NURS 4000 FINAL EXAM WITH COMPLETE
SOLUTIONS
Cystic Fibrosis Patho
Genetic disease causing thick, sticky secretions
Cystic Fibrosis respiratory s/s
-persistent productive cough with phlegm
-wheezing, SOB, frequent lung infections/pneumonia
-Barrel chest, clubbing, accessory muscle use
Cystic Fibrosis GI s/s
-Very salty skin
-poor growth/weight gain with normal appetite
-abdominal pain, constipation, steatorrhea
Cystic Fibrosis Diagnostic
Sweat chloride test- GOLD STANDARD (60 mEq/L=abnormal)
-newborn screening
-electrolytes, vitamin levels
Cystic Fibrosis Nursing Focus
-Airway clearance/ gas exchange- bronchodilators, mucolytics, hypertonic saline, pulmonary
hygiene, huff coughing, postural drainage
-Nutrition- high calorie, pancreatic enzymes, fat-soluble vitamins
-Infection- immunizations, promp antibiotics
,Lung Cancer s/s
-Chronic cough or change in chronic cough
-Wheezing, SOB
-Rust colored or blood-streaked sputum (hemoptysis)
-Pain (chest, bone, head)
-Hoarseness, dysphagia
-Recurring pleural effusions, pneumonia, bronchitis
-Weight loss, anorexia, fatigue
Lung Cancer Diagnostics:
Chest X-ray, CT, PFT, sputum cytology, bronchoscopy
Lung Cancer Nursing Focus
-Airway clearance, breathing, activity tolerance, pain management, addressing anticipatory
grieving
-Know chemo, radiation, surgery, and palliative care roles
Pulmonary Embolism Patho
Clot in pulmonary artery --> V/Q mismatch --> impaired gas exchange, hypoxemia, pulmonary
HTN
Pulmonary Embolism Risk Factors
Stasis: immobility, surgery, long travel
Vessel damage: trauma, surgery
,Hypercoagulability: clotting disorders, pregnancy, OCPs, smoking, obesity
History of DVT
Pulmonary Embolism S/S
-Dyspnea, chest pain
-Tachypnea, tachycardia
-Anxiety, sense of impending doom
-Crackles, diaphoresis, low grade fever, hemoptysis
-Progression: distended neck veins, cyanosis, hypotension, shock
Pulmonary Embolism Diagnostics
-CT chest with contract, V/Q scan, pulmonary angiogram
-D-dimer, coagulation studies (PT/INR, PTT, platelets)
-ECG and ABGs
Pulmonary Embolism Nursing Focus
-High fowlers, O2, frequent VS, focused respiratory and perfusion assessment
-IV access and fluids
-Administer anticoagulants (heparin/enoxaparin, then warfarin or DOAC)
-Bleeding precautions, monitor coag labs
Pulmonary Embolism prevention teaching
-No smoking, weight loss, increased activity, position changes
-Adequate hydration
- Avoid estrogen- containing OCPs if high risk
, Sickle Cell Disease Patho
Genetic Hgb disorder --> sickling when O2 demand is high or supply is low --> vaso-occlusion,
hemolysis, chronic anemia
Sickle cell crisis types
-Vaso-occlusive (pain)
-Splenic sequestration
-Aplastic crisis
-Hemolytic crisis
Sickle cell s/s
-Fatigue, pallor, SOB, anemia
-Severe pain (joints, chest, back) swelling
-any signs of organ dysfunction (brain, lungs, kidneys, skin)
sickle cell crisis management
THINK HOP
-Hydration (vigorous IV fluids)
-Oxygen therapy
-Pain control (opioid analgesia)
-rest, treat triggers, prevent infection
-possible transfusion or apheresis
Sickle cell complications
-stroke, acute chest syndrome, renal insufficiency, ulcers, infection, splenic sequestrian
SOLUTIONS
Cystic Fibrosis Patho
Genetic disease causing thick, sticky secretions
Cystic Fibrosis respiratory s/s
-persistent productive cough with phlegm
-wheezing, SOB, frequent lung infections/pneumonia
-Barrel chest, clubbing, accessory muscle use
Cystic Fibrosis GI s/s
-Very salty skin
-poor growth/weight gain with normal appetite
-abdominal pain, constipation, steatorrhea
Cystic Fibrosis Diagnostic
Sweat chloride test- GOLD STANDARD (60 mEq/L=abnormal)
-newborn screening
-electrolytes, vitamin levels
Cystic Fibrosis Nursing Focus
-Airway clearance/ gas exchange- bronchodilators, mucolytics, hypertonic saline, pulmonary
hygiene, huff coughing, postural drainage
-Nutrition- high calorie, pancreatic enzymes, fat-soluble vitamins
-Infection- immunizations, promp antibiotics
,Lung Cancer s/s
-Chronic cough or change in chronic cough
-Wheezing, SOB
-Rust colored or blood-streaked sputum (hemoptysis)
-Pain (chest, bone, head)
-Hoarseness, dysphagia
-Recurring pleural effusions, pneumonia, bronchitis
-Weight loss, anorexia, fatigue
Lung Cancer Diagnostics:
Chest X-ray, CT, PFT, sputum cytology, bronchoscopy
Lung Cancer Nursing Focus
-Airway clearance, breathing, activity tolerance, pain management, addressing anticipatory
grieving
-Know chemo, radiation, surgery, and palliative care roles
Pulmonary Embolism Patho
Clot in pulmonary artery --> V/Q mismatch --> impaired gas exchange, hypoxemia, pulmonary
HTN
Pulmonary Embolism Risk Factors
Stasis: immobility, surgery, long travel
Vessel damage: trauma, surgery
,Hypercoagulability: clotting disorders, pregnancy, OCPs, smoking, obesity
History of DVT
Pulmonary Embolism S/S
-Dyspnea, chest pain
-Tachypnea, tachycardia
-Anxiety, sense of impending doom
-Crackles, diaphoresis, low grade fever, hemoptysis
-Progression: distended neck veins, cyanosis, hypotension, shock
Pulmonary Embolism Diagnostics
-CT chest with contract, V/Q scan, pulmonary angiogram
-D-dimer, coagulation studies (PT/INR, PTT, platelets)
-ECG and ABGs
Pulmonary Embolism Nursing Focus
-High fowlers, O2, frequent VS, focused respiratory and perfusion assessment
-IV access and fluids
-Administer anticoagulants (heparin/enoxaparin, then warfarin or DOAC)
-Bleeding precautions, monitor coag labs
Pulmonary Embolism prevention teaching
-No smoking, weight loss, increased activity, position changes
-Adequate hydration
- Avoid estrogen- containing OCPs if high risk
, Sickle Cell Disease Patho
Genetic Hgb disorder --> sickling when O2 demand is high or supply is low --> vaso-occlusion,
hemolysis, chronic anemia
Sickle cell crisis types
-Vaso-occlusive (pain)
-Splenic sequestration
-Aplastic crisis
-Hemolytic crisis
Sickle cell s/s
-Fatigue, pallor, SOB, anemia
-Severe pain (joints, chest, back) swelling
-any signs of organ dysfunction (brain, lungs, kidneys, skin)
sickle cell crisis management
THINK HOP
-Hydration (vigorous IV fluids)
-Oxygen therapy
-Pain control (opioid analgesia)
-rest, treat triggers, prevent infection
-possible transfusion or apheresis
Sickle cell complications
-stroke, acute chest syndrome, renal insufficiency, ulcers, infection, splenic sequestrian
