Here is what I took away from the review session with Mrs. Semillo today.
There were a few things that she mentioned more than once or that she mentioned out of the blue.
- The majority of the questions will be about the assessment of and rationale for the cardiopulmonary system.
- When checking circulation, note 'mottled' skin (red/blue/purple blotches)
- When checking circulation, note the oral mucosa (tongue: shiny and beefy)
- Meds that can effect circulation are Coumadin (Warfarin) and Aspirin (most commonly)
- Do NOT use MRI if pt has metal, pacemaker, old lead based tatoo
- Do NOT do a CT if pt is allergic to iodine or shellfish
- If doing a bronchoscopy, check gag reflex (aspiration)
- If Left Ventricle enlarged, you may see edema or hear crackles (lung sounds)
- With apnea, crackles indicate secretions, fluid
- #4: Know that subjective is symptoms, objective is signs
Nurses treat signs/symptoms
Outcomes need to be specific and measureable (when, how much, how many, etc)
Be able to identify a good outcome statement
Be able to prioritize (ABC's, then safety)
Interventions need to address the signs and symptoms (the 'as manifested by')
- #5: Hypoxemia is measureable
The common diagnoses for oxygenation are:
- Ineffective tissue perfusion
- Impaired gas exchange
- Ineffective airway clearance
- #6: Know that you ask OPEN-ENDED questions.
- #10: If someone is having difficulty breathing, sit them up, use purse-lipped technique.
- When someone has a trach, air always needs to be humidified
- #11: Hyperoxygenate before suctioning (3-5 x's; 750mL (1 1/2 x's normal Tidal Volume (500mL))
- Check cannulas and masks for pressure sores
If anyone has anything else, please comment.
Trina, you did a pretty good job of summing it all up. Thanks for posting that, I missed the 1st half of the study session yesterday and your input is very helpful.
ReplyDeleteI second that!
ReplyDeleteI just noticed you asked if anyone had anything else to add. Hmmm... some of this might be redundant, but here goes:
ReplyDelete1. know difference between primary and secondary data (such as chart, client's spouse).
2. Related to diagnoses/the nursing process: Be aware of Gordons' 11 functional health patterns (see box 11-4 on p. 190). All refer to patterns to signify a sequence of recurring behavior. Gordons' health patterns appears in the front of our Diagnoses handbook.
3. The three categories that fall under a cardiopulmonary system assessment are: 1) circulation (blood/vascular) 2) perfusion (cardio), and 3) ventilation (respiratory)
Assessing circulation, look at skin, eyes, oral mucosa, cap refill, and objective data, such as labs (hg/hct), VS, MRIs and CT scans.
Assessing perfusion, look at heart rate/murmurs, BP, carotid/peripheral pulses (weak/absent), edema
Assessing ventilation, look at 02 sat, resp. rate, breathing pattern, patent airway, SOB, tidal volume, med. history (smoking, asthma, allergies, family history), cough (productive or non-productive, quality of sputum (color, amt., viscosity), meds (opioids depress respiratory syst), gag reflex/aspirations
4. Be able to recognize a properly worded nursing diagnostic statement, with three parts: " 1)____________ (problem/NANDA wording), 2) related to (or RT) ____________ (etiology/cause), 3) as evidenced by (or manifested by) _______________" (signs/symptoms).
thanks.
ReplyDeleteI was wondering about Gordon's. I will take a look at it just in case.
thanks for the information about the perfusion/vent/circ chart. There was so much information from that, I didn't put much of it up.
Very helpful.
Oh, which elicited a cough? Opioids? Morphine was it?