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HESI®-RN Comprehensive Review | Registered Nurse (RN) School Study Aid
Neonatal Respiratory Distress Syndrome
- Cause/Mechanism
- Fetal Lung Immaturity
- Lack of Surfactant
- Assessment
- Respiratory Distress
- Nasal Flaring
- Retractions
- Grunting
- Interventions
- Surfactant
- Oxygen
- Mechanical Ventilation
- Considerations
- Total Parenteral Nutrition (TPN)
2 mins
Acute Respiratory Distress Syndrome (ARDS) Assessment
- Cause
- Damaged Alveolar-Capillary Membrane
- Assessment
- Restlessness
- Dyspnea
- Refractory Hypoxemia
- Decreased PaO2
- Diffuse Pulmonary Infiltrates
- Atelectasis
- Pulmonary Hypertension
2 mins
Acute Respiratory Distress Syndrome (ARDS) Interventions
- Interventions
- Closely Monitor Patient
- ABG's (Arterial Blood Gases)
- Oxygen
- Assess for O2 Toxicity
- Mechanical Ventilation
- PEEP
- Assess for Pneumothorax
- Permissive Hypercapnia
- Considerations
- High Mortality Rate
2 mins
ECG: Sinus Tachycardia
- Rate
- > 100 bpm
- Rhythm
- Regular
- P Wave
- Present, Upright, Every QRS
- PR Interval
- < 0.20 seconds
- QRS Interval
- < 0.12 seconds
- Treatment
- Treat Underlying Cause
2 mins
Airway and Lungs Assessment
- Inspection
- Examine Back of Chest
- Determine Respiratory Rate for 1 Minute
- Assess for Abnormalities with Uneven Movement or Use of Accessory Muscles
- Inspect Skin, Nails and Mucous Membrane
- Palpation
- Palpate for Crepitus, Tenderness, Alignment, Masses or Retraction
- Palpate for Tactile Fremitus
- Check Chest-Wall Symmetry and Expansion
- Note Resonance, Hyperresonance, Dullness and Tympany
- AUSCULTATION
- Use Diaphragm of Stethoscope to Listen to Full Inspiration and Full Expiration
- Ask Patient to Breathe Through Mouth
- Normal Breath Sounds
- Abnormal Breath Sounds
5 mins
Lung Sounds - Wheezes
- Location
- Throughout Lung
- Description
- High Pitched
- Sounds Like
- Musical
- Cause
- Air Moving through Narrowed Airways
38 secs
Lung Sounds - Crackles
- Location
- Lower Lobes
- Description
- Fine/Coarse
- Sounds Like
- Fine: Twisting Hair through Fingers
- Coarse: Velcro
- Cause
- Collapsed Small Airways and Alveoli "Popping Open"
1 min
Lung Sounds - Rhonchi
- Location
- Trachea and Bronchi
- Description
- Low Pitched Rumbling
- Sounds Like
- Gurgling
- Cause
- Narrowed Airway
- Secretions or Bronchospasm
49 secs
Lung Sounds - Pleural Friction Rub
- Location
- Anterior Lateral Lung
- Description
- Dry, Rubbing, or Squeaking
- Sounds Like
- Rubbing a Balloon with Finger
- Cause
- Inflamed Pleura
50 secs
Hypoxia (Early Symptoms)
- Diaphoresis
- Restlessness
- Tachypnea
- Dyspnea on Exertion
- Tachycardia
- Hypertension
- Arrhythmias
- Decreased Urine Output
- Unexplained Fatigue
1 min
Hypoxia (Late Symptoms)
- Cyanosis
- Cool, Clammy Skin
- Use of Accessory Muscles
- Retractions
- Hypotension
- Arrhythmias
2 mins
ECG: Sinus Bradycardia
- Rate
- < 60 bpm
- Rhythm
- Regular
- P Wave
- Present, Upright, Every QRS
- PR Interval
- < 0.20 seconds
- QRS Interval
- < 0.12 seconds
- Treatment
- Atropine
1 min
Asthma Assessment
- Assessment
- Triggers (Cold air, Dander, Dust, Infection, Mold, Pollen, Smoke)
- Shortness of Breath (SOB)
- Tachypnea and Tachycardia
- Wheezing
- Diaphoresis
- Accessory Muscles
- Decreased Pulmonary Function Tests
2 mins
Asthma Implementation and Education
- Medication
- Oxygen
- Corticosteroids
- Ipratropium (Anticholinergic)
- Albuterol
- Implementation
- Inhaler/nebulizer
- Pulse Oximetry
- Pursed Lip Breathing
- Education
- Carry Inhaler
- Rinse Mouth after Inhaler
- Identify Trigger (Cold Air, Dander, Dust, Infection, Mold, Pollen, Smoke)
2 mins
Stages of Asthma Treatments
- Mild Intermittent
- Short-acting Inhaled Beta-Agonist
- Mild Persistent
- Low-Dose Inhaled Corticosteroid
- Montelukast (Leukotriene Receptor Antagonist)
- Moderate Persistent
- Low to Medium-dose Inhaled Corticosteroid
- Zileuton
- Severe Persistent
- High-Dose Inhaled Corticosteroid
- Systemic Corticosteroids
- Omalizumab (Allergies)
2 mins
Respiratory Acidosis Assessment
- Assessment
- Decreased pH < 7.35
- Increased PaCO2 > 45
- Reduced Respirations
- Anxiety
- Change in LOC
- Tachycardia
- Cyanosis
- Increased Electrolytes
- ECG Changes
- Muscle Weakness
- Hyporeflexia
2 mins
Respiratory Acidosis Interventions
- Improve Respiration
- Pharmacologic Interventions
- Bronchodilators
- Respiratory Stimulants
- Drug Antagonists
- Nonpharmacologic Interventions
- Oxygen
- Assisted Ventilation
- Prevent Complications
1 min
Oxygen Delivery Methods
- Nasal Cannula
- Simple Face Mask
- Non-Rebreather Mask
- Venturi-Mask
- Safety Precautions
- Oxygen In Use Sign
- No Electrical Sparks
- Six Feet Away from Open Flames
- Nursing Considerations
- Dry Nasal and Upper Airway Mucosa
- Skin Irritation
- Home Education
1 min
Beta-2 Agonists
- Short-term Treatment
- Terbutaline
- Asthma
- Tocolysis
- Albuterol
- Asthma
- Long-term Treatment
- Salmeterol
- Asthma
- Chronic Obstructive Pulmonary Disease (COPD)
3 mins
Cystic Fibrosis Assessment
- Thickened Mucus
- Recurrent Pulmonary Infections
- Pulmonary Congestion
- Pancreatic Insufficiency
- Steatorrhea
- Fat-Soluble Vitamin Deficiencies
- Salty Taste to Skin
- Meconium Ileus
- Delayed Growth and Poor Weight Gain
2 mins
Cystic Fibrosis Interventions
- Bronchodilators
- N-Acetylcysteine (Mucolytics)
- Inhaled Hypertonic Saline
- Early Antibiotics
- Dornase Alfa (Mucolytic Agent)
- Postural Drainage with Percussion
- Fat Soluble Vitamin Supplements
- Pancreatic Enzymes with Every Meal
- High Protein, High Calorie Diet
- Added Dietary Salt
- Glucose Monitoring
2 mins
Airway, Breathing, Circulation (ABC's)
- Airway Assessment
- Changed Sound of Voice
- "See-saw" Respirations
- Stridor
- Breathing Assessment
- Normal Respiratory Rate: 12–20 Breaths/Min
- Use of Accessory Muscles in Respiration
- Cyanosis
- Circulation Assessment
- Color of Hands and Digits
- Normal Capillary Refill Time (CRT): 2 Seconds
- Decreased LOC
- Considerations
- Initial ‘Look, Listen and Feel” Assessment
- Emergency Treatment
- Prioritization in Exam Questions
5 mins
Epinephrine (Adrenaline)
- Mechanism
- Alpha and Beta Agonist
- Indications
- Anaphylaxis
- Primary Open Angle Glaucoma (POAG)
- Bleeding
- Cardiac Arrest
- Side Effects
- Tachycardia
- Hypertension
- Tremors
- Insomnia
- Considerations
- Multiple Strengths
2 mins
Pancreatin, Pancrelipase (Pancreatic Enzymes)
- Mechanism
- Pancreatic Enzymes
- Indications
- Cystic Fibrosis
- Pancreatic Insufficiency
- Side Effects
- GI Distress
- Considerations
- Inactivated by Gastric Acid
- 24 Hour Fat Excretion
- Take with Every Meal and Snack
2 mins
Epiglottitis Assessment
- Cause/Mechanism
- Haemophilus Influenzae
- Assessment
- Drooling
- Fever
- Stridor
- Restlessness
- Dyspnea
- Cough
- Tripod Position
- Considerations
- Emergency Treatment
- Do Not Examine Throat
2 mins
Epiglottitis Interventions
- Interventions
- Maintain Airway
- Upright/Sitting Position
- Humidified Oxygen
- Intubation/Tracheostomy Supplies At Bedside
- IV Antibiotics
- Decrease Anxiety
- Considerations
- NPO
- Vaccine
- Restrain to Prevent Extubation
2 mins
Haemophilus Influenzae Disease
- Disease
- Pneumonia
- Cherry Red Epiglottitis
- Meningitis
- Otitis Media
- COPD Exacerbation
- Thumbprint Sign (on X-ray)
- Treatment
- Rifampin Prophylaxis
- Ceftriaxone
2 mins
Respiratory Syncytial Virus (RSV) Assessment
- Mechanism
- Viral Infection Affecting Epithelial Cells
- Signs and Symptoms
- Begins After a Upper Respiratory Infection
- Copious Secretions
- Coughing and Sneezing
- Wheezing
- Otitis Media or Conjunctivitis (Possible Ear or Eye Drainage)
- Poor Feeding
- Tachypnea
2 mins
Respiratory Syncytial Virus (RSV) Interventions
- Prophylaxis
- Palivizumab (Synagis)
- Management
- Hospitalization
- Contact Precautions
- Oxygen
- Separate Room
- Maintain Fluid Intake
- Short-acting Beta-Agonist Bronchodilator
2 mins
Otitis Media Assessment
- Red or Bulging Tympanic Membrane
- Ear Pain
- Pulling at Ear
- Fever
- Upper Respiratory Infection
- Considerations
- More Common in Young Children
- Eustachian Tube Narrower
- Conductive Hearing Loss
- Smoking Increases Risk
2 mins
Otitis Media Interventions
- Antipyretics
- Analgesics
- Antibiotics
- Irrigation
- Position on Affected Side
- Myringotomy
- Tympanostomy Tube
2 mins
Tonsillitis
- Cause
- Bacterial or Viral Inflammation
- Assessment
- Sore Throat
- Dysphagia
- Interventions
- Throat Culture
- Antibiotics
- Tonsillectomy
- Considerations
- Often Streptococcus
- Monitor for Acute Glomerulonephritis
- Monitor for Rheumatic Heart Disease
3 mins
Tonsillectomy
- Indications
- Recurrent Tonsillitis
- Considerations
- Saline Gargles
- Ice Chips
- Monitor for Bleeding
- Within 24 Hours
- After 5-7 days
- Soft Foods
- Do Not Cough, Clear Throat, or Blow Nose
- Do Not Use Straws
2 mins
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