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NUR 203 Respiratory + Mental Health Exam B/G
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NUR 203 Respiratory + Mental Health Exam B/G-NUR 203 Respiratory + Mental Health Exam B/G-NUR 203 Respiratory + Mental Health Exam B/G
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NUR 203 Respiratory + Mental HealthExam B/G
Physiological process for successful gas exchange - correct answer 1) mechanics: chest rise and
fall, diaphragm moves up and down
2) vascular movement: blood flow to lungs is adequate
abnormal accumulation of fluid in the interstitial spaces and alveoli of the lungs - correct
answer pulmonary edema
etiology of pulmonary edema - correct answer L. ventricular failure (MI, Cardiomyopathy, etc)
Renal Failure
Mitral Stenosis
Rapid administration of IV fluids
why does renal failure cause pulmonary edema - correct answer filters not working, not pulling
fluid off
why does rapid administration of IV fluids cause pulmonary edema - correct answer cause
baroreceptors in vessels to act up
if we hear wheezing, what is it usually related to?
EXs? - correct answer 1. foreign body
2. tightened airway- constriction
Ex: Asthma, Inhalation burn, PNA with tenacious secretions
how do we treat asthma - correct answer need steroids
how do we treat secretions - correct answer need fluids
What does rhonchi sound like and what is it usually related to? - correct answer musical, junky
sounds
related to infectious/inflammatory process
what do we do for rhochi - correct answer TCDB, encourage forceful cough
what is coarse crackles - correct answer a lot of crackles
what do crackles/rales sound like, where do we hear them and why? - correct answer Sounds
like rubbing hair. Represents fluid in tissue of lungs, does not clear with cough.
Hear 1st at bases posterior because head is up, fluid settles at bases.
,NUR 203 Respiratory + Mental Health
Exam B/G
On a CXR we see a white area on upper L lobe, what is it? - correct answer NOT fluid, fluid is
heavy and will fall- this will be secretions or a mass
clinical manifestations of pulmonary edema - correct answer agitation
disorientation
increasing respiratory distress, dyspnea, cyanosis
tachycardia
crackles (rales)
cold, clammy skin
pink, frothy sputum
tachypnea
orthopnea
What does BMP look at?
Why? - correct answer look at K because diuretics given
Why do we get a CBC? - correct answer H/H to see our O2 carrying capacity
Diagnostics/Labs for pulmonary edema - correct answer CXR
ABGs
BMP
CBC
BNP
What does a BNP show us - correct answer Corresponds with left ventricular pressure.
Elevated levels correspond with degree of heart failure.
Cardiogenic or noncardiogenic
noncardiogenic has... - correct answer normal BNP
normal PAWP because not r/t back up
If we have a high BNP r/t L ventricular failure, what do we give - correct answer dobutamine
cardiogenic pulmonary edema is related to - correct answer PAWP- how much fluid volume at
pulmonary bed
,NUR 203 Respiratory + Mental Health
Exam B/G
For cardiogenic, we must.. - correct answer decrease afterload because of resistance, prevent
fluid backing up- this does not help non cardiogenic
to get rid of pulmonary edema we must.. - correct answer give diuretics to decrease preload
medical management for pulmonary edema - correct answer correct underlying disorder
#1 priority- oxygen
Diuretics
Morphine
Vasodilators
Dobutamine
Digoxin
Milrinone
What does morphine do for patients with pulmonary edema?
What do we critically evaluate when giving it? - correct answer Afterload and preload reducer,
decreases WOB
relieve anxiety
evaluate RR
Nursing management for pulmonary edema - correct answer assist with intubation
administer O2
elevate HOB- high fowlers: allows for full expansion, fluid lower to optimize upper airway
psych support
monitor hemodynamics: PAWP, CVP
Vital signs- may get every minute
strict I/O
chemical and physical restraints for intubation - correct answer Pancuronium
Rocuronium
Propofol
, NUR 203 Respiratory + Mental Health
Exam B/G
Dexmedetomidine
what are the names of the 2 paralytics - correct answer Pancuronium
Rocuronium
nursing considerations for paralytic - correct answer give so they don't extubate themselves
and allows patient to relax
names of the 2 sedatives - correct answer propofol- short acting
Dexmedetomidine- preferred if weaning from vent, not profound respiratory depressant
s/s of pain with patient on paralytic - correct answer increased bp
increased hr
diaphoretic
If area of CXR is whited out - correct answer something is there (pulmonary edema) and we
will hear crackles
triggers next breath - correct answer CO2, lungs expanding with negative pressure
rising steady CO2 causes - correct answer brain becomes desensitized to CO2
brain senses increased CO2 - correct answer does not listen, brain listens to decreased O2
Pink puffer COPD emphysema - correct answer pink/rosy
difficulty decreasing CO2
can cause pulmonary edema - correct answer profoundly hypoxic
causes because of cell wall permeability
decreased pulmonary compliance causes - correct answer stiff lungs
ARDS symptoms - correct answer Dyspnea
decreased surfactant
PaO2/FiO2 decreased
decreased pulmonary compliance
non-cardiac, bilateral pulmonary edema
dense pulmonary infiltrates on CXR
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