Exam (elaborations)
NURS 231 FINAL EXAM QUESTIONS AND ANSWERS
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Nurs 231 Pathophysiology
Institution
Nurs 231 Pathophysiology
NURS 231 FINAL EXAM QUESTIONS AND ANSWERS
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NURS 231 FINAL EXAM QUESTIONS
AND ANSWERS
*PulmonaryaEmbolismaPathophysiology*
(UNDERSTAND)a-
aans✔✔aacollectionaofaparticulateamattera(solids,aliquids,aair)athataentersavenousacirculatio
naandalodgesainatheapulmonaryavessels.aLargeaemboliaobstructapulmonaryabloodaflow,alea
dingatoareducedagasaexchange,areducedaoxygenation,apulmonaryatissueahypoxia,adecrea
sedaperfusion,aandapotentialadeath.aAnyasubstanceacanacauseaanaembolismaaabloodaclotai
satheamostacommon.
MostacommonlyaoccursafromaaaDVTafromaaaveinaofathealegaorapelvisawhereapartaofatheaclot
abreaksaoffaandafindsaitsawayatoathearightasideaofatheaheartathroughatheavenaacavaaitathenal
odgesainatheapulmonaryaarteryaoraoneaofaitsabranches.aThisaalsoameansathatabloodacannot
agoathroughathealeftasideaofatheaheartatoabeaperfusedatoathearestaofatheabody.aPlateletsacoll
ectaonatheaembolus,atriggeringatheareleaseaofasubstancesathatacauseabloodavesselaconstri
ctionacausingaimpairedagasaexchangeaandatissueaperfusion
MajoraRiskaFactorsaforaVTEaleadingatoaPEaare:a-aans✔✔-prolongedaimmobility
-centralavenousacatheters
-surgery
-obesity
-advancingaage
-conditionsathataincreaseabloodaclotting
-historyaofathromboembolism
-smoking
-pregnancy
-estrogenatherapy
-heartafailure
-stroke
-cancer
-trauma
*PreventionaofaPulmonaryaEmbolism*a-aans✔✔-
Startapassiveaandaactivearangeaofamotionaexercisesaforatheaextremitiesaofaimmobilizedaan
dapostoperativeapatient's.
-Ambulateapatient'sasoonaafterasurgery
,-Useaantiaembolismaandapneumaticacompressionastockingsaandadevicesaafterasurgery.
-Evaluateapatientaforacriteriaaindicatingatheaneedaforaanticoagulantatherapy.
-Avoidatheauseaofatightagarters.aGirdles,aandaconstrictingaclothing.
-Preventapressureaunderatheapoplitealaspace
-Performacomprehensiveaassessmentaofaperipheralacirculation.
-
Elevateatheaaffectedalimba20adegreesaoramoreaaboveathealevelaofatheaheartatoaimproveave
nousareturn,aasaappropriate.
-Changeapatientapositionaeverya2ahours.
-
Preventainjuryatoatheavesselalumenabyapreventingalocalapressureatrauma,ainfection,aorasep
sis
-Refrainafromamassagingalegamuscles
-Instructapatientanotatoacrossalegs
-Administeraprescribedaprophylacticalow-doseaanticoagulantaandaantiaplateletadrugs
-TeachapatientatoaavoidaactivitiesathataresultainatheaValsalvaamaneuver
-
Adminiteraprescribedadrugs,asuchaasastoolasofteneraso,athatawillapreventaepisodesaofathea
ValsalvaaManeuver
-Teachapatientaandafamilyaaboutaprecautions
-
Encourageasmokeacessationa(tobaccoauseanarrowsabloodavesselsaandaincreasesathearisk
aforaclotaformation)
-Hormone-basedacontraceptivesaincreaseabloodaclotting
Hemoptysisa-aans✔✔bloodasputum
Syncopea-aans✔✔faintingaoralossaofaconsciousness
PulmonaryaEmbolismaKeyaFeaturesa-
aans✔✔*ItaisaimportantatoarememberathatamanyapatientsawithaPEadoanotahaveathea"classic
"asymptoms.*
ClassicaSymptoms:
-Dyspnea,asuddenaonset
-Sharp/stabbingachestapain
-Apprehension,arestlessness
-Feelingaofaimpedingadoom
-Cough
-*Hemoptysis*
Signs:
-*Pleuriticachestapain*
-*DryaCough*
-Tachypnea
-Crackles
,-PleuralaFrictionaRub
-Tachycardia
-S3aoraS4aheartasound
-Diaphoresis
-Lowagradeafever
-Petechiaaoverachestaandaaxillae
-Decreasedaarterialaoxygenasaturationa(SaO2)
CardiacaSymptomsafromaPulmonaryaEmbolisma-aans✔✔-Tachycardia
-Distendedaneckaveins
-Syncope
-Cyanosis
-Hypotension
-Abnormalaheartasoundsa(S3aandaS4)
-AbnormalaECG
LaboratoryaAssessmentawithaPulmonaryaEmbolisma-aans✔✔-
Theahyperventilationatriggeredabyahypoxiaaandapaina*firstaleadsatoarespiratoryaalkalosis,ain
dicatedabyalowapartialapressureaofaarterialacarbonadioxideaonaABGaanalysis.*
-
TheaPaO2aratioafallsaasaaaresultaofa"shunting"aofabloodafromathearightasideaofatheaheartatoat
healeftawithoutapickingaupaoxygenafromathealungs.aShuntingacausesatheaPaCO2alevelatoari
searesultingainarespiratoryaacidosis
-*Later,ametabolicaacidosisaresultsafromabuildupaofalacticaacidacausedabyatissueahypoxia.*
*ABG's:aLowaPAO2*
*PulseaOximetry:aLowaSaO2*
D-Dimera-
aans✔✔thisarisesawithafibrinolysisa(breakdownaofabloodaclots).aWhenatheavalueaisanormala
oralowaitacanaruleaoutaaaPE.aHowever,aevenaifatheavalueaisahigh,aotheradiagnosticatestingais
aneededatoadetermineawhetheraaaPEahasaoccurred.a(thisatestaisanonspecificatoaPE)
ImagingaAssessmentaforaPulmonaryaEmbolisma-aans✔✔-
Pulmonaryaangiographyaisathea"goldastandard"
-ComputedaTomographyaPulmonaryaAngiographyaorahelicalaCTamayaalsoabeaused
-CXRamayadiagnoseaconditionsathatamimicaaaPE
-
DoppleraultrasoundamayabeausedatoadocumentatheapresenceaofaVTEaandatoasupportaaaPE
adiagnosis
CareaofatheaPatientaWithaaaPulmonaryaEmbolisma-aans✔✔-
Applyaoxygenabyanasalacannulaaoramask
-Reassureapatientathatatheacorrectameasuresaareabeingataken
-Placeapatientainahigh-fowlersaposition
-Applyatelemetryamonitoringaequipment
, -Obtainaanaadequateavenousaaccess
-Assessaoxygenationacontinuouslyawithapulseaoximetry
-
Assessarespiratoryastatusaataleastaeveryathirtyaminutesaby:alisteningatoalungasounds,ameas
uringathearate,arhythm,aandaeaseaofarespirations,acheckingaskinacoloraandacapillaryarefill,ac
heckingapositionaofatrachea.
-
Assessacardiacastatusaby:acomparingabloodapressuresainathearightaandaleftaarms,acheckin
gapulseaforaquality,acheckingacardiacamonitoraforadysrhythmias,acheckingaforadistentionaofa
neckaveins
-Ensureathataprescribedachestaimagingaandalaboratoryatestsaareaobtainedaimmediately
-Examineatheathoraxaforapresenceaofapetechiae
-Administeraprescribedacoagulants
-Assessaforableeding
-Handleapatientagently
-InstituteaBleedingaPrecautions
ManagingaHypoxemiaa-
aans✔✔*Whenaaapatientahasaaasuddenaonsetaofadyspneaaandachestapain,aimmediatelyano
tifyathearapidaresponseateam.aReassureatheapatientaandaelevateatheaheadaofatheabed.aPre
pareaforaoxygenatherapyaandabloodagasaanalysisawhileacontinuingatoamonitoraandaassessa
foraotherachanges.*
OxygenaTherapy:acriticalaforaaapatientawithaPE.aInasevereacases,atheapatientamayaneedam
echanicalaventilation.
ContinuallyaMonitoratheapatientaforaanyachangesainastatusa(respiratory,a*cardiac*,aperfusio
n,aLOC)a*CARDIACaR/
TaINCREASEDaRISKaFORaDYSRHYTHMIASaR/
TaTOaELECTROLYTEaIMBALANCEaR/TaACIDaBASE*
DrugaTherapy:abeginsaimmediatelyawithaanticoagulantsatoapreventaembolusaenlargementa
andamoreaclotting.
IndicatorsaofaAdequateaTissueaPerfusiona-aans✔✔-ABGsawithinanormalalimits
-PulseaOxaabovea92%
-Cognitiveastatusaunimpairedacomparedawithabaseline
-AbsenceaofapalloraandaCyanosis
TherapeuticaPTTaValuesa-aans✔✔1.5-
2xatheacontrolavalueaforathisahealthaproblem;a*WEaWANTaTHEMaHIGHERaTHANaNORMA
LaRANGE.aTheiraconditionaisaNOTanormal.*
MassiveaPE
(MortalityaRateaasaHighaasa65%)a-aans✔✔PossibleaSymptoms: