Exam 2 - Pulmonary Edema and Ulcers

Question 1

Priority in treatment of pulmonary edema

Answer 1

Reduce fluid volume overload

Question 2

How do you reduce fluid volume overload in pulmonary edema pts?

Answer 2

Administer Lasix (usually IV push)
Administer morphine (anxiety)

Question 3

What are other treatments for pulmonary edema?

Answer 3

Improve ventricular function (may be given beta blocker)

Increase respiratory exchange

Question 4

Nursing care for pts with pulmonary edema

Answer 4

Positioning - elevate HOB, administer oxygen, lower legs over side of bed
Psychological support
Monitor meds

Question 5

Where are venous ulcers usually located?

Answer 5

Gaiter area - medial malleolus; infrequently later malleolus or anterior tibial area

Question 6

Pain with venous ulcers?

Answer 6

Minimal pain if superficial, may be very painful

“Achy” pain

Question 7

Depth of venous ulcers

Answer 7

Superficial

Question 8

Shape of venous ulcers

Answer 8

Irregular borders

Question 9

What does a venous ulcer look like?

Answer 9

Granulation tissue - beefy red to yellow fibrinous in chronic, long-term ulcer
Skin of lower leg is leathery with brawny appearance

Question 10

leg edema with venous ulcers

Answer 10

Moderate to severe; persistent for prolonged time

Question 11

What else is present with venous ulcers?

Answer 11

Eczema with pruritis
Lg amount of exudate
Slough

Question 12

Usual locations of arterial ulcers

Answer 12

Tip of toes
Toe webs
Heel or other pressure areas if confined to heel

Question 13

Pain with arterial ulcers

Answer 13

Very painful
Intermittent claudication
Rest pain of digits/forefoot
Unrelenting pain

Question 14

Depth of arterial ulcer

Answer 14

Deep, often involving joint space

Question 15

Shape of arterial ulcer

Answer 15

Circular, small

Question 16

Arterial ulcer appearance

Answer 16

Pale to black, dry gangrene

Little exudate, slough and necrotic tissue

Question 17

Edema with arterial ulcer

Answer 17

Minimal, unless extremity kept in dependent position constantly to relieve pain

Question 18

Expected treatment for venous ulcers

Answer 18

Compression
Moist dressings (as long as not infected)

Question 19

What is NOT indicated for venous ulcers?

Answer 19

prophylactic antibiotic therapy

Question 20

Expected treatment for arterial ulcers?

Answer 20

Restore circulation to area by interventional radiology, balloon angioplasty, place a stent, bypass graft (in severe cases)

Question 21

Other treatments for ulcers

Answer 21

Culture and antibiotic therapy for active infection
Amputation if gangrene
Debridement
Calcium alginate dressings - change when would starts to seep out or every 7 days
Foam dressings
Keep wound area clean
Stimulated healing
Hyperbaric oxygenation
Negative pressure wound therapy

Question 22

Nursing considerations for compression treatment of ulcers

Answer 22

It is important to assess arterial status to assure that co-existing arterial disease is not present. If there is bad arterial supply and compression is tried, necrosis can occur!

Question 23

Nursing interventions for pts with ulcers

Answer 23

Nutrition - balanced diet with adequate protein, calories, and micronutrients
Weight reduction
Smoking cessation
Exercise - daily walking program when ulcer is healed

Question 24

Pt teaching for ulcers

Answer 24

Avoid sitting or standing with feet dependent for prolonged periods of time
Do not elevate arterial ulcers
Prescription compression stockings should be worn daily and replaced q 4-6 months to decrease incidence of chronic venous insufficiency
Venous dermatitis could result from contact with sensitizing products (i.e. gentamyacin, bandages, adhesives, ointments with lanolin, parabens, alchol, benzocaine, or balsam of Peru, and OTC creams with fragrances and preservatives)