MDC 4 Exam 2 NUR2755: Latest Update 2023 with Answers Multidimensional Care IV

Pulmonary embolism - ANSWER Collection of particulate matter (solids, liquid or air) entering the venous system and lodges in pulm. vessels Can obstruct blood flow resulting in reduced gas exchange, reduced oxygenation, lung tissue hypoxia, decreased perfusion, and death Fat emboli - ANSWER Occurs with a fracture of femur. Does not impede blood flow but injures blood vessels and causes ARDS. Nursing intervention for fat emboli - ANSWER Immobilize injury to prevent from dislodging PE s/s - ANSWER Dyspnea, tachypnea, tachycardia, sudden pleuritic chest pain, dry cough, hemoptysis, distended neck veins, syncope, cyanosis, hypotension, abnormal heart sounds, abnormal ECG, sense of impending doom PE ABGs - ANSWER Resp. alkalosis initially due to anxiety, and then resp. acidosis PaO2 low, PaCO2 high PE imaging - ANSWER CT or pulmonary angiography PE nursing interventions - ANSWER High-fowlers, assess for bleeding, anticoagulants, BP compared on R and L arm, assess lung sounds PE drug therapy and surgical management - ANSWER Anticoagulants, fibrinolytics Embolectomy, inferior vena cava filtration Acute respiratory failure (ARF) - ANSWER inadequate gas exchange Types of ARF - ANSWER Ventilator failure, oxygenation failure (gas exchange), or both ARF ABGs - ANSWER PaO2 60 PaCO2 45 pH 7.35 SaO2 90% ARF - ventilatory failure definition - ANSWER Air movement/intake is inadequate resulting in too little oxygen to the alveoli resulting in CO2 retention and hypoxemia ARF - ventilatory failure causes - ANSWER COPD, ARDS, PE, stroke, opioid use, sleep apnea, high cervical spinal cord injury, Guillain Barre, physical problems of lung or chest wall, defect in respiratory control center of the brain, poor function of respiratory muscles ARF - oxygenation failure definition - ANSWER Air moves in and out without difficulty, but does not oxygenate the blood sufficietly (no exchange at the alveoli) ARF - oxygenation failure causes - ANSWER Breathing air with low oxygen level, abnormal Hgb, pneumonia, CHF with pulmonary edema, ARDS, hypovolemic shock ARF s/s - ANSWER Dyspnea, orthopnea, change in resp rate/pattern, changes in lung sounds, decreased O2 saturation, acidosis per ABGs, elevated PaCO2 levels, restlessness, irritability, confusion, tachycardia, decreased LOC, headache, drowsiness ARF meds - ANSWER Nebulizers, inhalers, corticosteroids, diuretics, antibiotics (if infection) ARF nursing interventions - ANSWER Assist to comfortable position (upright if possible), relaxation, guided imagery, conserve energy, encourage deep breathing, IS ARDS - ANSWER ARF symptoms with hypoxia (even when given 100% oxygen), decreased lung elasticity, dyspnea, bilateral non-cardiac pulmonary edema, dense pulmonary infiltrates Poor surfactant in alveoli ARDS causes - ANSWER Post acute lung injury in people with no pulmonary disease as a result of sepsis, burns, pancreatitis, trauma, and transfusions Acute lung injury - ANSWER an umbrella term for hypoxemic respiratory failure; acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury Surfactant production is impaired Acute lung injury causes - ANSWER Shock, trauma, pancreatitis, fat emboli, pneumonia, sepsis, inhalation of toxic gases, aspiration, ASA, opioids, heroin, drowning Acute lung injury s/s - ANSWER Noisy respirations, cyanosis, pallor, retractions, lung sounds initially clear, then results in crackles due to fluid build up, hypotension, tachycardia, dysrhythmias, elevated temp ARDS nursing interventions - ANSWER Intubation/mechanical ventilation (PEEP high - monitor for tension pneumothorax) Positioning: prone to promote lung drainage Increase nutrition to prevent difficulties weaning from vent