoulder  and  jaw   atheromatous plaque.S2    -­‐  due  to  the  closure  of  the  semi-­‐lunar  (pulmonic/aortic)  valves   emotional muscles      S3  –  Ventricular  Diastolic  Gallop   response   Nursing  Management:                    Mechanism:  vibration  resulting  from  resistance  to  rapid     ü Excessive Dyspnea                                                            ventricular  filling  secondary  to  poor  compliance   intake of Tachycardia   NTG  Tablets(sublingual)  S4    -­‐  Atrial  Diastolic  Gallop   foods or Palpitations   Give  3  doses  interval  of  3-­‐ heavy meal Diaphoresis   5minutes   Mechanism:  vibration  resulting  from  resistance  to  late         ü Keep  the  drug  in  a  dry                                          ventricular  filling  during  atrial  systole  Heart  Murmurs   ECG:  may  reveals   place,  avoid  moisture  Ø Incompetent  /  Stenotic  Valve   ST  segment   and  exposure  to  sunlight    Pericardial  Friction  Rub   depression   ü Change  stock  every  6  Ø It  is  an  extra  heart  sound  originating  from  the  pericardial  sac   T  wave  inversion     months  Ø Mechanism:  Originates  from  the  pericardial  sac  as  it  moves   ü Offer  sips  of  water  Ø Timing:  with  each  heartbeat   before  giving  sublingual     nitrates,    C.  ECG     NTG  Nitrol  or   Transdermal  patch   ü Avoid  placing  near  hairy   areas  as  it  may  decrease   drug  absorption   ü Avoid  rotating   transdermal  patches.        POSSIBLE  TOPICS  ON  MEDICAL  AND  SURGICAL  HEALTH  NURSING  FOR  THE  UPCOMING  JULY  2012  PNLE  *Patterned  on  the  previous  board  exams  from  December  2006  –  December  2011…  the  purpose  of  this  note  is  to  GUIDE  students  on  the  possible  topics  that  might  be  part  of  the  upcoming  July  2012  PNLE  
  5. 5. WHAT YOU SHOULD KNOW BEFORE THE PNLE JULY  2012  PNLE  PEARLS  OF  SUCCESS    PART  6:  MEDICAL  AND  SURGICAL  HEALTH  NURSING    Myocardial   Chest  pain   Nursing  Management   RESPIRATORY  NURSING  Infarction   Usually  radiates   Goal:  Decrease  myocardial    (MI)   from  neck,  back,   oxygen  demand   A.  Chronic  Obstructive  Pulmonary  Diseases     shoulder,  arms,      Death  of   jaw  &  abdominal   ü Administer narcotic Chronic  Bronchitis   Smoking   ü Consistent productivemyocardial   muscles   analgesic as ordered: (Blue  Bloaters)   Air   coughcells  from   (abdominal   Morphine Inflammation  of  the   pollution   ü Dyspnea on exertioninadequate   ischemia):  severe   ü Administer  oxygen  low   bronchi  due  to     with prolongedoxygenation,   crushing   flow  2-­‐3  L  /  min     hypertrophy  or   expiratory gruntoften  caused     ü Enforce  CBR  in  semi-­‐ hyperplasia  of  goblet   ü Anorexia andby  sudden   Not  usually   fowlers  position  without   mucous  producing  cells   generalized bodycomplete   relieved  by  rest  or   bathroom  privileges   leading  to  narrowing  of   malaiseblockage  of  a   by  nitroglycerine   ü Instruct  client  to  avoid   smaller  airways   ü Cyanosiscoronary     forms  of  valsalva   ü Scattered rales/rhonchiartery   N/V   maneuver       Dyspnea   ü Monitor  urinary  output   Bronchial  Asthma   Allergens   ü Cough that is productiveCharacterized   Increase  in  blood   &  report  output  of  less   Reversible  inflammatory   ü Dyspneaby  localized   pressure  &  pulse   than  30  ml  /  hr:   lung  condition  caused  by   ü Wheezing on expirationformation  of   Hyperthermia:   indicates  decrease   hypersensitivity  to   ü Tachycardia,necrosis   elevated  temp   cardiac  output   allergens  leading  to   palpitations and(tissue   Skin:  cool,  clammy,   ü Resumption  of  ADL   narrowing  of  smaller   diaphoresisdestruction)   ashen   particularly  sexual   airways   ü Mild apprehension,with   Mild  restlessness   intercourse:  is  4-­‐6  weeks   restlessnesssubsequent   &  apprehension   post  cardiac  rehab,  post   ü Cyanosishealing  by     CABG  &  instruct  to:  scar  formation   ECG:   ü Instruct  client  to  assume   Bronchiectasis   Recurrent     ü Consistent productive&  fibrosis   ST  segment   a  non  weight  bearing   Permanent  dilation  of   LRTI   cough   elevation   position   the  bronchus  due  to   Congenital   ü Dyspnea T  wave  inversion   ü Client  can  resume  sexual   destruction  of  muscular   disease   ü Presence of cyanosis Widening  of  QRS   intercourse:  if  can  climb   and  elastic  tissue  of  the   Presence   ü Rales and crackles complexes   or  use  the  staircase   alveolar  walls   of  tumor   ü Hemoptysis   Chest   ü Anorexia and The  Most  Critical  Period     trauma   generalized body 6-­‐8  hours  because  majority     malaise ü of  death  occurs  due  to   arrhythmia  leading  to   Pulmonary   Smoking   ü Productive  cough   premature  ventricular   Emphysema   Pollution   ü Dyspnea  at  rest   contractions  (PVC)   Terminal  and   Hereditary   ü Prolonged  expiratory   *Lidocaine:  DOC  for   irreversible  stage  of   Allergy   grunt   arrhythmia   COPD  characterized  by  :   ü Resonance  to       hyperresonance     • Inelasticity of alveoli ü Decreased  tactile  F.  Congestive  Heart  Failure   • Air trapping fremitus  Inability  of  the  heart  to  pump  blood  towards  systemic  circulation   • Maldistribution of ü Decreased  breath     gasses sounds    I. Left  sided  heart  failure   • Overdistention of ü Barrel  chest   Ø 90% - Mitral valve stenosis thoracic cavity ü Anorexia  and   Ø Pulmonary Symptoms (Barrel chest) generalized  body       malaise  II. Right  sided  heart  failure   ü Rales  or  crackles   Ø Tricuspid valve stenosis ü Pursed-­‐lip  breathing     Ø Venous congestion symptoms      NURSING  MANAGEMENT     Nursing  Management:    Goal:  increase  myocardial  contraction     ü Enforce CBRü Administer medications as ordered ü Low inflow O2 admin; high inflow will cause respiratory arrest § Cardiac  glycosides   * most accurate: venturi mask ü Digoxin  *Antidote:  Digibind   ü Administer medications as ordered § Loop  diuretics   Bronchodilators   § Bronchodilators   Antimicrobials   § Narcotic  analgesics   Corticosteroids  (5-­‐10  minutes  after  bronchodilators)   ü Morphine  sulfate     Mucolytics/expectorants   § Vasodilators   ü Force fluids § Anti-­‐arrhythmic  agents   ü Nebulize and suction client as neededü Administer O2 inhalation at 3-4 L/minute ü Provide comfortable and humid environmentü Restrict Na and fluids ü Avoidance of smoking and allergensü Monitor strictly VS and IO and Breath SoundsWeigh pt daily and   assess for pitting edema and abdominal girth daily and notify MD  ü Provide meticulous skin care  ü Provide a dietary intake which is low in saturated fats and caffeine    POSSIBLE  TOPICS  ON  MEDICAL  AND  SURGICAL  HEALTH  NURSING  FOR  THE  UPCOMING  JULY  2012  PNLE  *Patterned  on  the  previous  board  exams  from  December  2006  –  December  2011…  the  purpose  of  this  note  is  to  GUIDE  students  on  the  possible  topics  that  might  be  part  of  the  upcoming  July  2012  PNLE