NURS 640 EXAMS 2 QUESTIONS AND ANSWERS
SURE A+
✔✔CXR indications - ✔✔infection eval
acute chest pain or dyspnea
chronic dyspnea
hemoptysis
concern for malignancy
trauma
asthma/bronchitis
tube/line placement
✔✔chest CT indications - ✔✔vascular (PE), lung parenchyma (mass), chest structures
(pleaural effusion), hilar nodes( inflam, malig), cancer staging.
✔✔FEV1 - ✔✔forced air out in first second
✔✔FVC - ✔✔total air volume out
✔✔OSA - ✔✔repetitive narrowing/closure of upper airway
intermittent oxygen level reductions
SNS activation: brain arousal & disruption of sleep, SNS activation, increased
HR/BP/BG, increased nocturia
sx: daytime sleepy, fatigue, awakenings, gasping/choking, insomnia, nocturia, snoring,
apnea, restless sleep, HTN, CAD, CHF, a-fib, stroke, DM, depression, anxiety, insomnia
PMH: HTN, HF, DM, a-fib, stroke, dep/anx, insomnia
assess: obesity, enlarged neck, narrow airway (tongue, tonsil enlargement),
small/recessed jaw
Dx: sleep study
,✔✔STOP-bang OSA - ✔✔**
Snoring
Tired
Observed apneas
Pressure (HTN)
BMI >35
Age >50
Neck >15.7 in
Gender = male
1 pt for each
>=5 HIGH risk OSA
3-4 intermediate risk
✔✔Chronic OSA therapy goals - ✔✔dilate/stabilize airway
-CPAP/BiPAP
-dental appliance
-surg intervention
Assess adherence!!
weight loss and substance avoidance encouraged
✔✔inpatient management OSA - ✔✔continuous pulse ox- esp w sleep/sedation/narcs
maintain/initiate PAP therapy - encourage patients to bring their own. use with ALL
sleep.
use home settings
uncomplicated: continue CPAP
complicated: (also has COPD, HF, obesity, neuromuscular disease) use NIMV/BiPAP
✔✔I SNORED OSA - ✔✔Insomnia
snoring
nocturnal awakenings
obesity
restorative sleep/refreshing sleep
excessive daytime somnolence
driving problems
✔✔Pneumonia - ✔✔inflammatory response in lung caused by microorganism infection.
CAP
HCAP (HAP, VAP)
aspiration
atypical (legionella, mycoplasma)
, Viral (influ, SARS, RSV)
Fungal (pneumocycstits jiroveci)
bronchial involvement: walls of bronchioles. diffuse, patchy, can involve multiple lobes.
Lobar: involves larger, continuous are of lung lobe. larger distribution and more focal
consolidation.
✔✔PNA sx - ✔✔cough, sputum, fever, chills, sweats, rigors
acute presentation, dyspnea, chest discomfort, scant hemoptysis, malaise, fatigue, HA,
abd pain
✔✔PNA assessment and PE - ✔✔Assess: travel, sick contacts, immunization, smoking,
comorbidities (immunocompromised, pulm dx), recent tx
PE: cough, lung consolidation, dull to perucssion, increased lung sounds over
consolidated areas, crackles/rhonchi/wheezing, increased temp/RR/HR, decrease
BP/SpO2
severe: cyanosis, respiratory destress.
✔✔PNA- older adults - ✔✔confusion, drowsiness, fatigue, HA, falls, functional decline,
nausea, loss of appetite
✔✔PNA- testing - ✔✔microorganism: Sputum gram stain, antigen assays, influenza
rapid testing, multiplex PCR
*Do before initiation of abx!
blood testing: to assess PNA severity, leukocytosis, chem panels, HIV testing, Blood
cultures, procalcitonin (raised with bacterial!), ABG
Radiographic: CXR 2 view (more difinitive dx, may be normal early on, monitor for
progression, clear after 6 weeks), CT (not often used), thora (diagnostic), Broch
(accurate dx, sputum collected)
✔✔PNA- DDx - ✔✔bronchitis exacerbation
PE
Neoplasm
Pulm Edema
✔✔CURB-65 - ✔✔Confusion
BUN >19
RR >30
Hypotension <90/60
Age 65
2+ = admit
SURE A+
✔✔CXR indications - ✔✔infection eval
acute chest pain or dyspnea
chronic dyspnea
hemoptysis
concern for malignancy
trauma
asthma/bronchitis
tube/line placement
✔✔chest CT indications - ✔✔vascular (PE), lung parenchyma (mass), chest structures
(pleaural effusion), hilar nodes( inflam, malig), cancer staging.
✔✔FEV1 - ✔✔forced air out in first second
✔✔FVC - ✔✔total air volume out
✔✔OSA - ✔✔repetitive narrowing/closure of upper airway
intermittent oxygen level reductions
SNS activation: brain arousal & disruption of sleep, SNS activation, increased
HR/BP/BG, increased nocturia
sx: daytime sleepy, fatigue, awakenings, gasping/choking, insomnia, nocturia, snoring,
apnea, restless sleep, HTN, CAD, CHF, a-fib, stroke, DM, depression, anxiety, insomnia
PMH: HTN, HF, DM, a-fib, stroke, dep/anx, insomnia
assess: obesity, enlarged neck, narrow airway (tongue, tonsil enlargement),
small/recessed jaw
Dx: sleep study
,✔✔STOP-bang OSA - ✔✔**
Snoring
Tired
Observed apneas
Pressure (HTN)
BMI >35
Age >50
Neck >15.7 in
Gender = male
1 pt for each
>=5 HIGH risk OSA
3-4 intermediate risk
✔✔Chronic OSA therapy goals - ✔✔dilate/stabilize airway
-CPAP/BiPAP
-dental appliance
-surg intervention
Assess adherence!!
weight loss and substance avoidance encouraged
✔✔inpatient management OSA - ✔✔continuous pulse ox- esp w sleep/sedation/narcs
maintain/initiate PAP therapy - encourage patients to bring their own. use with ALL
sleep.
use home settings
uncomplicated: continue CPAP
complicated: (also has COPD, HF, obesity, neuromuscular disease) use NIMV/BiPAP
✔✔I SNORED OSA - ✔✔Insomnia
snoring
nocturnal awakenings
obesity
restorative sleep/refreshing sleep
excessive daytime somnolence
driving problems
✔✔Pneumonia - ✔✔inflammatory response in lung caused by microorganism infection.
CAP
HCAP (HAP, VAP)
aspiration
atypical (legionella, mycoplasma)
, Viral (influ, SARS, RSV)
Fungal (pneumocycstits jiroveci)
bronchial involvement: walls of bronchioles. diffuse, patchy, can involve multiple lobes.
Lobar: involves larger, continuous are of lung lobe. larger distribution and more focal
consolidation.
✔✔PNA sx - ✔✔cough, sputum, fever, chills, sweats, rigors
acute presentation, dyspnea, chest discomfort, scant hemoptysis, malaise, fatigue, HA,
abd pain
✔✔PNA assessment and PE - ✔✔Assess: travel, sick contacts, immunization, smoking,
comorbidities (immunocompromised, pulm dx), recent tx
PE: cough, lung consolidation, dull to perucssion, increased lung sounds over
consolidated areas, crackles/rhonchi/wheezing, increased temp/RR/HR, decrease
BP/SpO2
severe: cyanosis, respiratory destress.
✔✔PNA- older adults - ✔✔confusion, drowsiness, fatigue, HA, falls, functional decline,
nausea, loss of appetite
✔✔PNA- testing - ✔✔microorganism: Sputum gram stain, antigen assays, influenza
rapid testing, multiplex PCR
*Do before initiation of abx!
blood testing: to assess PNA severity, leukocytosis, chem panels, HIV testing, Blood
cultures, procalcitonin (raised with bacterial!), ABG
Radiographic: CXR 2 view (more difinitive dx, may be normal early on, monitor for
progression, clear after 6 weeks), CT (not often used), thora (diagnostic), Broch
(accurate dx, sputum collected)
✔✔PNA- DDx - ✔✔bronchitis exacerbation
PE
Neoplasm
Pulm Edema
✔✔CURB-65 - ✔✔Confusion
BUN >19
RR >30
Hypotension <90/60
Age 65
2+ = admit
