NU 155 EXAM 2 TESTED QUESTIONS AND COMPLETE
SOLUTIONS
◉ vesicular breath sounds
Answer: -heard in the 6th intercostal space over lung tissue
-sounds low medium pitched, soft whooshing 2-3x length of expiration
◉ Bronchovescular breath sounds
Answer: -heard main-stem bronchi, below clavicles, beside sternum, posteriorly, between scapulae
-sounds like moderate high pitches hollow muffled
equal sounds on inspiration and expiration
◉ Bronchial breath sounds
,Answer: -heard over trachea above sternal notch (often indicate atelectasis)
-sounds high pitched, loud harsh tubular quality, inspiration half as long as expiration
◉ COPD (chronic obstructive pulmonary disease): (PATHO, Dx, S/S, N/I, pt. teaching)
Answer: -combo of *chronic bronchitis, asthma, and emphysema*
-caused by: *tobacco smoke (90%)*, occupational hazards like farming, biomass fuels, firefighters
-*Dx*: chest X-ray, EKG, labs like high hematocrit, ABG
-*S/S*: dyspnea, barrel chest, polycythemia (high RBC), hypercapnia (high CO2), coughing up in the
morning
-*N/I* titrate o2 to 92%, bronchodilators, hydrate uncaffeinated liquids
-teach pt: avoid over eating, smaller bites, increase fluid and calcium, adequate protein, rest before
eating and meds, and avoid lying down after
◉ Thyroid Storm (thyroid crisis)
Answer: -*causes*: drugs or dyes with iodine, pregnancy/child birth, M.I. or cardiac emergencies,
severe emotional distress, trauma, surgery, levothyroxine overdose
, -*s/s*: 106ºF +, 200bpm, high b/p, tachypnea, HTN, restlessness, agitation, confusion, if *untreated*
delirium to coma to heart failure to death
-*Tx*: MUST begin as soon as symptoms occur!, reduce temp. slow HR, sedatives, increase fluid avoid
dehydration
◉ DKA -VS- HHS
Answer: +DKA (Type 1): hyperglycemic crisis associated with elevated ketones!
+HHS (Type 2): hyperglycemic crisis without association of ketones!
-*DKA:* BS >300mg/dL *HHS:* BS > 600mg/dL
*DKA* Ketonuria
-*HHS* Older adults at higher risk, and higher mortality r/t severe dehydration and extreme
hyperglycemia (than DKA)
-*DKA:* N/V, abdominal pain, rigidity *HHS:* NO GI NO KETOACIDOSIS
-*DKA:* Kussmaul breathing *HHS:* Seizures
-*DKA:* Acetone (fruit) breath *HHS:* Confusion
-*DKA:* Stupor or coma (late) *HHS:* Coma
SOLUTIONS
◉ vesicular breath sounds
Answer: -heard in the 6th intercostal space over lung tissue
-sounds low medium pitched, soft whooshing 2-3x length of expiration
◉ Bronchovescular breath sounds
Answer: -heard main-stem bronchi, below clavicles, beside sternum, posteriorly, between scapulae
-sounds like moderate high pitches hollow muffled
equal sounds on inspiration and expiration
◉ Bronchial breath sounds
,Answer: -heard over trachea above sternal notch (often indicate atelectasis)
-sounds high pitched, loud harsh tubular quality, inspiration half as long as expiration
◉ COPD (chronic obstructive pulmonary disease): (PATHO, Dx, S/S, N/I, pt. teaching)
Answer: -combo of *chronic bronchitis, asthma, and emphysema*
-caused by: *tobacco smoke (90%)*, occupational hazards like farming, biomass fuels, firefighters
-*Dx*: chest X-ray, EKG, labs like high hematocrit, ABG
-*S/S*: dyspnea, barrel chest, polycythemia (high RBC), hypercapnia (high CO2), coughing up in the
morning
-*N/I* titrate o2 to 92%, bronchodilators, hydrate uncaffeinated liquids
-teach pt: avoid over eating, smaller bites, increase fluid and calcium, adequate protein, rest before
eating and meds, and avoid lying down after
◉ Thyroid Storm (thyroid crisis)
Answer: -*causes*: drugs or dyes with iodine, pregnancy/child birth, M.I. or cardiac emergencies,
severe emotional distress, trauma, surgery, levothyroxine overdose
, -*s/s*: 106ºF +, 200bpm, high b/p, tachypnea, HTN, restlessness, agitation, confusion, if *untreated*
delirium to coma to heart failure to death
-*Tx*: MUST begin as soon as symptoms occur!, reduce temp. slow HR, sedatives, increase fluid avoid
dehydration
◉ DKA -VS- HHS
Answer: +DKA (Type 1): hyperglycemic crisis associated with elevated ketones!
+HHS (Type 2): hyperglycemic crisis without association of ketones!
-*DKA:* BS >300mg/dL *HHS:* BS > 600mg/dL
*DKA* Ketonuria
-*HHS* Older adults at higher risk, and higher mortality r/t severe dehydration and extreme
hyperglycemia (than DKA)
-*DKA:* N/V, abdominal pain, rigidity *HHS:* NO GI NO KETOACIDOSIS
-*DKA:* Kussmaul breathing *HHS:* Seizures
-*DKA:* Acetone (fruit) breath *HHS:* Confusion
-*DKA:* Stupor or coma (late) *HHS:* Coma
