Exam practice questions long answer - set 1 Flashcards
What is the underlying pathophysiology of pneumonia?
An infectious microorganism reaches the alveoli, macrophages become overwhelmed and they signal neutrophils, the neutrophils will engulf the alveoli producing a fibrin rich exudate. This exudate fills infected and neighbouring alveoli causing alveoli to stick together and decrease ventilation. The oedema in the alveoli also increase diffusion distance for gases, impairing gas exchange.
The nurse undertakes the essential assessments of cultural and spiritual needs, family support, falls risk, smoking history, braden scale, and then records vital signs. This patient has pneumonia.
Identify 3 other priority nursing assessments that are specific to your patient during this acute stage and give your rationale.
Assess the patient’s airway through seeing if they are able to speak full sentences, and while doing so watching for WOB and use of accessory muscles
Posterior chest assessment, assessing for dullness on percussion of the lung fields (indicating lung consolidation)
Posterior chest assessment, assessing for bronchial breath sounds on auscultation (Can indicate consolidation)
Based on the following nursing assessments for a patient with pneumonia: Assess patients airway, Posterior chest (percussion), Posterior chest (auscultation)
list 3 priority nursing interventions during the acute phase and provide the rationale for each.
Teach the huff coughing technique to mobilize secretions and expand their lungs to promote ventilation and perfusion.
Encourage fluid intake of 2-3L to thin secretions in the airways and alveoli to aid in the removal of secretions and promote effective gas exchange
Positioning - place the pt in the high fowler’s position as this aids in lung expansion and coughing up of secretions.
For a pt that has pneumonia and has an improved condition what would be two assessments the nurse would perform and what would they expect to find that indicates that their interventions have been effective.
Posterior chest assessment, resonance over the lung fields during percussion
Posterior chest assessment, mostly vesicular sounds heard over the lung fields without adventitious sounds during ascultation
Patient 2, who is Maori, is admitted with a myocardial infarction
State 5 important points that the cardiac rehabilitation nurse would provide education on prior to discharge.
Keep diet low in sodium and reduce fluids to 2L and under
Reduce alcohol, cholesterol and caffeine intake
Reduce levels of stress
Exercise regularly
Smoking cessation
Patient 2, who is Maori, is admitted with a myocardial infarction
The patient tells you that they are upset that the pillow reserved for their head was places on their chair. Discuss the actions you would take to ensure that tikanga is observed.
I would apologise that this occurred and ensure the pillows for this patients head were a blue colour to indicate these were for the head and and inform other staff to please keep these pillows at the top of the bed only to ensure the head is respected. Use white pillows for the body. As per tikanga policy
Patient 4, develops pain and swelling in their L) leg. An ultrasound scan confirms a deep vein thrombosis (DVT).
Please outline the aetiology and pathophysiological process that has most likely occurred in the formation of their DVT
DVT’s are caused by 3 main factors described as Virchows triad. These are stasis of blood flow, hyper coagulability, Endothelial injury. You can be more predisposed to these 3 factors if you are older, pregnant, or have had a long period of immobility.
A DVT is a formation of a clot in the deep veins. It is a type of VTE (venous thrombo embolism), blood stasis leads to the formation of a DVT as blood in the peripheral veins will start to clot together due to lack of mobility, hypercoagubility will increase hemostasis of blood in the peripheral veins increasing blood clotting and endothelial damage will causing blood clotting in order to ‘heal’ the damage. This is a result of the platelets in the blood and exacerbated by WBC’s.
You are allocated Patient 5 who was admitted with a spinal fracture at the level of the first thoracic vertebrae (T1) the nurse notices a kink in the patients indwelling catheter
Briefly explain the life-threatening complication that could occur from this, and list the clinical manifestations of this complication that is unique to spinal patients.
This can lead to autonomic dysreflexia as the kinked indwelling catheter can cause bladder distension causing a stimulus in the lower body that the body overreacts to. This will cause symptoms such as HTN, a pale, cool and clammy tone to the lower skin, and flushed upper skin, nausea and vomiting, headache, pupil constriction, and bradycardia. This is unique to spinal patients, particularly those with a spinal injury at T6 or above.
Name three medication commonly used in management of chest pain and their classes and actions
GTN to relax smooth muscle, and dilate veins and arteries
Morphine (analgesia) to depress the CNS hence reduce pain and promote vasodilation
Aspirin (antiplatelet) to impede clotting
Explain the role of statins in acute chest pain management
Statins work to decrease total cholesterol levels which is a risk factor for atherosclerosis. Statins also slow down the progression of disease so they can help delay symptoms such as angina (chest discomfort or breathlessness)
List the three key medication classes in the management of heart failure and give examples of these
Ace inhibitors to promote vasodilation and diuresis by decreasing afterload and preload hence decreasing workload of the heart
Beta blockers to slow conduction (HR) and lessen the force of contraction to reduce myocardial workload
Diuretics to provide relief of clinical symptoms of fluid overload.
What is CAD?
Coronary artery disease (CAD), also called ischaemic heart disease, happens when the major blood vessels in the heart get narrow and stiff. It can cause myocardial infarction and angina.
What is rheumatic fever?
Rheumatic fever starts with a sore throat that is known as ‘strep throat’ – a throat infection caused by a bacteria called Group A Streptococcus.
This is an autoimmune disease. It happens when your immune system makes a mistake and attacks other parts of your body, as well as the strep throat germs.
This can cause inflammation and oedema in the heart, joints (elbows and knees), brain and skin
Identify signs and symptoms of a person experiencing an arrythmia
Anxiety.
Fatigue.
Lightheadedness or dizziness.
Sweating.
Fainting (syncope) or near fainting.
Monro-Kellie hypothesis states…
that the sum of volumes of brain, CSF, and intracranial blood is constant. An increase in one should cause a decrease in one or both of the remaining two.
