NUR 265 EXAM 2 STUDY GUIDE LATEST UPDATE |Galen College of Nursing

Lungs Physiology ● 2 Pleural, 1 attached to outside of lungs and 1 attached to inside of ribs. ● Space between the 2 pleural is negative to atmosphere ● When inhale becomes more positive and atmosphere more negative. Exhaling is passive ● Most of lower lobes are posterior, must listen to lungs posteriorly ● Breath sounds o Bronchial: High pitched & loud, normal in tracheal & larynx o Bronchovesicular: Moderate pitched & amplitude, normal over major bronchi o Vesicular: Low pitched & soft, like wind through trees, normal in lower lung fields where smaller bronchioles & alveoli are. Pulmonary Emboli (P 603) ● Occlusion of portion of pulmonary artery by a blood clot – from venous circulation – lower extremities or heart. ● Causes ventilation-perfusion mismatch (V/Q) – Ventilated alveoli no longer perfused due to clotted artery. ● Risk Factors o Venous stasis (w/prolonged immobility); Central venous catheters; Surgery (NPO, dehydrated, immobilized pts); Obesity; Advanced age; Hypercoagulability (Platelets 400K and not enough fluids; sticky blood); Hx of thromboembolism. o Greatest r/f in the young is the combo of smoking and hormone based contraceptives. ● Nursing Assessment Findings o Respiratory Classic Manifestations (Hypoxia drives all s/s) ▪ Dyspnea (sudden onset); Chest pain (sharp & stabbing); Apprehension, restlessness; Feeling of impending doom; Cough; Hemoptysis (blood in sputum). o Respiratory Signs ▪ Pleural friction rub (scratching sounds from pleura rubbing together & pain on deep inspiration); Tachypnea; Crackles (or normal); S3 or S4; Diaphoresis; Low grade fever; Petechiae over chest and axillae; Decreased arterial oxygen saturation (SaO2) o Many pts w/ a PE do not have “classic” sx (i.e. hypoxia), but instead have vague sx resembling the flu (n/v & general malaise) o Cardiac Manifestations ▪ Decreased tissue perfusion: tachycardia, JVD, Syncope (loss of consciousness), Cyanosis, & Hypotension. o In patients with r/f for PE, JVD (RSHF), syncope (decreased blood flow to brain), cyanosis (severe hypoxia) and hypotension together, NEED RAPID RESPONSE TEAM CALLED. HAVE HELP ON WAY B4 O2 APPLIED o When pt has sudden onset of dyspnea, chest pain, and/or hypotension, immediately notify Rapid Response Team. Reassure pt. and elevate HOB. Prepare for O2 therapy and ABG analysis o Saddle Emboli – Embolism at split of pulmonary artery that blocks both branches to the lungs ● Medical Dx o Chest X-ray – May show PE if large but will help r/o other things o CT scan – Most often used to dx PE o TEE (Transesophageal Echocardiography) – See if there are clots in the atria o Ventilation Perfusion scan (V/Q) ▪ Considered if pt is allergic to contrast dye done w/CT scan ▪ Radioactive substance to see if air is getting into the alveoli; injected into blood to look at clot and can also detect pneumothorax. Done 2x o ABGs▪ Respiratory Alkalosis FIRST from hyperventilation ▪ THEN Respiratory Acidosis from shunting ● Shunting of blood from the right side of the heart to the left side w/o picking up O2 from lungs – causes PaCO2 level to rise resulting in respiratory acidosis. ▪ LATER Metabolic Acidosis & lactic acid buildup from tissue hypoxia