Which of the following will cause a nurse to suspect that a patient's pulmonary contusion is worsening?
a. A pulmonary artery catheter showing a central venous pressure of 6 cm H2O and a wedge pressure of 8 mm Hg
b. An increased need for pain medication
c. An arterial blood gas value that demonstrates respiratory alkalosis
d. Increased peak airway pressures on the ventilator
D
A contusion manifests initially as a hemorrhage followed by alveolar and interstitial edema. The edema can remain rather localized in the contused area or can spread to other lung areas. Inflammation affects alveolar-capillary units. As more units are affected by inflammation, further pathophysiologic events can occur, including decreased compliance, increased pulmonary vascular resistance, and decreased pulmonary blood flow. These processes result in a ventilation–perfusion imbalance that results in progressive hypoxemia and poor ventilation over a 24- to 48-hour period.
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The nurse is teaching a group of nursing students about the cultural implications associated with eye diseases. At the conclusion of the teaching session, which student comment indicates the need for further education?
1. "It is important to assess the African American client for clinical manifestations associated with increased intraocular pressure." 2. "We should assess serum glucose levels in our adult Hispanic clients." 3. "Our diabetic clients should return every 2 years for an assessment of their vision and their retina." 4. "Poorly controlled serum glucose levels can result in retinal changes that affect the client's vision and can even result in blindness."
An older woman who receives intravenous (IV) fluids is making wide gesticulations with her arms and loudly insulting the nursing staff. Which intervention should the nurse implement to maintain safe, effective nursing care initially?
a. Apply bilateral upper extremity restraints. b. Administer haloperidol (Haldol) for agita-tion. c. Close the door to her room to reduce the noise. d. Determine the patients needs.
A nurse encourages a patient who is diagnosed with lung disease not to smoke because smoking:
A) Decreases the amount of mucus production B) Oxygenates the hemoglobin C) Inflates the alveoli in the lungs D) Damages the ciliary cleansing mechanism of the respiratory tract
A patient has undergone bone marrow transplant. Which injection should the nurse anticipate this patient will receive to help stabilize the immune response and prevent rejection?
a. Dexamethasone (Decadron) b. Filgrastim (Neupogen) c. Zidovudine (Retrovir) d. Nevirapine (Viramune)