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I completed my B.sc.nursing in 2018 at JG college of nursing (Ahmedabad,gujarat,india)

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Chronic Obstructive Pulmonary Disease (COPD) describes a group of lung diseases where airflow is blocked, including chronic bronchitis, emphysema, and asthma. Treatment of COPD is supportive and typically includes supplemental oxygen (as needed to maintain SpO2 88-92%), medications to decrease inflammation and mucus, and management of symptoms through dietary and lifestyle modifications.

Respiratory

COPD

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RSV/Bronchiolitis

What is bronchiolitis?
● Inflammation of the bronchioles
● Bronchioles
○ Smallest branches of the airway
○ Lead to alveoli
● Alveoli
○ Air sacs
○ Location of gas exchange in the lungs 
● Thick mucus clogs up the 
bronchioles
● Leads to decreased gas exchange 
in alveoli
○ Air trapping
○ Collapsed alveoli

Overview
● Most common in children under 2 years old
● Seasonal illness
○ Most common in winter
● Causative agent usually viral
○ Respiratory Syncytial Virus (RSV)
● Very contagious
● Worst on days 4-6
Assessment
● Cough
● Fever
● Increased work of breathing
○ Retractions
■ Subcostal
■ Intracostal 
■ Tracheal tug
○ Nasal flaring
○ Head bobbing
○ Tachypnea
● Lung sounds
○ Crackles
○ Wheezing
● Hypoxia
○ Circumoral cyanosis
○ Mottling
○ Delayed capillary refill
○ Decreased SpO2
● Changes in behavior
○ Irritability
○ Lethargy
○ Poor feeding

Treatment
Supportive treatment
● Oxygenation
○ Nasal cannula - high flow nasal cannula
○ Always humidified 
● Fluid & Nutrition
○ NGT
○ Enteral feedings
○ IVF
● Antipyretics
● Analgesics 
Nursing Considerations
● Continue to monitor respiratory status for changes
○ Work of breathing - improving? Worsening?
○ Continuous pulse oximetry
● Maintain airway at all times
○ Semi fowlers preferred positioning
○ Keep neck extended to open airway
■ Shoulder roll
○ Suction available

Epiglottitis

What is epiglottitis?
● Inflammation of the epiglottis
● Epiglottis
○ A leaf-shaped flap in the throat that prevents food from entering the windpipe 
and the lungs. It stands open during breathing, allowing air into the larynx
● Inflammation restricts the airway
● Caused by an infection 
○ Bacterial 
● Haemophilus influenzae type b
● Medical emergency

Assessment
● Fever
● Difficulty swallowing
● Drooling
● Stridor
● Tripoding
● No cough
● Change in LOC
● Cherry red epiglottis 
The 4 D’s of epiglottitis
● Dysphagia
● Dysphonia
● Drooling
● Distress

Treatment
● IV antibiotics
● Humidified oxygen
● Intubation and mechanical 
ventilation
● Keep the child calm
● No interventions until airway is 
secure 
● Do not irritate the throat
○ NO tongue depressor
○ NO oral thermometer
○ NO assessing the throat
● NPO
● Tripod position
● Avoid supine
Education
● Hib vaccine has reduced incidence
● Encourage parents to vaccinate to prevent
● When to call 911
○ Trouble swallowing, breathing, and talking
○ Straining the neck forward (trying to open the airway)
○ Drooling (when it becomes too painful to swallow)
○ A harsh raspy sound when inhaling (stridor), a sign that the airways are blocked
○ Blue, purple, or gray skin or lips
○ Trouble waking up to awake or arouse or unresponsive
○ Trouble breathing

Intussusception

What is Intussusception?
● Occurs when one part of the intestine slips inside the other intestine
● “Telescoping”
● Often occurs where the small intestine and large intestine meet. 
Assessment
● Red currant jelly 
stools
● Cyclical abdominal 
pain
● Nausea
● Vomiting
● Green, bilious emesis
● Sausage-shaped 
mass in abdomen

Treatment
● Enema to attempt to push the 
intestine back out
○ Air enema
○ Hydrostatic enema
○ Barium enema
● If successful a surgical repair is 
needed.
Management
Pre-op
● Monitor stool
● NPO
● IV fluids
● IV antibiotics

Post-op
● Monitor bowel function
● Infection is common 
complication
○ Monitor temps, WBCs, CRP
● Slowly advance diet

NCLEX Question
Which of the following symptoms should the nurse monitor for in her patient 
suspected of intussusception? Select all that apply. 
a. Red currant jelly stool
b. Hematemesis 
c. Palpable, sausage-shaped mass in RUQ
d. Steatorrhea
Answer: A and C 
A is correct. Red currant jelly stool is a classic finding of intussusception. When the bowel telescopes 
into another portion of the intestine, it causes intestinal obstruction and subsequently red currant 
jelly stools. 
B is incorrect. Hematemesis, or bloody vomiting, is not an expected finding in intussusception. We 
would expect vomiting of gastric contents, and possibly green bile if there is an obstruction. 
C is correct. Palpable, sausage-shaped mass in RUQ is a classic finding of intussusception. This is 
due to the physical telescoping of the intestine and the mass can sometimes be felt on palpation. 
D is incorrect. Steatorrhea is the passage of oily, pale, foul-smelling stool. It indicates fat 
malabsorption and can be a sign of Celiac disease, but would not be present in a patient with 
intussusception.

Omphalocele

What is omphalocele?
● Congenital abnormality where 
the abdominal contents 
protrude through the 
umbilicus while remaining in 
the peritoneal sac. 
● Occurs during weeks 9-10 of 
gestation. 
● Usually diagnosed on a 
prenatal ultrasound.

Assessment
● Visible defect
● Some infants have 
only the omphalocele
● Some also have 
cardiac defects 
● Lung size can be 
affected
Complications
● Hypothermia
● Dehydration
● Sepsis

Management
Pre-op
● Keep exposed intestines moist
● Cover with sterile gauze soaked 
in saline
● IV fluids
● IV antibiotics
● Thermoregulation

Post-op
● Parenteral feeds
● Trophic feeds started enterally 
very gradually
● Monitor weight
● Very long hospital stay

Cleft Lip
A congenital abnormality 
where there is a slip, or 
gap, in the upper lip on 
one or both sides. 
Cleft Palate
A congenital abnormality where there is a split, or gap, in the hard palate (the 
roof of the mouth)

Assessment
● Visible defect
● Monitor respiratory status
● Airway patency 
● Nutritional status
● Weight gain
● Hydration 
Complications
● Feeding difficulties
● Weight loss
● Failure to thrive
● Speech and language delays
● Hearing issues
● Ear infections
● Aspiration

Management
● Surgically corrected
○ Cleft lip first at 3-6 months of age
○ Cleft palate second at 6-24 months of age 
● Pre-operative care
○ Monitor for aspiration
○ Assess airway patency frequently 
● Post-operative care 
○ Positioning:
■ Position upright for feedings
■ Cleft palate - can be prone post op to help drain secretions
■ Cleft lip should NOT be prone as this could disturb the suture line
○ Protect suture line
○ Elbow restraints to avoid toddler putting things in the mouth that would compromise the 
sutures
○ No hard foods, straws, pacifiers, etc. 
○ No oral or nasal suctioning
Feedings
● Specialized bottle to facilitate a good suction/latch
● Small, frequent feedings
● Upright position
● Burp frequently - will swallow a lot of air
● May take longer to feed than other children
● Monitor for aspiration
○ At risk for feeding to go out of their nose.

Hypoplastic Left Heart Syndrome
Definition
Disorder including 4 components: mitral stenosis or 
atresia, aortic stenosis or atresia, coarctation, and a 
hypoplastic left ventricle.


NCLEX Question
Which of the following defects are part of the diagnosis Hypoplastic Left Heart 
Syndrome (HLHS)? Select all that apply. 
a. Atretic mitral valve
b. Hypoplastic right ventricle
c. Atretic tricuspid valve
d. Hypoplastic left ventricle
Answer: A and D
A is correct. HLHS is a disorder including 4 components: mitral stenosis or atresia, aortic 
stenosis or atresia, coarctation, and a hypoplastic left ventricle. An atretic mitral valve is part 
of the diagnosis. 
B is incorrect. There is not a hypoplastic right ventricle in HLHS. Instead there is a hypoplastic 
left ventricle. 
C is incorrect. There is not an atretic tricuspid valve in HLHS. There is mitral stenosis or 
atresia, and aortic stenosis or atresia, but the tricuspid valve is intact and functioning. 
D is correct. HLHS is a disorder including 4 components: mitral stenosis or atresia, aortic 
stenosis or atresia, coarctation, and a hypoplastic left ventricle. A hypoplastic left ventricle is 
part of the diagnosis.

Transposition of the Great Arteries


Definition
A switch of the the aorta and pulmonary artery. The aorta 
is coming off of the RV and the pulmonary artery is coming 
off of the LV. Creates two parallel and separate tracks.

Coarctation of the 
Aorta
Definition
Congenital cardiac condition characterized by a 
constriction of the descending aorta.

Specific findings
● Upper extremities
○ Bounding pulses
○ Hypertensive
○ Warm
○ Pink
● Lower extremities
○ Weak or absent pulses
○ Hypotensive
○ Pale
○ Cool

Tet Spells
● Hypoxic spells that occur in TOF. 
● Begins with irritability and hyperpnea and 
followed by a prolonged period of intense 
cyanosis leading to syncope.
● Thought to be secondary to a spasm of the 
infundibulum of the outflow tract, or a drop in 
systemic vascular resistance (SVR).
● A drop in SVR increases the right to left shunt 
and decreases pulmonary blood flow.
Tet Spell Interventions
Comfort and calm
Knee-to-chest position
Supplemental oxygen
Sedation - morphine
Volume
Sodium bicarbonate
Propranolol
Phenylephrine 
Increases the SVR, which decreases R-->L shunting to increase pulmonary blood flow.

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https://yourknowledgedigest.files.wordpress.com/2020/09/saunders-qa-review-for-the-nclex-rn-examination-7th-ed.pdf

SAUNDERS RN  7 edQA

NOTES 👇👇👇

✅The RN can safely delegate the following tasks to the UAP to promote client safety during toileting and ambulating:

**Place the bedside commode, assistive devices (eg, canes, walkers), and personal belongings (eg, eyeglasses, hearing aids, cell phones) as close to the client as possible
**Remind the client of the importance of changing position slowly to minimize orthostatic hypotension
**Report observations of changes in the client's condition (eg, level of consciousness, vital signs, pain level) immediately
**Keep the bed in the lowest position (locked) as it reduces the distance to the floor in the event of a fall
**Provide nonskid footwear for the client before ambulating
**Keep the environment dry and free of clutter and obstacles (eg, intravenous infusion device tubing and poles, electronic device wires and cords)

The role of UAP includes:

*Assisting with activities of daily living (eg, toileting, bathing, skin care, oral care, personal hygiene) (Option 1)
*Assisting with feeding
*Reporting changes in ability to eat or difficulty swallowing (Option 5)
*Reporting changes in behavior
*Placing bed alarms to reduce risk of falls (Option 4)

📚The RN can safely delegate these tasks to UAP:

## Ambulate and promote mobility of stable clients
## Assist with activities of daily living (eg, feeding, bathing, dressing, hygiene)
## Perform oral (nonsterile) suctioning for clients during oral care 
## Collect and document vital signs
## Turn and reposition stable clients



✅✅The role of the LPN includes:

< Administration of enteral feedings (if prescribed)
<Administration of medications
<Monitoring for safety hazards
<Monitoring for behavioral changes


✅✅the registered nurse (RN) may assign the following tasks to the licensed practical nurse (LPN):

*Administer medications (Option 1)
*Monitor neurovascular status of involved extremity
*Monitor for bleeding at catheter site every 15 minutes for the first hour, then according to facility policy (Option 3)
*Report any changes in neurovascular status or bleeding to the RN


✅The RN may delegate care of stable clients with established ostomies to the licensed practical nurse (LPN).

The following actions related to ostomy care are generally within the LPN scope of practice:

*Provide ostomy care and observe for skin breakdown 
*Perform specific assessments (eg, bowel sounds, stoma color) 
*Monitor drainage characteristics (eg, color, amount) 
*Reinforce education
*Irrigate an established ostomy
*Document observations and interventions