Enthusiasm

1. Enthusiasm Stagnation Frustration Apathy

2. #7 in class • #18, 28, 38 in textbook

3. Problems Critical thinking application Brain storming

4. Critical Thinking Indicators • Include three aspects of critical thinking • Behaviors demonstrating • Knowledge & intellectual skills • Affective or emotional behaviors

5. Critical Thinking in Action • Chart 3-1 (pp.26) details some questions to help the nurse analyze a patient care situation and determine a course of action

6. Knowledge & Intellectual Skills • Nursing process and decision-making skills Evaluation judges the value of information • From lower to high level • Simple as baseline Synthesis builds a pattern from diverse elements Analysis separates information into part for better understanding Application applying knowledge to a new situation understanding information Comprehension recall of data Knowledge (Bloom,1956)

7. Learn from your mistakesand strengths to improve your own style Build your fundamental knowledge Understandyour fundamental knowledge

8. 18 DO2 vs. VO2 MI, CV disoders • A patient who arrives in the emergency department complaining of squeezing substernal pain that radiates to the left shoulder and jaw also complains of nausea, diphoresis, and shortness of breath. What should the nurse do? • Complete the patient’s registration information, perform an EKG, gain IV access, and take vital signs • Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician • Gain IV access, give sublingual nitroglycerin, and alert the cardiac catheterization team • Administer oxygen, attach a cardiac monitor, take vial signs, and administer sublingual nitroglycerin

9. 21 Sodium  →→ Hypertension Tx Hypertension→→ Sodium, but Potassium • The nurse is caring for a patient receiving spironolactone to treat hypertension. Which instruction should the nurse give the patient? • Choose foods high in potassium • Take potassium supplements each day • Discontinue sodium restrictions • Avoid salt substitutes

10. Medication Treatment Table 32-4, pp. 1026-1029 • Diuretic and related drugs • Thiazide diuretics • Loop diuretics • Potassium-sparing diuretics • Aldosterone receptor blockers • Adrenergic inhibitors-central-acting adrenergic antaginists • Calcium channel-blocking agents • ACE inhibitors • Angiotensin II receptor antagonists • Beta-Adrenergic blockers • Alpha-adrenergic blockers • Vasodilators

11. 26 • The nurse is caring for a 28-year-old nonsmoker with a deficiency in the enzyme antitrypsin. To what deficiency does this predispose the young patient? • Pulmonary edema • Development of lobular emphysema • Cystic fibrosis • Empyema

12. Changes in Alveolar Structure with Emphysema The bronchioles, alveolar ducts, and alveoli are destroyed, and the air spaces within the lobule are enlarged Changes occur in the lobule, preserving the peripheral portions of the acinus

13. Laboratory Assessment • Status if arterial blood gas values for abnormal oxygenation, ventilation, and acid-base status • Sputum samples • Hemoglobin and hematocrit blood tests • Serum alpha1-antitrypsin levels drawn • Chest x-ray • Pulmonary function test

14. Risk Factors for COPD • Tobacco smoke causes 80-90% of COPD cases! • Passive smoking • Occupational exposure • Ambient air pollution • Genetic abnormalities • Alpha1-antitrypsin deficiency

15. 20 • A patient diagnosed with multiple sclerosis has decreased vital lung capacity. The nurse is aware that vital capacity measures: • The volume of air inhaled and exhaled with each breath • The volume of air in the lungs after a maximum inspiration • The maximum volume of air inhaled after normal expiration • The maximum volume of air exhaled from the point of maximum inspiration

16. Lung Capacities • Total Lung Capacity (TLC) = RV+IRV+TV+ERV • Vital Capacity (VC) =IRV+TV+ERV=TLC-RV • Functional Residual Capacity (FRC) = RV+ERV • Inspiratory Capacity (IC) = TV+IRV

17. Pulmonary Function Tests • The most accurate measures for asthma are pulmonary function tests using spirometry including • Forced vital capacity (FVC) • Forced expiratory volume in the first second (FEV1) • Peak expiratory rate flow (PERF) • Chest x-ray to rule out other causes

18. 25 • A 10-year-old girl is having an asthma attack on the school grounds at recess. Which the following is the preferred treatment to alleviate her airflow obstruction? • Corticosteroids • Anticholinergics • Beta-adrenergics • Peak flow monitoring device

19. Medications Used for Asthma • Quick-relief medications, see Table 24-2, pp.693 • Beta2-adrenergic agonists • Anticholinergics • Long-acting medications, see Table 24-4, pp.713 • Corticosteroids • Long-acting beta2-adrenergic agonists • Leukotriene modifiers

20. 20 • Auscultation of the lung fields provides the nurse with information on the type of breath sound the patient is exhibiting. While listening over the manubrium, the nurse auscultates loud expiratory sounds that lst longer than inspiratory sounds. The nurse will document her findings as: • Vesicular breath sounds • Bronchovesicular breath sounds • Bronchial breath sounds • Tracheal breath sounds

21. Assessment of Breath Sounds • Normal breath sounds (see Table 21-5, pp.575) • Bronchial • Bronchovesicular • Vesicular • Abnormal (adventitious) breath sounds (see Table 21-6, pp. 575) • Crackles • Wheezes • Rhonchus • Friction rubs

22. 30 • Changes in the cardiac structure and function occur in the heart of an older adult. Which of the following is a normal change expected in the aging heart? • Deceased left ventricular ejection time • Deceased connective tissue in the SA and AV nodes and bundle branches • Thinning and flaccidity of cardiac valves • Widening of the aorta Increase Increase Thickeing rigidity

23. Enthusiasm Stagnation Frustration Apathy

24. Teaching vs. LearningAssess, Learn, Evaluate We always teach you, not evaluate you

25. Critical Thinking Indicators • Include three aspects of critical thinking • Behaviors demonstrating • Knowledge & intellectual skills • Affective or emotional behaviors

26. Ways to Exercise Your Brain • Pre-reading • Review anatomy & pathophysiology from your previous lectures or textbook • Power-points • Add notes from textbook into handout • Assign reading, especially emphasizing in class • Practice questions from CD, NCLEX, or learning resource center • Group study review (Sharing) • Ask questions immediately after reading • After exam • ALWAYS clarify the concepts which you have missed