NR 341 Exam 2: Questions With Verified Solutions
Cause of pericarditis Right Ans - virus after MI, Rheumatic fever
What can pericarditis lead to Right Ans - cardiac tamponade
Assessment/indicators of pericarditis Right Ans - -complaints of localized
"pleuritic" chest pain that lasts a few seconds and increases with cough,
swallowing, and inspiration and is relieved with leaning forward
-pericardial friction rub
-ST segment elevation in ALL leads
Tx for pericarditis Right Ans - Pain relief → colchicine, indomethacin,
ibuprofen, or steroids
Antibiotics in presence of infection
Pericardiocentesis if effusion present
Indicated by muffled heart tones Right Ans - cardiac tamponade
Should be ruled out for any pt presenting with fever + new murmur (usually
bacterial) Right Ans - endocarditis
Assessment for endocarditis Right Ans - Fever lasting for several weeks,
medium-high grade
Headaches/Fatigue/Malaise/Weight loss
Exertional dyspnea + Cough
Murmurs may not be detectable
Skin changes: Pallor, purpura, petechiae
Osler's nodes (painful nodules in the phalanges)
Splinter hemorrhages (look @ fingernails)
Janeway lesions (macules on palms and soles)
Splenomegaly
Transesophageal echocardiography (TEE) Right Ans - gold standard dx for
endocarditis
Interventions for endocarditis Right Ans - Oxygen
Decrease activity while febrile
Obtain blood cultures
, Abx
Antipyretics
I&O
VS
Anti-inflammatories
prevention of endocarditis Right Ans - abx before invasive procedures
tx for endocarditis Right Ans - Tx: antipyretics, abx, rest
-may need a heart valve (last intervention)
Ventilator indications Right Ans - Hypoxemia = PaO2 ≤ 60 mmHg on FiO2 >
0.50
Hypercapnea = PCO2 ≥ 50 mmHg with pH ≤ 7.25
Progressive deterioration
↗ WOB, ↗ RR, ↘ VT
Endotracheal Suctioning PRN Right Ans - Hyperoxygenate (w/ 100% O2)
throughout procedure
Avoid normal saline instillation
Nasotracheal tube contraindicated in Right Ans - pt with skull/facial
fracture
Pt. has an ETT placed in, you don't see left lung expansion with inspiration...
what could be going on? Right Ans - Tube likely in the wrong place
Ex: it's in the esophagus
Likely in right bronchus
Fraction of Inspired Oxygen (FiO2): Right Ans - % of O2 the ventilator is
giving
possible causes of high pressure alarms Right Ans - kink in the tubing
↑ secretions
Mucus plug
Wheezing
Bronchospasm
Displaced ETT
Kink (or water) in tubing
Cause of pericarditis Right Ans - virus after MI, Rheumatic fever
What can pericarditis lead to Right Ans - cardiac tamponade
Assessment/indicators of pericarditis Right Ans - -complaints of localized
"pleuritic" chest pain that lasts a few seconds and increases with cough,
swallowing, and inspiration and is relieved with leaning forward
-pericardial friction rub
-ST segment elevation in ALL leads
Tx for pericarditis Right Ans - Pain relief → colchicine, indomethacin,
ibuprofen, or steroids
Antibiotics in presence of infection
Pericardiocentesis if effusion present
Indicated by muffled heart tones Right Ans - cardiac tamponade
Should be ruled out for any pt presenting with fever + new murmur (usually
bacterial) Right Ans - endocarditis
Assessment for endocarditis Right Ans - Fever lasting for several weeks,
medium-high grade
Headaches/Fatigue/Malaise/Weight loss
Exertional dyspnea + Cough
Murmurs may not be detectable
Skin changes: Pallor, purpura, petechiae
Osler's nodes (painful nodules in the phalanges)
Splinter hemorrhages (look @ fingernails)
Janeway lesions (macules on palms and soles)
Splenomegaly
Transesophageal echocardiography (TEE) Right Ans - gold standard dx for
endocarditis
Interventions for endocarditis Right Ans - Oxygen
Decrease activity while febrile
Obtain blood cultures
, Abx
Antipyretics
I&O
VS
Anti-inflammatories
prevention of endocarditis Right Ans - abx before invasive procedures
tx for endocarditis Right Ans - Tx: antipyretics, abx, rest
-may need a heart valve (last intervention)
Ventilator indications Right Ans - Hypoxemia = PaO2 ≤ 60 mmHg on FiO2 >
0.50
Hypercapnea = PCO2 ≥ 50 mmHg with pH ≤ 7.25
Progressive deterioration
↗ WOB, ↗ RR, ↘ VT
Endotracheal Suctioning PRN Right Ans - Hyperoxygenate (w/ 100% O2)
throughout procedure
Avoid normal saline instillation
Nasotracheal tube contraindicated in Right Ans - pt with skull/facial
fracture
Pt. has an ETT placed in, you don't see left lung expansion with inspiration...
what could be going on? Right Ans - Tube likely in the wrong place
Ex: it's in the esophagus
Likely in right bronchus
Fraction of Inspired Oxygen (FiO2): Right Ans - % of O2 the ventilator is
giving
possible causes of high pressure alarms Right Ans - kink in the tubing
↑ secretions
Mucus plug
Wheezing
Bronchospasm
Displaced ETT
Kink (or water) in tubing
