NCLEX-RN Review-Gabriela R. 🩺💊💉
Chest Tubes
Used for:
To drain air, fluid, or blood from the pleural space (Chest cavity)
Post surgery (cardiothoracic surgery)
Collapsed Lungs (Tension PTX, Hemothorax)
Effusion=Fluid=Pleural Effusion
Chest Tube Drainage System
Water Seal Chamber (Air leak chamber)
We DO NOT want to see constant bubbling=Air Leak
If there is gentle intermittent bubbling=OKAY
Titling is normal and okay!!!!
Suction Control Chamber
Constant bubbling is OKAY!!!!!
If the drainage system gets knocked over=Obtain a new one
If the tube becomes dislodged from the drainage system=Place the distal end into a bottle of normal saline
If the tube becomes dislodged from the pts chest=Immediately place a 3-sided occlusive dressing to the site
Place the pt. in semi or high fowlers
may need oxygen
Contact MD
prepare for a new chest tube placement
The use of all 4 side rails in an up position
Differential Diagnosis
The different conditions that may be happening w/ a pt.
Benign or Malignant
ALL CANCERS BLEED!!!!!!!!!!
Lung cancer=hemoptysis (coughing up blood)
Wilms Tumor
A malignant tumor in the kidney
Seen in pediatrics between 2-6 years old
Causes hematuria
Significantly spikes the BP!!!! Must monitor BP
DO NOT EVER PALPATE THE ABDOMEN OR FLANK!!!!!!
Kidneys
Filter toxins (Urea) from the blood
Convert Urea into urine for excretion
Regulates BP (Raas system)
Regulating fluid balance & electrolyte balance
Phases of a Seizure
Aura-Any sound, smell, taste, or vision a pt. has just before a seizure
Tonic Phase-Stiffening
Clonic Phase (Ictal Phase)-Shaking & jerking
Post ictal
Diabetes
A disease that affects the pancreas, causing no insulin production OR low insulin production OR insulin resistance
Insulin
Hormone
Lock & Key-Is the key that opens up the cells and allows the cells to use glucose for energy
Lowers the BGL
Type 1 Diabetes
Born with it!!!! Genetic
Juvenile Onset
The pancreas does NOT produce any insulin!!
On Insulin for LIFE!!!!
No cure
DKA (Only seen in Type 1 DM)
BGL severely increase to 250-550 mg/dl (non-compliant w/ Insulin)
The cells begin to STARVE!!!!!! (No insulin)
The cells start using FATS for energy
The biproduct of fat breakdown=KETONES!!!!
Ketones are ACIDS!!!!!!
Metabolic Acidosis
MASSIVE DEHYDRATION!!!!
Salts (Sodium) & Sugars (Glucose/Dextrose) are dehydrating agents!!!!!
-mycin=Antibiotic (Bacterial Infections)
Erythromycin
Vancomycin
Tobramycin
SABAs
Short acting beta agonists
Albuterol
Bronchodilator or Beta-2 agonist
Used for Wheezing & Rhonchi
Asthma
COPD (Chronic bronchitis & Emphysema)
Pneumonia
Smoke inhalation
Atrovent (Ipratropium bromide)
Anticholinergic=Dries up mucus in the bronchioles
LABAs
Montelukast (Singular)
Long term asthma control
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Cardiovascular & Pulmonary Receptors
Memory Trick
The Number 1 best feeling is to be EXCITED!!!!
Alpha-1 (Blood Vessels)
Excitability
Vasoconstriction=Increases BP
Alpha-2 (Blood vessels)
Relaxation
Vasodilation=Decreases BP
Beta-1-Heart
Excitability
Increases the HR
Beta-2-Lungs
Relaxation
Bronchodilation
Agonists or Antagonists
Agonist
Goes with or enhances something
Antagonist
Blocks something or goes against something
Narcan
Beta Blockers
Calcium Channel Blockers
Beta Blockers
MOA-Block the Beta-1 response of the heart, decreasing the HR, and in turn lowers the BP
Cystic Fibrosis (Exocrine Disorder)
Patho-Genetic disease that prevents the pancreas from producing exocrine digestive enzymes & thick mucus accumulates in the lungs and cannot be thinned out or cleared
No Cure
Susceptible to respiratory infections
Must take pancreatic enzymes
Need CPT (Chest Physiotherapy)
Coughing
SOB/Dyspnea
Macronutrients
Carbs
Protein
Fats-most difficult to breakdown, so the GI tract needs digestive enzymes (Amylase, Lipase, trypsin)
Neurological assessment
GCS
Eyes-4
Verbal-5
Motor-6
Less than 8=Ventilate & Intubate!!!!
Fractures
Closed
Open=Compound fracture=Biggest concern=INFECTION
Oblique
Comminuted fractures
Differentials
Decompensated shock
Tension PTX
Open fracture
Multiple abrasions & bruising
Cardiac tamponade
Tampon=to press upon
Accumulation of blood or fluid in the pericardial sac, that presses on the heart, decreasing cardiac output
Analgesics (pain meds)
Opioid analgesics
Non opioid analgesics
NSAIDS