Enthusiasm

Stagnation

Apathy

Frustration

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p.782＊

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＊ p.970 p.805＊

p.818＊

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p.950＊

p.951＊

p.956＊

p.970 p.950＊

p.820＊

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p.553 p.578＊

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p.591 p.688＊

p.688＊

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p.689＊

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p.763＊

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p.743＊

#7 in class#18, 28, 38 in textbook

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3 18 1 11 30 16 2 18 12 15 9 4 15 21 10 9 9 14 11 8

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4 3 3 6 6 10 0 30 20 20 0 1 2 3 17 2 16 3 26 15

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6 7 4 25 4 17 15 7 0 6

Problems

Critical thinking application

Brain storming

Critical Thinking Indicators

Include three aspects of critical thinking Behaviors demonstrating Knowledge & intellectual skills Affective or emotional behaviors

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

Knowledge & Intellectual Skills

Nursing process and decision-making skills

知識

理解

應用

評鑑

綜合

分析

Knowledge

Comprehension

Application

Analysis

Synthesis

Evaluation

(Bloom,1956)

From lower to high level

Simple as baseline

recall of data

understanding information

applying knowledge to a new situation

separates information into part for better understanding

builds a pattern from diverse elements

judges the value of information

Learn from your mistakes and strengths to improve

your own style

Build your fundamental knowledge

Understand your fundamental knowledge

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?

A) Complete the patient’s registration information, perform an EKG, gain IV access, and take vital signs

B) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician

C) Gain IV access, give sublingual nitroglycerin, and alert the cardiac catheterization team

D) Administer oxygen, attach a cardiac monitor, take vial signs, and administer sublingual nitroglycerin

MI, CV disoders

DO2 vs. VO2

18

The nurse is caring for a patient receiving spironolactone to treat hypertension. Which instruction should the nurse give the patient?

A) Choose foods high in potassium

B) Take potassium supplements each day

C) Discontinue sodium restrictions

D) Avoid salt substitutes

Sodium →→ HypertensionTx Hypertension→→ Sodium, but Potassium

21

Medication Treatment 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

Table 32-4, pp. 1026-1029

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?

A) Pulmonary edema

B) Development of lobular emphysema

C) Cystic fibrosis

D) Empyema

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

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

Risk Factors for COPD

Tobacco smoke causes 80-90% of COPD cases!

Passive smoking Occupational exposure Ambient air pollution Genetic abnormalities

Alpha1-antitrypsin deficiency

20

A patient diagnosed with multiple sclerosis has decreased vital lung capacity. The nurse is aware that vital capacity measures:

A) The volume of air inhaled and exhaled with each breath

B) The volume of air in the lungs after a maximum inspiration

C) The maximum volume of air inhaled after normal expiration

D) The maximum volume of air exhaled from the point of maximum inspiration

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

Lung Capacities

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 secon

d (FEV1) Peak expiratory rate flow (PERF) Chest x-ray to rule out other causes

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?

A) Corticosteroids

B) Anticholinergics

C) Beta-adrenergics

D) Peak flow monitoring device

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

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:

A) Vesicular breath soundsB) Bronchovesicular breath soundsC) Bronchial breath soundsD) Tracheal breath sounds

20

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

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?

A) Deceased left ventricular ejection time

B) Deceased connective tissue in the SA and AV nodes and bundle branches

C) Thinning and flaccidity of cardiac valves

D) Widening of the aorta

Increase

Increase

Thickeing rigidity

Enthusiasm

Stagnation

Apathy

Frustration

Teaching vs. LearningAssess, Learn, Evaluate

We always teach you,

not evaluate you

Critical Thinking Indicators

Include three aspects of critical thinking Behaviors demonstrating Knowledge & intellectual skills

Affective or emotional behaviors

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