NURS 640 STUDY EXAMS GUIDE ALL QUESTIONS
AND ANSWERS SURE A+
✔✔deep neck infections - ✔✔ludwig angina: cellulitis, mouth floor infection
abscess- dental most common. dont r/o malig. edema/erythema of neck/chin/mouth.
TX: PCN + flagyl (IV for abscess)
✔✔eopiglottitis - ✔✔rapid worsening sore throat
"Thumb sign" on Xray
TX: IV abx, IV steroids, monitor for airway comp
✔✔Squamous cell carcinoma - larynx - ✔✔male, age 50-70
tobacco use
HBV in nonsmokers
sx: change in voice, throat pain, airway compromise, weight loss
TX: depends of extent and cell type
✔✔vocal cord paralysis - ✔✔d/t: nerve damage, lesion, surgical adverse effect, tumor
evaluate for cranial nerve deficits
protect airway!
,✔✔FB - throat - ✔✔Trachea/bronchi
- risk factor: dentures, advanced age
EMERGENCY!! will need surgical removal
esophagus
-not emergency of airway uneffected.
endoscopy for removal
✔✔neck mass - ✔✔consider malignancy
>40 increased cancer risk
<30 or >70 consider lymphoma
✔✔Pulm- acute development - ✔✔PE
inhalation injury
infection
mechanical obstruction: FB/tumor
✔✔pulm- chronic development - ✔✔Asthma
COPD
OSA
malignancy
obesity/deconditioning
systemic disorders with pulm complications
cardiac etiologies
✔✔Things to consider for HPI pulm - ✔✔think about their baseline
how far can you go w/o being SOB
is this similar to other exacerbations
what inhalers do you use
any issues w management
compliant with home regimen
use OLDCHARTS
PMH: lung disease, comorbidity
PSH: lung airway, chest
social: smoking, occupational, hobby, sick contacts, recent travel, TB
ROS: include constitutional, ENT, cardiac, GI, neuro
✔✔pulse ox - ✔✔rapid, non-invasive, continuous
represents the amount of oxygen bound to functional hgb
SpO2 >96% correlates with PaO2 >70
**limitations in accuracy: SpO2 <80%, mobement, bright light interference, dye, nail
polish, non-functional hgb, reduced blood flow.
, ✔✔PFT - ✔✔full PFT: obstruction or restriction of flow (spiro)
-reversibility with BD admin (spiro pre/post)
-lung expansion (volume)
-gas diffusion (helium)
-available in PFT lab
assess for: *obstructions (COPD, PNA), *restriction (Obesity, skeletal deformity), gas
exchange, tumor impact
**DLCO impacted by:
-*[anemia, polycythemia, Alveolar hemorrhage], restrictive lung disease and obesity that
may limit correlation to disease severity
-DLCO is indicator of gas (O2) exchange - impaired by hypoxemia
in hospital: dx COPD/asthma, assess for surgery
**BD reversible=asthma
**BD not reversible= COPD
✔✔Peak flow meter - ✔✔-available at home
-objective assessment of airflow obs and severety of it
-measured against the patients baseline
-primarily for asthma at home and for assessment of exacerbation.
✔✔Cough - ✔✔HPI:
acute (<3 weeks), subacute (3-8 weeks), chronic (>8weeks).
asthma triggers, URI, infection
dry vs productive, SOB?, frequency, diurnal vs nocturnal
Assessment:
Pulm, ENT, GERD, malignancy, infection, pharm
CXR, PFT, Think GERD/ENT/asthma
✔✔Dyspnea - ✔✔HPI: chronic/acute/recurrent, exposures, asthma triggers, positioning,
exertion, functional assessment, SOB?, frequency
DDx: pulmonary, cardiac, anemia, acute/non-acute process, PE, malig, CHF, ACS
dx: CXR, PFT, CBC, BNP`
✔✔hemoptysis - ✔✔HPI: acute/chronic, associated sx, risk factors, color, estimated
amount, upper/lower airway, severity, frequency
DDx: infection, inflammation, malignancy
dx: CXR, labs, sputum culture, TB testing, CT for PE
✔✔hypoxemia - ✔✔low O2 in the blood
AND ANSWERS SURE A+
✔✔deep neck infections - ✔✔ludwig angina: cellulitis, mouth floor infection
abscess- dental most common. dont r/o malig. edema/erythema of neck/chin/mouth.
TX: PCN + flagyl (IV for abscess)
✔✔eopiglottitis - ✔✔rapid worsening sore throat
"Thumb sign" on Xray
TX: IV abx, IV steroids, monitor for airway comp
✔✔Squamous cell carcinoma - larynx - ✔✔male, age 50-70
tobacco use
HBV in nonsmokers
sx: change in voice, throat pain, airway compromise, weight loss
TX: depends of extent and cell type
✔✔vocal cord paralysis - ✔✔d/t: nerve damage, lesion, surgical adverse effect, tumor
evaluate for cranial nerve deficits
protect airway!
,✔✔FB - throat - ✔✔Trachea/bronchi
- risk factor: dentures, advanced age
EMERGENCY!! will need surgical removal
esophagus
-not emergency of airway uneffected.
endoscopy for removal
✔✔neck mass - ✔✔consider malignancy
>40 increased cancer risk
<30 or >70 consider lymphoma
✔✔Pulm- acute development - ✔✔PE
inhalation injury
infection
mechanical obstruction: FB/tumor
✔✔pulm- chronic development - ✔✔Asthma
COPD
OSA
malignancy
obesity/deconditioning
systemic disorders with pulm complications
cardiac etiologies
✔✔Things to consider for HPI pulm - ✔✔think about their baseline
how far can you go w/o being SOB
is this similar to other exacerbations
what inhalers do you use
any issues w management
compliant with home regimen
use OLDCHARTS
PMH: lung disease, comorbidity
PSH: lung airway, chest
social: smoking, occupational, hobby, sick contacts, recent travel, TB
ROS: include constitutional, ENT, cardiac, GI, neuro
✔✔pulse ox - ✔✔rapid, non-invasive, continuous
represents the amount of oxygen bound to functional hgb
SpO2 >96% correlates with PaO2 >70
**limitations in accuracy: SpO2 <80%, mobement, bright light interference, dye, nail
polish, non-functional hgb, reduced blood flow.
, ✔✔PFT - ✔✔full PFT: obstruction or restriction of flow (spiro)
-reversibility with BD admin (spiro pre/post)
-lung expansion (volume)
-gas diffusion (helium)
-available in PFT lab
assess for: *obstructions (COPD, PNA), *restriction (Obesity, skeletal deformity), gas
exchange, tumor impact
**DLCO impacted by:
-*[anemia, polycythemia, Alveolar hemorrhage], restrictive lung disease and obesity that
may limit correlation to disease severity
-DLCO is indicator of gas (O2) exchange - impaired by hypoxemia
in hospital: dx COPD/asthma, assess for surgery
**BD reversible=asthma
**BD not reversible= COPD
✔✔Peak flow meter - ✔✔-available at home
-objective assessment of airflow obs and severety of it
-measured against the patients baseline
-primarily for asthma at home and for assessment of exacerbation.
✔✔Cough - ✔✔HPI:
acute (<3 weeks), subacute (3-8 weeks), chronic (>8weeks).
asthma triggers, URI, infection
dry vs productive, SOB?, frequency, diurnal vs nocturnal
Assessment:
Pulm, ENT, GERD, malignancy, infection, pharm
CXR, PFT, Think GERD/ENT/asthma
✔✔Dyspnea - ✔✔HPI: chronic/acute/recurrent, exposures, asthma triggers, positioning,
exertion, functional assessment, SOB?, frequency
DDx: pulmonary, cardiac, anemia, acute/non-acute process, PE, malig, CHF, ACS
dx: CXR, PFT, CBC, BNP`
✔✔hemoptysis - ✔✔HPI: acute/chronic, associated sx, risk factors, color, estimated
amount, upper/lower airway, severity, frequency
DDx: infection, inflammation, malignancy
dx: CXR, labs, sputum culture, TB testing, CT for PE
✔✔hypoxemia - ✔✔low O2 in the blood
