NURS 425 Exam 2 Blueprint
Disclaimer: This document is designed to help guide your study and help you focus on topics
that we find to be some of the most important information that was covered in the material for
the exam. This is not all of the information that will be on the exam, so please do not expect
this to be the only information covered on the exam.
Topics for exam 2:
Respiratory:
1. Review: Respiratory System
a. There are 2 types of circulation in the lungs: pulmonary and bronchial
i. Pulmonary – Gas Exchange
1. Pulmonary artery and vein
ii. Bronchial – supports Conducting Airways
1. Helps warm and humdify air
2. Bronchial veins empty into pulmonary vein and allow some
deoxygenated blood to enter into oxygenated blood coming from
pulmonary circulation (not harmful nor beneficial)
b. Diffusion of Gas
i. O2 diffuses across the alveolocapillary membrane
ii. Enters the plasma and binds with hemoglobin
iii. Hemoglobin transports oxygen to tissues
2. Review: Respiratory Disorders
a. Risk Factors
i. Traumatic
1. Contact sports, fighting, MVA, falls, recent procedures, assisted
respiratory care
ii. Nontraumatic
1. Young, thin, male gender, ages 10-30 yo, Marfan’s syndrome, smokers,
environmental factors
b. Manifestations
i. Confusion, lethargy, dizziness, loss of consciousness
ii. Tachycardia that may transition to bradycardia
iii. Tachypnea, dyspnea, wheezes, crackles, diminished breath sounds
iv. Nausea/vomiting
c. Causes
i. Restrictive – lungs cannot expand properly
, 1. Fibrosis, amyloidosis (accumulation of proteins that disrupt normal
organ function)
2. Neuromuscular disease, trauma, obesity, deformity
ii. Obstructive – lungs cannot expel CO2
1. Alveoli (parenchyma of O2 exchange) expand but can’t deflate
adequately
2. COPD (emphysema, chronic bronchitis), asthma
d. Labs and Diagnostics
i. Labs
1. Chemistry panel (electrolytes, glucose, protein, lipid)
2. CBC (WBC, RBC, Hgb, Hct, Plt)
3. ABG (pH, O2, CO2, HCO3)
4. Sputum examination
ii. Diagnostics
1. Chest X-ray
2. CT
3. MRI
4. Bronchoscopy
5. Pulmonary function test
e. Treatments
i. O2 supplementation (avoiding positive pressure), Mechanical ventilation, Chest
tube
ii. Blood products, Bronchodilators, Anti-inflammatories
f. Complications
i. Hypoxia, respiratory arrest
ii. Dysrhythmias, cardiac arrest
iii. Death
3. Risk factors, pathophysiology, treatments, and complications for hemothorax,
pneumothorax, tension pneumothorax
a. Hemothorax
i. Pathophysiology
1. Trauma causes blood to collect in the pleural space leaving less
room for the lungs to expand
ii. Treatments
1. Chest tube - drainage
b. Pneumothorax (Collapsed Lung)
i. Pathophysiology
1. Air leaks into pleural space
2. Traumatic
, a. Chest trauma, rib fractures, knife/gunshot wounds, sports
injury, medical procedures, CPR
3. Nontraumatic
a. Asthma, COPD, cystic fibrosis, whooping cough,
tuberculosis, spontaneous
ii. Treatments
1. Observation in smaller patients – corrects itself
2. Thoracentesis (removal of air from pleural cavity with needle and
syringe)
3. Chest tube - drainage
c. Tension Pneumothorax
i. Life threatening
ii. Pathophysiology
1. Air is trapped in pleural cavity displacing the trachea, lungs, heart,
and other structures
iii. Treatments
1. Needle decompression
a. Into the skin over the third intercostal space
2. Follow-on one-way catheter (a drainage catheter)
4. Chest tube
- Inserted through the intercostal space of the thorax and into the pleural space to
remove air/fluid
- Restores negative pressure in pleural space
a. Maintenance
i. An order is needed to manage chest tube dressing changes
ii. Water seal chamber fluid should rise and fall from 2-4 cm with inhalation
and exhalation until lung has fully reexpanded
iii. Q4 :
1. vitals and examine site and dressing
2. Monitor water seal and add fluid if necessary
3. Document color and amnt of drainage every hr for the first 24hrs,
every 8hrs thereafter
a. NOTIFY if greater than 70 mL/hr
iv.
b. Purposes of different Chambers
i. Drainage collection chamber – collects fluid (fluid is measured hourly for
first 24 hrs)
Disclaimer: This document is designed to help guide your study and help you focus on topics
that we find to be some of the most important information that was covered in the material for
the exam. This is not all of the information that will be on the exam, so please do not expect
this to be the only information covered on the exam.
Topics for exam 2:
Respiratory:
1. Review: Respiratory System
a. There are 2 types of circulation in the lungs: pulmonary and bronchial
i. Pulmonary – Gas Exchange
1. Pulmonary artery and vein
ii. Bronchial – supports Conducting Airways
1. Helps warm and humdify air
2. Bronchial veins empty into pulmonary vein and allow some
deoxygenated blood to enter into oxygenated blood coming from
pulmonary circulation (not harmful nor beneficial)
b. Diffusion of Gas
i. O2 diffuses across the alveolocapillary membrane
ii. Enters the plasma and binds with hemoglobin
iii. Hemoglobin transports oxygen to tissues
2. Review: Respiratory Disorders
a. Risk Factors
i. Traumatic
1. Contact sports, fighting, MVA, falls, recent procedures, assisted
respiratory care
ii. Nontraumatic
1. Young, thin, male gender, ages 10-30 yo, Marfan’s syndrome, smokers,
environmental factors
b. Manifestations
i. Confusion, lethargy, dizziness, loss of consciousness
ii. Tachycardia that may transition to bradycardia
iii. Tachypnea, dyspnea, wheezes, crackles, diminished breath sounds
iv. Nausea/vomiting
c. Causes
i. Restrictive – lungs cannot expand properly
, 1. Fibrosis, amyloidosis (accumulation of proteins that disrupt normal
organ function)
2. Neuromuscular disease, trauma, obesity, deformity
ii. Obstructive – lungs cannot expel CO2
1. Alveoli (parenchyma of O2 exchange) expand but can’t deflate
adequately
2. COPD (emphysema, chronic bronchitis), asthma
d. Labs and Diagnostics
i. Labs
1. Chemistry panel (electrolytes, glucose, protein, lipid)
2. CBC (WBC, RBC, Hgb, Hct, Plt)
3. ABG (pH, O2, CO2, HCO3)
4. Sputum examination
ii. Diagnostics
1. Chest X-ray
2. CT
3. MRI
4. Bronchoscopy
5. Pulmonary function test
e. Treatments
i. O2 supplementation (avoiding positive pressure), Mechanical ventilation, Chest
tube
ii. Blood products, Bronchodilators, Anti-inflammatories
f. Complications
i. Hypoxia, respiratory arrest
ii. Dysrhythmias, cardiac arrest
iii. Death
3. Risk factors, pathophysiology, treatments, and complications for hemothorax,
pneumothorax, tension pneumothorax
a. Hemothorax
i. Pathophysiology
1. Trauma causes blood to collect in the pleural space leaving less
room for the lungs to expand
ii. Treatments
1. Chest tube - drainage
b. Pneumothorax (Collapsed Lung)
i. Pathophysiology
1. Air leaks into pleural space
2. Traumatic
, a. Chest trauma, rib fractures, knife/gunshot wounds, sports
injury, medical procedures, CPR
3. Nontraumatic
a. Asthma, COPD, cystic fibrosis, whooping cough,
tuberculosis, spontaneous
ii. Treatments
1. Observation in smaller patients – corrects itself
2. Thoracentesis (removal of air from pleural cavity with needle and
syringe)
3. Chest tube - drainage
c. Tension Pneumothorax
i. Life threatening
ii. Pathophysiology
1. Air is trapped in pleural cavity displacing the trachea, lungs, heart,
and other structures
iii. Treatments
1. Needle decompression
a. Into the skin over the third intercostal space
2. Follow-on one-way catheter (a drainage catheter)
4. Chest tube
- Inserted through the intercostal space of the thorax and into the pleural space to
remove air/fluid
- Restores negative pressure in pleural space
a. Maintenance
i. An order is needed to manage chest tube dressing changes
ii. Water seal chamber fluid should rise and fall from 2-4 cm with inhalation
and exhalation until lung has fully reexpanded
iii. Q4 :
1. vitals and examine site and dressing
2. Monitor water seal and add fluid if necessary
3. Document color and amnt of drainage every hr for the first 24hrs,
every 8hrs thereafter
a. NOTIFY if greater than 70 mL/hr
iv.
b. Purposes of different Chambers
i. Drainage collection chamber – collects fluid (fluid is measured hourly for
first 24 hrs)
