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PN 4006 Questions and Answers
Where is the aortic landmark for auscultation? Right 2nd intercostal space Where is the pulmonic landmark for auscultation? left 2nd intercostal space Where is the erb's points landmark for auscultation? left 3rd intercostal space Where is the tricuspid landmark for auscultation? lower left sternal border, 4th intercostal space (in line with nipple) Where is the mitral landmark for auscultation? left 5th intercostal space medial to midclavicular line Where is "lub" and "dub" heard loudest? mitral area What is included in the assessment of peripheral perfusion? (CWMS) Pallor Mottling Cyanosis Capillary refill Skin temperature Respiratory rate and 02 sats Finger clubbing Colour of mucous membrane
Edema Tactile fremitus Crackles are caused by? the flow of air through liquid, present in the air pouches and smaller airways in the lungs. Where are crackles found? Fluid that is found in the lower lobes Where is wheezing heard? upper airway What is rhonchi? low-pitched, musical, snoring, adventitious lung sound caused by airflow obstruction from secretions Stridor is caused by narrowing or obstruction of the upper airway What are vesicular breath sounds? Vesicular breath sounds are soft low-ptiched sounds are are heard in the remainder of the lungs vesicular breathing sounds are caused by? air filling the alveolar sacs and resembles the sound of a muffled breeze Crackles can indicate what? Crackles are often associated with inflammation or infection of the small bronchi, bronchioles, and alveoli. Crackles that do not clear after a cough may indicatepulmonary edema or fluid in the alveoli due to heart failure, pulmonary fibrosis, or acute respiratory distress syndrome. What do wheezing lung sounds indicate?
central cyanosis causes? advanced lung disease, congenital heart disease, and hemoglobinopathies Central cyanosis occurs when? the level of deoxygenated hemoglobin in the arteries is below 5 g/dL with oxygen saturation below 85%. The bluish hue is generally seen over the entire body surface and visible mucosa. Signs and symptoms of central cyanosis? bluish discolouration, specially noticed on the mucous membranes of the lips, tongue, fingers and toes Poor skin turgor can be caused by? Vomiting Diarrhea Heat exhaustion Fever Diabetes Weight loss What is pathophysiology of clubbing of the nails? the result of low oxygen in the blood and could be a sign of various types of lung disease. Nail clubbing is also associated with inflammatory bowel disease, cardiovascular disease, liver disease and AIDS. Signs and symptoms of finger clubbing? The nail beds soften. The nails may seem to "float" instead of being firmly attached. The nails form a sharper angle with the cuticle. The last part of the finger may appear large or bulging The nail curves downward so it looks like the round part of an upside-down spoon how to don PPE?
Hand hygiene, gown, mask, goggles and gloves How to doff PPE? gloves, gown, goggles, mask Out of these types of tablet, which can be crushed? capsule, scored tablet, enteric coated or buccal tab? Scored tablets why are enteric coated tablets used The coating is designed to hold the tablet together in the stomach and may be there to protect the stomach from the medicine, protect the medicine from the acid in the stomach or to release the medicine after the stomach e.g. in the intestine Patient teaching on controlled coughing includes? Brace oneself, 2 feet on the floor, leaning forward, avoid breathing in quickly and deeply through your mouth after coughing. Managing pneumonia can be done by? Pushing IV fluids, antibiotics, o2, lay on side of unaffected lungs and teach about the medications they are taking. What are normal Pa02 levels? 75 - 100 mmHg. What are normal PaC02 levels? 38 - 42 mmHg. Normal pH of blood 7.35-7. What are normal values of Sa02?
Check dr orders, integrity, expiration date, maintain sterility, waist length, don't go below. Chicken arms, don't turn back to sterile field. If you are performing wound care and the patient dehiscences, what are you gonna do? apply a saturate gauze with saline and call the dr If there are holes in your sterile field, what do you do? Get a new sterile field If you forget an item during a sterile procedure, what can you do? Ask a colleague to grab it and drop it into the sterile field Signs and symptoms of infiltration of an IV? cold, swollen, tender, painful What do you do when you see infiltration? Stop the iv infusion, elevate, warm compress, start a new site Phlebitis s/s Redness at site Site warm to touch Local swelling Palpable cord along vein Wha to do you if you see phlebitis? compress, antibiotics, take out iv and start a new site Extravasation Treatment Stop infusion, notify MD, administer antidote if indicated. Elevate, infection control, wound care Extravasation s/s pain and/or burning at venipuncture site progressing erythema abd edema
formation of blisters Tissue sloughing --usually apparent at 1 to 4 weeks --result of tissue necrosis Tissue Necrosis --can involve small or large area --can involve underlying connective tissues If you see a leaking IV, what can you do? See if the hub is on correctly, if it is, it's probably a faulty. start a new line Hypervolemia S/S S&S Include: bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, w/ a urine specific gravity < 1. What should you do with a hypervolemic pt? Stop IV, notify dr, diuretics, elevate the bed and supply o2. What is insensible fluid loss? The amount of fluid lost on a daily basis from the lungs, skin, respiratory tract, and water excreted in the feces. The exact amount cannot be measured, but it is estimated to be between 40 and 900 mL in an adult under normal circumstances. What is sensible water loss? perceived by the individual e.i. excess perspiration, vomiting, urinating What would happen to a patient who has heart failure and hypervolemia? (vitals) and what actions would you take?
This rapid conduction allows coordinated ventricular contraction (ventricular systole) and blood is moved from the right and left ventriclesto the pulmonary artery and aorta respectively. What is lordosis? Swayback in the lumbar region (Lumbar, Lordosis). and it may be associated with spondylolisthesis, inflammation of the intervertebral disk, or obesity. What is scoliosis? abnormal lateral curvature of the spine. The vertebral abnormalities cause curvature and other deformities of the spine because one area of the spinal column lengthens at a slower rate than the rest. What is spinal stenosis? narrowing of the lumbar or cervical spinal canal, leading to compression of the nerve roots. With aging, the intervertebral disk degenerates and collapses, leading to spur formation. This most commonly occurs at C5-6 and C6- 7 What is spinal fusion? Spinal fusion is a surgical procedure used to stabilize and immobilize the spinal column. It is essentially a "welding" process. The basic idea is to fuse together two or more vertebrae so that they heal into a single, solid bone. What is the pathophysiology of lupus? Lupus results from a breakdown of the normal disease-fighting function of the immune system. Instead of producing antibodies that attack infectious organisms, the body produces antibodies—called autoantibodies—that react with components of the body's own tissues s/s of lupus
- butterfly rash (dry, scaly rash on face/upper body)
- joint pain & dec ROM
- fever
- nephritis
- pleural effusion
- pericarditis
- abd pain
- photosensitivity What is the pathophysiology of gout? Overproduction or underexcretion of uric acid --> deposits urate crystals in tissues & synovial fluid --> monoarticular joint inflammation & arthritis s/s of gout Severe pain in a peripheral joint, often great toe Swelling of joint, redness Trophi in lower extremities (small, white nodules visible through the skin) Renal stones Pathophysiology of rheumatoid arthritis? Although the pathophysiology of RA is not completely understood, the process generally involves dysregulated inflammation, with antigen presentation, T-cell activation, and autoantibody production all serving as mediators in the inflammatory process. s/s of rheumatoid arthritis s/s similar to osteoarthritis, synovial fluid will be very different, presence of rheumatoid factors (RF tests), elevated ESR (erythrocyte sedimentation rate), joint fluid presents with inflammatory exudate, nodules (necrotic areas) on the bones Pathophysiology of osteoporosis? Bone resorption exceeds formation. Results in loss of compact bone Diagnosed with bone density scans
Elevate your legs above the level of your heart. Elevate your legs when you sit or lie down, as often as you can. This will help decrease swelling and pain. Wound assessment includes? Colour, odour, consistency, amount? Not the type of wound, location, area, exudate, pain, dimensions and tissue Drain insertion site assessment includes? Assess chest tube insertion site to ensure sterile dressing is dry and intact. Check insertion site for subcutaneous emphysema. Dressing should remain dry and intact; no drainage holes should be visible in the chest tube. Dressing is generally changed 24 hours post-insertion, then every 48 hours When removing sutures, where do you cut? Distal to the knot When removing staples, how do you know how many to remove? Drs order When removing sutures, in what order do you remove them and apply sterile strips? Every other suture, put on steri strips, remove rest of the other sutures then apply the rest of the steri strips. Who debrides with a scalpel and why? Dr will shave away for better wound healing? What is wound debridement? removal of dirt, foreign objects, damaged tissue and cellular debris What is a stage 1 pressure ulcer? Skin intact, red, non-blanching, warm, painful
What is a stage 2 pressure ulcer? Skin is not intact, loss of the dermis occurs, pink/red, open wound, shallow. partial thickness skin loss What is a stage 3 pressure ulcer? Full thickness skin loss, extends into the dermis and subcutaneous tissue. Slough and tunneling may be present What is a stage 4 pressure ulcer?
. Full thickness skin loss, exposed bone, tendon, or muscle, slough or eschar, and tunneling What stages of pressure ulcers can LPNs work on? 1 and 2 Treatment for stage 1 pressure ulcer? he first step to treating an ulcer in this stage is to remove pressure from the area. Any added or excess pressure can cause the ulcer to break through the skin surface. If you are lying down, adjust your position or use pillows and blankets as extra padding It's also important to keep the affected area clean and dry to reduce tissue damage. Stay well hydrated, and add foods high in calcium, protein, and iron to your diet. These foods help with skin health.If treated early, developing ulcers in stage one can heal in about three days. Treatment for stage 2 pressure ulcers? treat stage 2 sores by removing pressure from the wound. Clean the sore with water or a mild, sterile saltwater solution to dry out the wound. You may experience some pain or stinging. Treatment for a stage 3 pressure ulcer? doctor may prescribe antibiotic therapy and remove any dead tissue to promote healing and to prevent or treat infection. Treatment for stage 4 pressure ulcer?
What is the Braden Scale? an evidence-based tool that looks at various factors that put patients at risk for developing a pressure ulcer. Includes: sensory perception moisture activity mobility nutrition friction shear What numerical value do you want your Braden scale to have for a pt? above 15 Where can you collect your ABG'S? Blood gas samples are obtained through an arterial puncture at the radial, brachial, or femoral artery. A client may also have an an indwelling arterial catheter which can also be used to collect samples. What is sanguineous drainage? Bright red; indicates active bleeding What is serous drainage? clear, watery plasma What is serosanguineous drainage? Pale, pink, watery; mixture of clear and red fluid What is purulent drainage? thick, yellow, green, tan, or brown
How do you irrigate a wound? Gently instill a slow, steady stream of irrigating solution into the wound until the syringe empties. Make sure the solution flows from the clean tissue to the dirty area of the wound to prevent contamination of clean tissue by exudate. Be sure the solution reaches all areas of the wound
