Exam 3: NSG233/ NSG 233 (Latest 2023/ 2024 Update) Med Surg 3 Exam| Questions and Verified Answers| 100% Correct| Grade A- Herzing
Exam 3: NSG233/ NSG 233 (Latest 2023/
2024 Update) Med Surg 3 Exam| Questions
and Verified Answers| 100% Correct| Grade
A- Herzing
Q: Plan of care for vented trach patients:
Answer:
care every 8hr or more as needed
trach cuff pressure 20-25mm Hg
assist of 2 ppl w/ trach strap
obdurator @ bedside all times (keeps hole open)
Q: Chest tube intervention for accdiental disconnection from drainage system:
Answer:
Air can enter pleural space, producing a pneumothorax
- prevent by immersion of chest tube in sterile water will temporarily reestablish a water seal and
prevent collape or restore lung function
Q: Excessive bubbling in the water seal compartment of the chest tube:
Answer:
leak in drainage system
Q: Normal water level in chest drainage system
Answer:
20cm level
Q: Steps to chest tube insertion:
Answer:
- Insertion of chest tube = consent needed before action taken
- discuss the procedure with the patient
- provide pain medication, the procedure is not pleasant
- gather all supplies needed to assist with procedure
- assist the client into position-supine
Q: High frequency oscilator support ventilor- understanding of:
Answer:
delievers rapid, small pulses of air down the center of the airways to open up alveoli allowing
alveolar air to exit the lungs along the margins of the airways
Q: Effective coughing techniques after a thoracotomy:
Answer:
clear sounds after cough
Q: Assessment finding for pulmonary edema:
Answer:
pink frothy sputum
Q: What is propofol infusion syndrome?
Answer:
?????????????
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Trouble shooting ventilator alarms:
- can pause
- NEVER turn off
- check pt safety first
- check alarm if pt is okay (not in distress)
Non-invasive postiive pressure ventiatlion type patients:
COPD, chronic heart failure, sleep disorders
**PP during inspiration keeps airway and trachea open during sleep
Signs of ventilator intolerance?
restless, tachycardic
Expected assessments when vented:
????
VAP ventilator bundle SATA:
elevate head 30-45
“sedation vacation”
PPI prophylaxis
DVT prophylaxis
Daily oral care
Ventilator weaning criteria:
vital capacity 10-15mL/kg
Max inspiratory pressure (MIP) at least -20cm H2O
Tidal volume (TV): 7-9mL/kg
Minute ventilation: 6L/min
Rapid/Shallow breathing index: below 100breaths/min/L: PaO2>60mm Hg w/ Fi)2 <40%
Complications of mechanical ventilation:
Alterations in cardiac function
Barotrauma/Pneumothorax
Pulmonary Infections
Delirium
Plan of care for vented trach patients:
care every 8hr or more as needed
trach cuff pressure 20-25mm Hg
assist of 2 ppl w/ trach strap
obdurator @ bedside all times (keeps hole open)
Chest tube intervention for accdiental disconnection from drainage system:
Air can enter pleural space, producing a pneumothorax
- prevent by immersion of chest tube in sterile water will temporarily reestablish a water seal and prevent collape or restore lung function
Excessive bubbling in the water seal compartment of the chest tube:
leak in drainage system
Normal water level in chest drainage system
20cm level
Steps to chest tube insertion:
- Insertion of chest tube = consent needed before action taken
- discuss the procedure with the patient
- provide pain medication, the procedure is not pleasant
- gather all supplies needed to assist with procedure
- assist the client into position-supine
High frequency oscilator support ventilor- understanding of:
delievers rapid, small pulses of air down the center of the airways to open up alveoli allowing alveolar air to exit the lungs along the margins of the airways
Effective coughing techniques after a thoracotomy:
clear sounds after cough
Assessment finding for pulmonary edema:
pink frothy sputum
What is propofol infusion syndrome?
?????????????
Why pantoprazole when on a vent?
????????????????????
Post-op care after esophageal varices endoscopy:
aspiration pneumonia
vagotomy syndrome
What to avoid if you have esophageal varies? SATA
lifting heavy objects
trainig with stolling, sneezing, coughing, vomitng
irritating foods/fluids
reflux
alcohol intake
aspirin intake
Dallon tamponade therapy for esophageal varies:
REMAIN bedside
- due to risk of displacement or threateningobstruction of the airway
What drug promotes motility after esophogeal resection:
metoclopramide (monitor heart closely)
Esophageal resection interventions: SATA
sit up in char
encourage incentive spirometry every hour
monitor temp q4hr
water cardiac for vagus nerve due to irriation
avoid ensure and boost
Pathophysiology of ascities:
increase pressure in portal system with vasodilation causes fluid to leak from capillaries into abdominal cavity
Symptoms of ascities:
enlarged abdomen
distended abdominal veins
SOB
abd distention
(signs fo portal hypertension)
Dietary restriciton in ascities:
low sodium
watch salt for ammonia/potassium
diuretic choice if diet not followed
Purpose of lactulose in hepatic encephalopathy:
increase stooling to help get out ammonia due to it causing the encephalopathy
Assessment fidning that indicates ascities is getting worse:
no weight loss
Plan of care for portal hypertension/cirrhosis: SATA
assess abd tympanic wave
monitor electrolytes
weigh daily
Heaptic encephalopathy- what do you assess:
neuro assessment
pt confused, unkempt
alterations in mood and sleep patterns
Stages of Encephalopathy:
- mild confusion, agitation, irritability, sleep disturbance, decreased affection
- lethargy, disorientation, inappropriate behavior, drowsiness
- somolent but arousable, slurred speech, confused, aggresisve
- coma
Heaptic encephalopathy phenomenon:
neuo psychiatric manifestation of hepatic failure associated with portal hypertension and shunting of blood from portal venous system into the systemic cirulation
Paracentesis procedure:
removal of fludi from peritoeal cavity through puncture with small surgical incision through abd wall under sterile conditions
Role of low sodium albumin in paracentesis:
prevents re-accumulation of fluid by increase blood volume.
** if colloid not used as well, kidneys will try to correct by absorbing sodium causing water retention
What is hepatocellular jaundice?
mobility of damaged liver cells to clear billirubin from blood
A renal contusion nursing diagnosis:
ineffective renal tissure perfusion
Modifiable bladder cancer risk:
smoking tobacco
Stoma and appliance care for cutaneous urinary diversion for bladder cancer? SATA
- monitor stomach for infection, irriation, decreased cirulation
- take vit c
- limit eggs, cheese, asparagus
- shower in non-moisturizing soap
What is a ureterosigmoidostomy?
continent diversion procedure in which urine is viserted into the rectum
“disturbed body image” bursing disgnosis goal:
are they acceptance of it, get pt to talk and verabilize about it
Pre-procedure instructions for intravesical chemotherapy for bladder cancer?
INSTILLS MEDICATIONS INTO BLADDER, HOLD SOLUTIONFOR 2 HOURS
Cachexic cancer patient- best solution for their eating food:
let them choose
prostate cancer- reducing risks:
reduce red meat or dietary produces high in fat
Gleason score of 3 follow up with prostate cancer?
external beam radiation therapy need for grade 3
Dischage transurethral resection education:
water s/s DVT (pain/redness lower extremeties)
retrograde ejaculation
heamturia
bladder spasms
Goserelin (Zoladex) hormone replacement treatment education:
increase blood glucose
increase risk myocardial infactions
** bone pain first week and bone density loss over time