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 field
C.
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

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

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 close
1.
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 and
3.
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 exposure
4.
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 radiation
C.
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, powders
Sources
of
Internal
Radiation
or medications on the site during the duration of the treatment; do
ü Implanted into affected tissue or body cavity not wash off the treatment site marks
ü 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
area
Side
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

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 procedures
B.
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 the
S1
-­‐
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

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 productive
myocardial
muscles
analgesic as ordered: (Blue
Bloaters)
Air
cough
cells
from
(abdominal
Morphine Inflammation
of
the
pollution
ü Dyspnea on exertion
inadequate
ischemia):
severe
ü Administer
oxygen
low
bronchi
due
to
with prolonged
oxygenation,
crushing
flow
2-­‐3
L
/
min
hypertrophy
or
expiratory grunt
often
caused
ü Enforce
CBR
in
semi-­‐ hyperplasia
of
goblet
ü Anorexia and
by
sudden
Not
usually
fowlers
position
without
mucous
producing
cells
generalized body
complete
relieved
by
rest
or
bathroom
privileges
leading
to
narrowing
of
malaise
blockage
of
a
by
nitroglycerine
ü Instruct
client
to
avoid
smaller
airways
ü Cyanosis
coronary
forms
of
valsalva
ü Scattered rales/rhonchi
artery
N/V
maneuver
Dyspnea
ü Monitor
urinary
output
Bronchial
Asthma
Allergens
ü Cough that is productive
Characterized
Increase
in
blood
&
report
output
of
less
Reversible
inflammatory
ü Dyspnea
by
localized
pressure
&
pulse
than
30
ml
/
hr:
lung
condition
caused
by
ü Wheezing on expiration
formation
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
diaphoresis
destruction)
ashen
particularly
sexual
airways
ü Mild apprehension,
with
Mild
restlessness
intercourse:
is
4-­‐6
weeks
restlessness
subsequent
&
apprehension
post
cardiac
rehab,
post
ü Cyanosis
healing
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 CBR
ü 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 needed
ü Administer O2 inhalation at 3-4 L/minute ü Provide comfortable and humid environment
ü Restrict Na and fluids ü Avoidance of smoking and allergens
ü 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