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NCLEX Review on ARDS

Hello everyone today we will be talking about Acute Respiratory Distress Syndrome (ARDS)

An Acute respiratory distress syndrome (ARDS) what occurs is that there is fluid that builds up in the tiny, elastic air sacs called (alveoli) in your lungs.

And what occurs is that the fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream.

And in turn this deprives your organs of the oxygen they need to function.

Now understand that ARDS typically occurs in people who are already critically ill or who have significant injuries.

Now lets look at a few of the symptoms

NCLEX Review Notes on ARDS

Symptoms

The signs and symptoms of ARDS can vary in intensity and basically depending on the cause and severity:

So the patient would be hypoxic and would show signs of
Severe shortness of breath
Labored and rapid breathing
and there would be
– Presence of crackles or (rhonci)
when we assess the patient

The patient would also have a Low blood pressure
and also be somewhat lethargic and confused

 

Lets look at a few of the Complications with ARDS

If you have ARDS, you can develop other medical problems while in the hospital. The most common problems are:

Blood clots. This is very dangerous because it can cause a (pulmonary embolism).
Collapsed lung (pneumothorax). there fore In most ARDS cases, a ventilator is used to increase oxygenation.
Infections. Because the ventilator is attached directly to a tube inserted in your windpipe, this makes it much easier for germs to infect and further injure your lungs.

Diagnosis
There’s no specific test to identify ARDS. The diagnosis is based on the physical exam, chest X-ray and oxygen levels.

– Diagnosed through the X- Ray (Ground Glass) Appearance within the lungs and this is due to the fluid buildup.

– A noncardiogenic Pulmonary Edema.
excess fluid in the lungs

Lab tests

The lab test will also show a decrease in the oxygen level throughout the body.

Treatment

The first goal in treating ARDS is to improve the levels of oxygen in your blood. Without oxygen, your organs can’t function properly.

NCLEX Review

Oxygen

So there are various ways that we can give supplemental oxygen
and that includes Mechanical ventilation.
The mechanical ventilator pushes air into your lungs and forces some of the fluid out of the air sacs.

The common Mechanical Ventillation includes PEEP or positive end-expiratory pressure.
basically its A method of ventilation in which airway pressure is maintained above atmospheric pressure

Another method is the CPAP or Continuous positive airway pressure
Now with CPAP, it basically applies mild air pressure on a continuous basis to keep the airways continuously open.

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NCLEX Pharmacology Review

NCLEX Review: Neurological Medications 

MAOI  (Monoamine oxidase inhibitors)

Important Medications in the NCLEX includes

  • Parnate (tranylcypromine sulfate)
  • Nardil (phenelzine sulfate)
Side Effects of MAOI

MAOI Side Effects

  • Dizziness
  • Dry mouth
  • Diarrhea
  • Weight gain

Remember: Do not take MAOI’s with TCAs and SSRIs

NCLEX Review: Remember to limit foods that contain high levels of tyramine, such as cheese, pickled foods, beer and wine

MAOIs or Monoamine oxidase inhibitors act by inhibiting the activity of monoamine oxidase, thus preventing the breakdown of monoamine neurotransmitters and thereby increasing their availability. Which gives off positive effects on depression and anxiety. so again basically MAOI’s helps balance certain brain chemicals called neurotransmitters and it does this by reducing the amount of monoamine oxidase which the substance that breaks down the neurotransmitters, hence there would be more neurotransmitter in the brain which helps decrease the symptoms of depression.

Now the 2 important MAOI’s drugs that you might encounter in your NCLEX exam includes:

  1. Parnate  (tranylcypromine sulfate)
  2. Nardil  (phenelzine sulfate)

As we learn from our Psych class back in nursing school, We as nurses don’t usually offer MAOI because of the lethal dietary and drug interactions (and this is the most important thing that we have to know for the NCLEX in reagards with MAOI and this is also a big reason why MAOI is usually used as last line of treatment and is used only when other classes of antidepressant drugs (for example SSRI and TCA’s) have failed.

NCLEX Review Neurological Pharmacology

We need to know for the NCLEX that our patient needs to limit foods that contain high levels of tyramine, such as cheese, pickled foods, beer and wine.  And here is why…. well because Tyramine is an amino acid that helps regulate blood pressure. So basically if we combine tyramine with MAOIs the interaction cause dangerously severe high blood pressure it can trigger a hypertensive crisis… and we don’t want that on our patient.

So again, the biggest tip we can take away from this video is to remember that when giving MAOI’s… avoid food with high levels of tyramine…. so no cheese, pickles and beer or wine.

Study Hard and Good Luck  : )

 

 

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NCLEX Review Shownotes:

Understand that the Nervous system includes the Central Nervous System (CNS), the Peripheral Nervous Sytem (PNS) and the Autonomic Nervous System or the (ANS).

When I say the CENTRAL NERVOUS SYSTEM, We can simplify at as the BRAIN and the SPINAL CORD.

The PERIPHERAL NERVOUS SYSTEM on the other hand, contains the CRANIAL NERVES and the SPINAL NERVES.

  • WHEN WE TALK ABOUT THE AUTONOMIC NERVOUS SYTEM, WE ARE BASICALLY TALKING ABOUT THE “SYMPATHETIC” (FIGHT OR FLIGHT) SYSTEM OR THE “PARASYMPATHETIC” SYSTEM.
  • .THE BASIC COMPONENT OF THE NERVOUS SYSTEM IS THE NERVE CELL OR NEURON

NEURON

– is the primary component of the nervous system.

– it is composed of cell body (gray matter), axon and dendrites.

BRAIN  (Central Nervous System: Brain and Spinal Cord).

CEREBRUM- Outermost area (cerebral cortex) is gray matter, deeper area is composed of white matter

  • TWO HEMISPHERES: LEFT AND RIGHT AND EACH HEMISPHERE IS DIVIDED INTO TWO LOBES.

FRONTAL LOBE

  • PERSONALITY, BEHAVIOR
  • HIGHER INTELLECTUAL FUNCTIONING
  • BROCA’S AREA: (MOTOR SPEECH AREA)

PARIETAL LOBE

  • POSTCENTRAL GYRUS: REGISTERS SENSATION (TOUCH, PRESSURE)
  • INTEGRATES SENSORY INFORMATION

TEMPORAL LOBE

  • HEARING, TASTE, SMELL (HINT: LOCATION OF EARS – CLOSE THE TEMPLES)
  • WERNICKE’S AREA: SENSORY SPEECH AREA
  • (UNDERSTANDING, FORMATION OF LANGUAGE)

OCCIPITAL LOBE

  • VISION

Peripheral Nervous System- composed of Spinal Nerves (31)

Autonomic Nervous System- part of the Peripheral Nervous System

  • REGULATES FUNCTIONS OCCURRING AUTOMATICALLY IN THE BODY.
  • ANS REGULATES SMOOTH MUSCLE, CARDIAC MUSCLE AND GLANDS.

IT IS NOT NECESSARY TO KNOW EVERY PHYSIOLOGY FOR EVERY SINGLE PART OF THE BRAIN.  BUT JUST IN CASE WE END UP GETTING LOW LEVEL QUESTIONS ON THE EXAM, THEN IT IS IMPORTANT THAT WE UNDERSTAND THE BASIC CONCEPT AND FUNCTION OF EACH AREA. IT WOULD ALSO BE A GREAT IDEA TO KNOW THE CRANIAL NERVES.

Quick NCLEX Overview:

EYE AND EAR DISORDERS

GLAUCOMA

Glaucoma: there is an increased of intraocular pressure in the eye.

There are two types:

  1. OPEN ANGLE GLAUCOMA OR “PRIMARY” GLAUCOMA
  2. PRIMARY ANGLE GLAUCOMA.

Open angle glaucoma is slow in onset and chronic, while the primary angle glaucoma needs immediate treatment.

Open Angle Glaucoma

Bilateral

Acute Angle-closure Glaucoma

Unilateral

TREATMENT

Beta Adrenergic Blockers

Cholinergic Agents (Pilocarpine) ♣ (Make sure to know this for the NCLEX)

AVOID ANTICHOLINERGICS (Atropine)

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NCLEX Review Notes:

NCLEX Review on Cardiac Diseases: Heart Failure

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– It is an insufficiency and the inability of the pumping ability of the heart.

LEFT SIDED HEART

– Failure of the left side of the heart to pump enough blood to meet the metabolic demands of the body.

  • THERE IS AN IMPAIRED OXYGENATION AND A DECREASE IN MYOCARDIAL WORKLOAD IN THE HEART.

ASSESSMENT FINDINGS in patients with Left Sided heart failure.

  • CRACKLES
  • DYSPNEA
  • GALLOP RHYTHM: S3, S4

NCLEX Review on Heart Failure Cont.

What we would usually find in patient with left sided heart failure  is that there is an INCREASE IN PULMONARY CONGESTION and there would be a left ventricular hypertrophy.
MANAGEMENT

  • LOW SODIUM DIET
  • SEMI FOWLERS POSITION ON PT.
  • WEIGHT PATIENT DAILY
  • ADMINISTER IV, OXYGEN AND MEDS AS ORDERED.
  • MONITOR VITALS, I/O

RIGHT SIDED FAILURE

– Failure of the right side of the heart to pump enough blood to meet the metabolic demands of the body.
Causes:

  • LEFT SIDED HEART FAILURE
  • COPD
  • ATHEROSCLEROSIS
  • PULMONARY HYPERTENSION

Assessment:

  • JUGULAR VEIN DISTENTION
  • DEPENDENT EDEMA
  • WEIGHT EDEMA

Diagnostic Procedures:

  • B- Type Natriuretic Peptide (BNP)  Levels= Elevated
  • ABG’s indicates hyposemia and hypercapnia.
  • Hemodynamic Monitor= Increase CVP

TREATMENT:

  • Oxygen Therapy
  • Paracentesis
  • Thoracentesis

Drug Therapy:

  • Cardiac Glycoside (Digoxin) Lanoxin
  • Inotropic Agents (Dopamine, Dobutamine)
  • Diuretics: Furosemide (Lasix)
  • Human BNP: (Nesiritide (Natrecor)

Interventions:

  • Keep Ct. in semi- fowlers position to increase chest expansion
  • Assess cardiovascular status and vital signs
  • Weigh the client daily: A weight gain of 1 to 2 lbs. indicates fluid gain.

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