NCLEX-PN

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1

S/S of __________ include

* Dyspnea on exertion (initial symptom)

* Barrel-shaped chest from lung over distention

* Prolonged expiration because accessory muscles are used for inspiration & abdominal muscles are used to force air out of the lungs.

* Decreased breath sounds

Emphysema

2

Emphysema

Permanent enlargement of the acini accompanied by destruction of the alveolar walls. Obstruction results from tissue changes NOT mucus production

3

Treatment:

Emphysema

* Avoid smoking & air pollution
* Bronchodilators (aminophylline) to promote cilia
transporting mucous
* Antibiotics to treat resp. tract infections
* Immunize to prevent influenza & pneumococcal
pneumonia
* Adequate hydration
* Chest physiotherapy to mobilize secretions
* Oxygen therapy @ low settings to increase
partial/pressure to arterial oxygen to 55-65mm Hg

4

Asthma & COPD

Obstruction for airway results from mucus production.

5

A form of COPD, is inflammation of the bronchi caused by irritant or infection. In _____ _______, hypersecretion of mucus & chronic productive cough last for 3 months of the year & occur for at least 2 consecutive years. * DISTINGUISHING CHARACTERISTIC IS OBSTRUCTION OF AIRFLOW CAUSED BY MUCUS*

Chronic Bronchitis

6

Chronic bronchitis

S/S of ______ are:
* Productive cough
* Dyspnea
* Cyanosis
* Use of accessory muscles for breathing
* Pulmonary hypertension caused by involvement of small pulmonary arteries (due to inflammation in the bronchial walls & spasms of pulmonary blood vessels from hypoxia)

7

Deficiency in the amount of oxygen reaching the tissues.

Hypoxia

8

Treatment:

Chronic Bronchitis

* Avoid air pollutants
* Stop smoking (if smoker)
* Antibiotics- treat reoccurring infections
* Corticosteroids to combat inflammation
* Diuretics for edema
* Bronchodilators to relieve bronchospasm & facilitate mucus clearance.
* Adequate hydration
* Chest physiotherapy to mobilize secretions
* Oxygen for hypoxia

9

_________ is an acute infection of the lung parenchyma that commonly impairs gas exchange.
Classified in 3 ways:
Origin: may be viral, bacterial, fungal or protozoa
Location: Bronchopneumonia involves distal airways
Alveoli; lobular- part of lobe & lobar- entire lobe.
Type: Primary results from inhalation or aspiration
of pathogen, such as bacteria or virus & includes
pneumococcal & viral pneumonia.

Pneumonia

10

Secondary pneumonia

May follow lung damage from noxious chemical or other insult or may result from hematogenous spread of bacteria; aspiration pneumonia results from inhalation of foreign matter, such as vomitus or food particles into the bronchi

11

Treatment:

Pneumonia

* Humidified oxygen therapy for hypoxia
* Bronchodilator therapy
* Antitussives (cough) suppressant)
* Analgesic to relieve pleuritic chest pain
* High calorie diet
* Bed rest
* Mech. ventilation for resp. failure
* Positive-end expiratory pressure ventilation to
maintain adequate oxygenation for pts. w/severe
PN on mechanical ventilation

12

Accumulation of air in the pleural cavity that leads to partial or complete lung collapse.

Pneumothorax

13

Ref. Range:

Glucose

70-105 or 80-110

14

Ref. Range:

BUN

7.0-25.7

15

Ref. Range

Creatinine

0.7-1.3

16

Ref. Range:

Sodium

135-145

17

Ref. Range

Potassium

3.5-5.1

18

Ref. Range:

Chloride

98-107

19

Ref. Range:

CO2

22-29

20

Ref. Range:

Calcium

8.5-10.4

21

Ref. Range:
Glomerular filtration rate (GFR)
A measure of the function of the kidneys. This test measures the level of creatinine in the blood and uses the result in a formula to calculate a number that reflects how well the kidneys are functioning, called the estimated GFR or eGFR

90 - 120 mL/min/1.73 m2

* Older people will have lower normal levels, because GFR decreases with age.

22

Ref. Range:

Alk Phosphate

40-150

23

Ref. Range: SGOT (AST)

Serum glutamic oxaloacetic transaminase
* Aspartate Aminotransferase (AST) An aspartate aminotransferase (AST) test measures the amount of this enzyme in the blood. AST is normally found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys. AST formerly was called serum glutamic oxaloacetic transaminase (SGOT).

5-34

24

Ref. Range: SGPT (ALT)
serum glutamic-pyruvic transaminase

ALT is an enzyme made in the liver. It is released into the blood when tissues are damaged. This enzyme is also called serum glutamic-pyruvic transaminase, or SGPT.
***The ALT test checks for and measures damage to the liver.***

0-55

25

Ref. Range:

Bilirubin Total

0.2-1.2

26

Ref. Range:

Protein Total

6.4-8.3

27

Ref. Range:

Albumin

3.6-5.2

28

When is it ordered?
* Frequently ordered as part of a panel of tests performed for a physical or health screening.
* Also ordered, along with other tests, when a person has symptoms of a liver disorder such as jaundice, fatigue, or weight loss, or symptoms of nephrotic syndrome such as swelling around the eyes, belly, or legs.
* A health practitioner may also order an albumin test to check or monitor a person's nutritional status.

* Low albumin levels are a warning and an indication that further investigation may be warranted. They may reflect a temporary condition that will resolve itself or may suggest an acute or chronic condition that requires medical intervention.

* A low albumin can suggest liver disease. Other liver enzyme tests are ordered to determine exactly which type of liver disease. A person may, however, have normal or near normal albumin levels with liver disease until the condition has reached an advanced stage. For example, in people with cirrhosis, albumin is typically (but not always) low whereas in most chronic liver diseases that have not progressed to cirrhosis, albumin is usually normal.

* Low albumin levels can reflect diseases in which the kidneys cannot prevent albumin from leaking from the blood into the urine and being lost.
* Low albumin levels can also be seen in inflammation, shock, and malnutrition.
* They may be seen with conditions in which the body does not properly absorb and digest protein, such as CROHN'S & CELIAC DISEASE, or in which large volumes of protein are lost from the intestines.

* HIGH albumin levels can be seen with dehydration, although the test is not typically used to monitor or detect this condition.

Albumin test

29

Ref. Range:

WBC

4.6-10.2

30

Ref. Range:

RBC

4.04-6.13

31

Ref. Range: Newborn (birth to 1 week)

Hgb

14-24

32

Ref. Range: Neonatal (1wk-1month)

Hgb

11-20

33

Ref. Range: Infant (1mo-2yrs)

Hgb:

10-15

34

Ref. Range: Child (2yr-Puberty)

Hgb

11-16

35

Ref. Range: Male Adolescent-Adult

Hgb

14-18

36

Ref. Range: Female Adolescent-Adult

Hgb

12-16

37

Ref. Range:

Platelet Count

142-424

38

Ref. Range:

NE%

37.0-80.0

39

Ref. Range:

LY%

10.0-50.0

40

Ref. Range:

MO%

0-12.0

41

Ref. Range:

EOS%

0-7.00

42

Ref. Range:

BASO%

0-2.50

43

Ref. Range:

NEU#

2.0-6.90

44

Ref. Range: >21yrs old

LYM#

0.8-4.8

45

Ref. Range:

MONO#

0-0.9

46

Ref. Range:

EOS#

0-0.7

47

Ref. Range:

BASO#

0-0.2

48

Ref. Range Temp: Newborn- 1yr old

96.8-99

49

Ref. Range Temp: Toddler 1-3yrs old

97.5-98.6

50

Ref. Range Temp: Preschooler (4-5yrs old) to Adolescent (13-18yrs old)

97.5-98.6

51

Ref. Range Apical rate: Newborn

100-170 or 110-160

52

Ref. Range Apical rate: 1yr old

90-130

53

Ref. Range Apical rate: Preschooler (4-5yrs old)

80-120

**helpful hint, a Preschoolers apical range is the same as the normal range for an adult BP**** 120/80
** Apical ranges from newborn to adult start off HIGH in #'s & drop as you age***

54

Ref. Range Apical rate: School-age 6-12yrs old

60-100

55

Ref. Range Apical rate: Adolescent 13-18

55-90

56

Ref. Range Apical rate Respirations: Newborn

30-60

57

Ref. Range Apical rate Respirations: 1yr old

20-40

58

Ref. Range Apical rate Respirations: Toddler 1-3

20-30

59

Ref. Range Apical rate Respirations: Preschooler (4-5yrs old)

16-22

60

Ref. Range Apical rate Respirations: School-age (6-12yrs old)

16-20

61

Ref. Range Apical rate Respirations: Adolescent (13-18yrs old)

12-20

62

Ref. Range Apical rate BP: Newborn

73/55

63

Ref. Range Apical rate BP: 1yr old

90/56

64

Ref. Range Apical rate BP: Toddler (1-3yrs old)

92/55

65

Ref. Range Apical rate BP: Preschooler (4-5yrs old)

95/57

66

Ref. Range Apical rate BP: School-age (6-12yrs old)

107/64

67

Ref. Range Apical rate BP: Adolescent (13-18yrs old)

121/70

68

Growth:

By __ months- wt. doubles & ht. 1" per month

6

69

Growth:
By __ months- wt. triples & ht. 1/2" per month

12

70

Growth:

Toddlers- wt. quadruples by ____ yrs
* Yearly gain 4-6 lbs.
* Age 2= 50% of adult height

2 1/2

71

Growth:

Preschoolers
* 4-6 lbs per year/ ht doubles by 4
Ex. If a child is 20" they will be ___" by age 4

40

72

Growth:

School-age children
* 4-6lbs per year/ ht. 3x by 13
So if 20in they'll be ___in by 13yrs

60

73

Development:

By 1yrs old

1. Can sit down from upright position
2. walks well while holding hand
3. Pincer grasp (Can pick up raisin)

74

Development: 18mos

1. Walks w/out help & jumps in place
2. Uses cup well & can stack blocks
3. Knows own name

75

Development: 2yrs old

1. Goes up stairs (2feet on each step)
2. Runs fairly/very well
3. Holds crayon w/fingers properly like a pencil
4. Can use cup w/straw

76

Fluid volume deficit: Manifestations

Acute weight loss > or equal to 5%, decreased skin turgor, dry mucous membranes, oliguria (scan urine), anuria (nonpassage or < 100ml's a day of urine), increased hematocrit, BUN increased out of proportion to Creatinine level, to hypothermia.

77

Fluid volume deficit: Mgmt strategies

Fluid challenge, fluid replacement orally or parenterally

78

Fluid volume excess: Manifestations

Acute weight gain >/equal, edema, crackles, shortness of breath, decreased BUN, decreased hematocrit, distended neck veins

79

Fluid volume excess: Mgmt strategies

- Fluid & sodium restriction
- diuretics
- dialysis

80

Sodium deficit: below 136
Manifestations

-Nausea,
-malaise(feeling of discomfort, illness)
-lethargy,
-HA, Abdominal cramps,
-apprehension (anxiety, worry, unease),
-SEIZURES *serious*

81

Sodium deficit: below 136
Mgmt stratigies

Diet, normal saline or hypertonic saline solutions

82

Sodium excess: above 145
Manifestations

- Dry, sticky mucous membranes (rough dry tongue)
- thirst
- fever
- restlessness
- weakness
- disorientation

83

Sodium excess: above 145
Mgmt. strategies

*Fluids
*Diuretics
*Dietary restrictions (of sodium)

84

Potassium deficit: below 3.5 mEq
Manifestations

* Anorexia
* Abdominal distention
* Paralytic ileus ( intestinal obstruction )
* Muscle Weakness
* ECG changes & dysrhythmias

85

Potassium deficit: below 3.5 mEq
Mgmt. strategies

* Diet
* Oral or parenteral potassium replacement therapy

86

Potassium excess: above 5.0 mEq
Manisfestations

Diarrhea
Colic
Nausea
Irritability
Muscle weakness
ECG changes (used to determine heart rate, heart rhythm and other information regarding the heart's condition)

87

Potassium excess: above 5.0 mEq
Mgmt strategies

Dietary restriction
Diuretics
IV glucose
Insulin & sodium bicarbonate
Cation exchange resin (Anion resins and cation resins are the two most common resins used in the ion exchange process. While anion resins attract negatively charged ions, CATION resins attract positively charged ions.)
Calcium gluconate
Dialysis
Kayxelagte (This medication is used to treat a high level of potassium in your blood)

88

Calcium deficit: below 9.0mg/dL
Manifestations

* Abdominal & muscle cramps
* Stridor
* Carpopedal spasm (A spasm of the feet/hands observed in hyperventilation, calcium deprivation, and tetany.
* Hyperactive reflexes
* Tetany
* Tingling of fingers & around mouth
* ECG changes (heart rate, rhythm & other cond)
* + Chvostek's or Trousseau's (abnormal reaction to the stimulation of the facial nerve. When the facial nerve is tapped at the angle of the jaw the facial muscles on the same side of the face will contract momentarily (typically a twitch of the nose or lips)

89

Calcium deficit: below 9.0 mg/dL
Mgmt strategies

* Diet
* Oral or parenteral calcium
* Salt replacement

90

Calcium excess: above 10.5 mg/dL
Manifestations

- Deep bone & flank pain
- Muscle weakness
- Depressed deep tendon reflexes
- Constipation
- N/V
- Confusion, impaired memory
- Polyuria & polydipsia
- ECG changes

91

Calcium excess: above 10.5 mg/dL
Mgmt Strategies

* Fluid replacement
* etidronate (used to tx excessive Ca+ Treats Paget disease of the bone. Also prevents or treats bone problems (heterotopic ossification) that may happen after hip replacement surgery or spinal injury.)
* Pamidronate (Treats high blood calcium levels (hypercalcemia) in pt.'s w/cancer. Also treats bone damage caused by Paget's disease, multiple myeloma, or breast cancer that has spread to the bones)
* Mithramycin (Plicamycin is an antineoplastic antibiotic produced by Streptomyces plicatus. It is an RNA synthesis inhibitor)
* Calcitonin (a hormone secreted by the thyroid that has the effect of lowering blood calcium)
* Glucocorticoids
* Phosphate salts

92

Bicarbonate deficit: Manifestations

- HA & confusion
- Drowsiness
- Increased Respiratory rate & depth
- N/V
- Warm flushed skin

93

Bicarbonate deficit: Mgmt Strategies

Bicarbonate replacement & Dialysis

94

Bicarbonate excess: Manifestations

- Depressed respirations
- Muscle hypertonicity
- Dizziness
- Tingling of fingers & toes

95

Bicarbonate excess: Mgmt Strategies

* Fluid replacement if volume is depleted
* Ensure adequate chloride

96

Protein deficit:
Manifestations

Chronic weight loss, emotional depression, pallor, fatigue, soft flabby muscles

97

Protein deficit:
Management strategies

Diet, dietary supplements, hyper alimentation, and albumin
Hyperalimentation: Artificial supply of nutrients, typically intravenously

98

Magnesium deficit: Below 1.3 mEq
Manifestations

Dysphagia, muscle cramps, hyperactive reflexes, tetany, positives Chvostek's or Trousseau's sign, tingling in the fingers, dysrhythmias, vertigo

99

Magnesium deficit: Below 1.3 mEq
Mgmt Strategies

Diet, oral or parenteral magnesium replacement therapy

100

Magnesium excess: Above 2.1 mEq
Manifestations

-Facial flushing,
-nausea/vomiting
-sensation of warmth
-drowsiness
-depressed deep tendon reflexes
-muscle weakness
-respiratory depression
-*cardiac arrest*

101

Magnesium excess: Above 2.1 mEq
Mgmt Strategies

- Calcium gluconate
- mechanical ventilation
- dialysis

102

Phosphorus deficit: below 2.7 mg/dL
Manifestations

- Deep bone & flank pain
- Muscle weakness & pain
- Paresthesia (abnormal sensation, typically tingling/prickling (“pins and needles”)
- Apprehension (anxiety or fear that something bad or unpleasant will happen)
- Confusion
- Seizures

103

Phosphorus deficit: below 2.7 mg/dL
Mgmt strategies

* Diet- oral or parenteral phosphorus supplementation therapy

104

Phosphorus excess: 4.6 mg/dL
Manifestations

- Tetany
- Tingling of fingers & around mouth
- Muscle spasms
- Soft tissue calcification

105

Phosphorus excess: 4.6 mg/dL
Mgmt strategies

* Diet restriction
* Phosphate binders (a group of medications used to reduce the absorption of phosphate and taken with meals and snacks)
* Normal Saline sol.
* IV dextrose solution & insulin