NUR 4764 Exam 2 Study Guide & Exam Blueprint Fall 2021
# Questions- 50 Total
3 Questions:
Pulmonary embolism prevention, diagnosis, care of patient
Respiratory
• Pulmonary Embolism
o Risk factors & causes
▪ DVT/PE.. Who is at risk?
• Prolonged immobilization
• Central venous catheters
• Surgery
• Obesity
• Advancing age
• Heart failure
• Hypercoagulability
• History of (VTE) thromboembolism
▪ DVT-related PE is the most common cause of preventable hospital death. Nurses should educate
themselves to consider PE in any patient at risk who experiences any acute nonspecific
cardiopulmonary complaints
• Approx. 10% of hospital deaths- PE
• Prevention:
o External Compression Devices/ Antiembolic hose?
o Compare extremities- unilateral swelling
o Measure
o Do not massage
o Elevate extremity
o Bed rest
o Administer anticoagulation medications
o Patient teaching
▪ Pulmonary Embolism (PE): any collection of particulate matter- solids, liquids, or gases- that
enters venous circulation and becomes lodged in the pulmonary vessels.
• PE clinical manifestations:
o Respiratory:
▪ Dyspnea- sudden onset
▪ Tachypnea
▪ Pleuritic chest pain
▪ Apprehension- restlessness
▪ Cough (dry)
o Cardiac:
▪ Tachycardia
▪ ECG changes
o Misc:
▪ Syncope
, ▪ Hypotension
▪ Hemoptysis
▪ Diaphoresis
▪ Fever, low grade
▪ Cyanosis
▪ May be clinically silent- no signs and symptoms, many PE cases first
detected post-mortem
o What to expect:
▪ ABG- of limited value for diagnosis
• May see low PCO2 from hyperventilation (low 30’s) respiratory
alkalosis)
• Low PO2- (50-70)
• Saturation- may show little change
▪ Spiral CTA- pulmonary arteries
▪ VQ Scan- renal disease, allergy to iodine
▪ Blood Work- D Dimer: fibrinolysis products (neg used to “rule out”)
• In more than 90% of people with a PE: a blood clot from a deep vein thrombosis (DVT)
breaks loose from one of the veins in the legs or pelvis
o Symptoms and diagnostic tests
▪ DVT: calf swelling, erythema (swelling) and leg warmth are indications that a patient may have
DVT
o VTE: Describe overlap therapy process from heparin to warfarin
▪ What is nurses role in VTE? A goal of 25% reduction of post-op complications nationwide
▪ The Joint Commission Core Measures for VTE. Prophylaxis, medication overlap, Warfarin
teaching
▪ Nurses are key in process to recognize persons at risk for VTE
Medications- PE / DVT
• Heparin- (IV) need baseline labs-platelets
o Anticoagulation to prevent the development of additional clots
o Assess for HIT (heparin induced thrombocytopenia)
o Antidote- protamine sulfate
• Lovenox- (LMWH)- (SQ) 1 mg/kg/ every 12 hr, SQ
o Preferred for prophylactic anticoagulation
• Coumadin – (PO)
o Allows for long anticoagulation in at risk patients to prevent the development of future clots
o Teach which foods are high in vitamin K (inverse relationship to INR)
o Antidote- Vitamin K
• Newer Drugs:
o dabigatran (Pradaxa)
▪ Antidote: idarucizumab (Praxbind) FDA approved 2015
o Rivaroxaban (Xarelto), Apixaban (Eliquis), Edoxaban (Savaysa)
▪ Antidote – Andexanet alpha (AndexXa) FDA approved May 2018
o Do not need to monitor “coags” PT/INR/PTT with Lovenox or newer PO drugs
• TPA (IV)
o Promotes lysis of PE (large) in hemodynamically unstable pts
o Antidote- FFP, clotting factors
, Need To Check Labs:
• Heparin Infusion:
o Partial Thromboplastin Time- (PTT) , (aPTT), (APTT)
o PTT Normal range
▪ 20- 30 seconds- some labs (30-40 seconds in others).
o Therapeutic range in the PE patient 1.5-2 times the normal control in seconds
• Coumadin:
o Prothrombin Time- (PT)
o PT Normal Range
▪ 11-12.5 seconds-
o PE treatment, 1.5-2. times the normal control in seconds
o Usually ordered along with INR levels 2-3
Prevention of PE is the Key: preventative ACTIONS are geared toward PREVENTING venous stasis
• Pre/post hospital:
o Stop smoking
o Reduce weight
o Increase physical activity
o If traveling or sitting for long periods, get up frequently and drink plenty of fluids
• Acute care setting:
o Mobility
o LMWH- Lovenox
o Pneumatic compression sleeves (SCDs)
o Perform a comprehensive assessment of peripheral circulation
o Position changes q2hr
o Discharge teaching, prophylaxis may continue at home after some surgeries
4 Questions:
Oxygen delivery & causes of hypoxemia
• Hypoxemia
o Lungs cannot transfer oxygen from alveoli to blood
o Low O2 sat indicated hypoxemia until proven otherwise
o Classifications:
▪ Normal (PaO2 rule of thumb): 80-100 33 Hg
▪ Mild hypoxemia: 60-80 mm Hg
▪ Moderate hypoxemia: 40-60 mm Hg
▪ Severe hypoxemia: <40 mm Hg
▪ This classification is based on predicted normal values for a patient who is less than 60
years old and breathing room air. For older patients, subtract 1 mm Hg for every year
# Questions- 50 Total
3 Questions:
Pulmonary embolism prevention, diagnosis, care of patient
Respiratory
• Pulmonary Embolism
o Risk factors & causes
▪ DVT/PE.. Who is at risk?
• Prolonged immobilization
• Central venous catheters
• Surgery
• Obesity
• Advancing age
• Heart failure
• Hypercoagulability
• History of (VTE) thromboembolism
▪ DVT-related PE is the most common cause of preventable hospital death. Nurses should educate
themselves to consider PE in any patient at risk who experiences any acute nonspecific
cardiopulmonary complaints
• Approx. 10% of hospital deaths- PE
• Prevention:
o External Compression Devices/ Antiembolic hose?
o Compare extremities- unilateral swelling
o Measure
o Do not massage
o Elevate extremity
o Bed rest
o Administer anticoagulation medications
o Patient teaching
▪ Pulmonary Embolism (PE): any collection of particulate matter- solids, liquids, or gases- that
enters venous circulation and becomes lodged in the pulmonary vessels.
• PE clinical manifestations:
o Respiratory:
▪ Dyspnea- sudden onset
▪ Tachypnea
▪ Pleuritic chest pain
▪ Apprehension- restlessness
▪ Cough (dry)
o Cardiac:
▪ Tachycardia
▪ ECG changes
o Misc:
▪ Syncope
, ▪ Hypotension
▪ Hemoptysis
▪ Diaphoresis
▪ Fever, low grade
▪ Cyanosis
▪ May be clinically silent- no signs and symptoms, many PE cases first
detected post-mortem
o What to expect:
▪ ABG- of limited value for diagnosis
• May see low PCO2 from hyperventilation (low 30’s) respiratory
alkalosis)
• Low PO2- (50-70)
• Saturation- may show little change
▪ Spiral CTA- pulmonary arteries
▪ VQ Scan- renal disease, allergy to iodine
▪ Blood Work- D Dimer: fibrinolysis products (neg used to “rule out”)
• In more than 90% of people with a PE: a blood clot from a deep vein thrombosis (DVT)
breaks loose from one of the veins in the legs or pelvis
o Symptoms and diagnostic tests
▪ DVT: calf swelling, erythema (swelling) and leg warmth are indications that a patient may have
DVT
o VTE: Describe overlap therapy process from heparin to warfarin
▪ What is nurses role in VTE? A goal of 25% reduction of post-op complications nationwide
▪ The Joint Commission Core Measures for VTE. Prophylaxis, medication overlap, Warfarin
teaching
▪ Nurses are key in process to recognize persons at risk for VTE
Medications- PE / DVT
• Heparin- (IV) need baseline labs-platelets
o Anticoagulation to prevent the development of additional clots
o Assess for HIT (heparin induced thrombocytopenia)
o Antidote- protamine sulfate
• Lovenox- (LMWH)- (SQ) 1 mg/kg/ every 12 hr, SQ
o Preferred for prophylactic anticoagulation
• Coumadin – (PO)
o Allows for long anticoagulation in at risk patients to prevent the development of future clots
o Teach which foods are high in vitamin K (inverse relationship to INR)
o Antidote- Vitamin K
• Newer Drugs:
o dabigatran (Pradaxa)
▪ Antidote: idarucizumab (Praxbind) FDA approved 2015
o Rivaroxaban (Xarelto), Apixaban (Eliquis), Edoxaban (Savaysa)
▪ Antidote – Andexanet alpha (AndexXa) FDA approved May 2018
o Do not need to monitor “coags” PT/INR/PTT with Lovenox or newer PO drugs
• TPA (IV)
o Promotes lysis of PE (large) in hemodynamically unstable pts
o Antidote- FFP, clotting factors
, Need To Check Labs:
• Heparin Infusion:
o Partial Thromboplastin Time- (PTT) , (aPTT), (APTT)
o PTT Normal range
▪ 20- 30 seconds- some labs (30-40 seconds in others).
o Therapeutic range in the PE patient 1.5-2 times the normal control in seconds
• Coumadin:
o Prothrombin Time- (PT)
o PT Normal Range
▪ 11-12.5 seconds-
o PE treatment, 1.5-2. times the normal control in seconds
o Usually ordered along with INR levels 2-3
Prevention of PE is the Key: preventative ACTIONS are geared toward PREVENTING venous stasis
• Pre/post hospital:
o Stop smoking
o Reduce weight
o Increase physical activity
o If traveling or sitting for long periods, get up frequently and drink plenty of fluids
• Acute care setting:
o Mobility
o LMWH- Lovenox
o Pneumatic compression sleeves (SCDs)
o Perform a comprehensive assessment of peripheral circulation
o Position changes q2hr
o Discharge teaching, prophylaxis may continue at home after some surgeries
4 Questions:
Oxygen delivery & causes of hypoxemia
• Hypoxemia
o Lungs cannot transfer oxygen from alveoli to blood
o Low O2 sat indicated hypoxemia until proven otherwise
o Classifications:
▪ Normal (PaO2 rule of thumb): 80-100 33 Hg
▪ Mild hypoxemia: 60-80 mm Hg
▪ Moderate hypoxemia: 40-60 mm Hg
▪ Severe hypoxemia: <40 mm Hg
▪ This classification is based on predicted normal values for a patient who is less than 60
years old and breathing room air. For older patients, subtract 1 mm Hg for every year
