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NUR 203 Respiratory + Mental Health Exam B/G
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1. Physiological process for successful 1) mechanics: chest rise and fall, diaphragm moves up
gas exchange and down
2) vascular movement: blood flow to lungs is adequate
2. abnormal accumulation of fluid in pulmonary edema
the interstitial spaces and alveoli of
the lungs
3. etiology of pulmonary edema L. ventricular failure (MI, Cardiomyopathy, etc)
Renal Failure
Mitral Stenosis
Rapid administration of IV fluids
4. why does renal failure cause pul- filters not working, not pulling fluid off
monary edema
5. why does rapid administration of IV cause baroreceptors in vessels to act up
fluids cause pulmonary edema
6. if we hear wheezing, what is it usu- 1. foreign body
ally related to? 2. tightened airway- constriction
EXs? Ex: Asthma, Inhalation burn, PNA with tenacious se-
cretions
7. how do we treat asthma need steroids
8. how do we treat secretions need fluids
9. What does rhonchi sound like and musical, junky sounds
what is it usually related to? related to infectious/inflammatory process
10. what do we do for rhochi TCDB, encourage forceful cough
11. what is coarse crackles a lot of crackles
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12. what do crackles/rales sound like, Sounds like rubbing hair. Represents fluid in tissue of
where do we hear them and why? lungs, does not clear with cough.
Hear 1st at bases posterior because head is up, fluid
settles at bases.
13. On a CXR we see a white area on NOT fluid, fluid is heavy and will fall- this will be secre-
upper L lobe, what is it? tions or a mass
14. clinical manifestations of pul- agitation
monary edema disorientation
increasing respiratory distress, dyspnea, cyanosis
tachycardia
crackles (rales)
cold, clammy skin
pink, frothy sputum
tachypnea
orthopnea
15. What does BMP look at? look at K because diuretics given
Why?
16. Why do we get a CBC? H/H to see our O2 carrying capacity
17. Diagnostics/Labs for pulmonary CXR
edema ABGs
BMP
CBC
BNP
18. What does a BNP show us Corresponds with left ventricular pressure. Elevated
levels correspond with degree of heart failure.
Cardiogenic or noncardiogenic
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19. noncardiogenic has... normal BNP
normal PAWP because not r/t back up
20. If we have a high BNP r/t L ventric- dobutamine
ular failure, what do we give
21. cardiogenic pulmonary edema is re- PAWP- how much fluid volume at pulmonary bed
lated to
22. For cardiogenic, we must.. decrease afterload because of resistance, prevent flu-
id backing up- this does not help non cardiogenic
23. to get rid of pulmonary edema we give diuretics to decrease preload
must..
24. medical management for pul- correct underlying disorder
monary edema #1 priority- oxygen
Diuretics
Morphine
Vasodilators
Dobutamine
Digoxin
Milrinone
25. What does morphine do for pa- Afterload and preload reducer, decreases WOB
tients with pulmonary edema? relieve anxiety
What do we critically evaluate when evaluate RR
giving it?
26. Nursing management for pul- assist with intubation
monary edema administer O2
elevate HOB- high fowlers: allows for full expansion,
fluid lower to optimize upper airway
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