[Music] hi guys it's me professor d and welcome back to my channel if you haven't done so already please don't forget to like comment and subscribe below the video i'll be doing today is going to be on oxygenation um guys if there any content that you want me to cover just make sure you put in the comments below and i'll make sure i'll get a video up for you so first question the client has experienced a myocardial infarction resulting in damage to the left ventricle a possible complication the client may experience that the nurses alert to is one jugular neck vein distension two pulmonary congestion three peripheral edema or four liver enlargement and i'll give you a moment to think of your answer and the correct answer guys is to pulmonary congestion so guys they told you in the question that the patient had damage to the left ventricle okay so that's the left side of the heart left starts with what an l whenever there's problems with the left side of the heart that starts with an l the patient has long issues because lung starts with an l as well so any left side problems the patient's going to have a lung issue such as shortness of breath dyspnea crackles congestion that you're hearing in the lungs so number two pulmonary congestion pulmonary means lung guys lung congestions that's a left sided heart failure left sided problem okay look at your other choices number one jugular neck vein distension number three peripheral edema and four liver enlargement all of those are signs and symptoms of right sided heart failure okay so when a patient has issues with the right side of the heart you're gonna see um these symptoms why because instead of the lungs lungs instead of the blood going to the lungs to pick up oxygen because the right side of the heart is not working properly all of that blood backs up and goes back into the body and so patient kind of looks like they're going into fluid overload they have the um jugular vein distension you see the pedal edema you'll see they may have um um truncal obesity you see they swell up their face swells up why because all of that blood that was supposed to be going to the lungs backs up into the body and that's why you'll see one three and four in right-sided heart failure but number two pulmonary congestion along with all of those other signs and symptoms i told you about you'll see in left-sided heart failure okay next question on admitting a client the nurse finds that there's a history of myocardial ischemia the most disconcerting dysrhythmia for electrocardiography to reveal is one sinus bradycardia two sinus dysrhythmia three ventricular tachycardia four atrial fibrillation and i'll give you a moment to think of your answer and the correct answer is three the worst thing you want to see is that patient going to v-tac okay that is the worst dysrhythmia aside from arrhythmia which means the heart's not beating at all right so vtoc is the worst one because what happens is cardiac output is severely decreased that patient um is going to be hypotensive and the chances are high that that patient will go into shock and then what happens is all of their organs collapse okay sinus bradycardia sinus dysrhythmia when you see that word sinus i want you to think normal so it's a normal unless the patient has uh um unless they're symptomatic okay so sinus bradycardia yeah their heartbeat may be a little bit low but they're they're not symptomatic they're not exhibiting any signs and symptoms same thing with sinus dysrhythmia so when you hear that see that sinus i want you to think normal because the patient doesn't have any um symptoms that goes with it okay and the last one afib we don't like afib but it's not as bad as a vtoc vtoc is the worst like i said aside from the patient going into arrhythmia where their heart's just not beating at all next question a client with a suspected narcotic overdose is brought to the emergency department by the police the nurse anticipates that assessment findings will reveal one agitation two hyperpenia three restlessness or four decrease level of consciousness and i'll give you a moment to think of your answer okay guys in the correct answers for decreased levels of consciousness guys what do narcotics do what do opioids do they slow everything down they slow down the heart rate they even slow down the patient's um thinking process okay so cognitively speaking that patient has slowed down and it can slow down to the point that that patient goes um into um what's the word i'm looking for in a coma all right and i want to show you something i want you to pay attention look at one two and three agitation hyperpenia restlessness okay all of these are signs and symptoms of what increase okay the only odd man out is number four where you see something being decreased if you guys um actually i just made a video 11 tips for passing nclex and one of the hints i told you is when you have a multiple choice and you don't know what the answer is always look for the odd man out and this is a perfect example because one two and three are all examples of stimulation or hyperstimulation and four is the only one that's different four is actually what decrease and that's actually the answer don't forget with narcotics narcotics can cause sedation patients on narcotics you better be checking their blood pressure you better be checking their pulse because you don't want it to drop too low okay next question the nurse is checking the client's overall oxygenation in assessment of the presence of central cyanosis the nurse will inspect the client one palms and soles of feet two nail beds three earlobes for tongue and i'll give you a moment to think of your answer and the correct answer is tong guys when you're looking for central cyanosis central so here face or trunk so one of the tongue is one of the places that you can see central cyanosis and i want you guys to take um [Music] take note look at choices one two and three all of those are peripheral okay those would be you'd be looking for peripheral cyanosis the palms the soles of the feet the nail beds earbud um earlobes all of those are peripheral the only one that is central is the tongue the client's admitted to the emergency department with the pneumothorax the nurse anticipates that the client will be experiencing one dyspnea two yupnia eupentia excuse me three feminists or four orthopenia so the correct answer is one dyspnea difficulty breathing that patient is in the er with a pneumothorax what is a pneumothorax that's collapse of the lung of course they're gonna have difficulty breathing okay so look at the other um choices you pennia whenever you see that um those two letters eu in front of the root word that means to be balanced okay so you penny means normal breathing well if the lungs collapse that patient is not going to be breathing normally three fremitas that's those are the vibrations that you feel when that patient um is speaking you're supposed to feel those vibrations obviously if that lung is collapsed uh no the fremitus is going to be decreased okay you may not feel it at all and orthopedia orthopedia is difficulty breathing when the patient's lying down patients who have orthopedic for example or copd patients they need to be sitting up or leaning forward in order to breathe okay so for these choices for a collapsed lung that patient's going to have difficulty breathing and the correct answer is one number 13 the client with a chronic obstructive respiratory disease is receiving oxygen via nasal cannula which of the following interventions does the nurse plan to include in the client's care one assess snares for skin breakdown every six hours two check patency of nasal cannula every two hours three inspect the mouth every six hours four check oxygen flow every 24 hours and the correct answer is one that patient with copd remember when they have copd they're going to be get getting oxygen but remember that oxygen is going to be low flow we never ever ever ever give a patient oxygen anything more than three liters and even with three liters we're iffy about okay because remember with those copd patients um the more oxygen we give them we turn off their a drive to actually breathe okay so the reason number one's the correct answer oxygen is very what trying and so what happens we're concerned about um the nasal cannula and that patient getting oxygen through the nasal cannula and that oxygen um drying out the nairs causing cracking because what can happen when it cracks bacteria can send in so that's our concern okay so any patient that's getting oxygen via nasal cannula we're going to be checking them for skin breakdown and sometimes we have to give them oxygenate oxygen that um is um moist moistened so that uh their skin doesn't break down okay he i couldn't think of the word humidified sometimes we have to give them humidified oxygen just to keep that skin from breaking down all of the following clients are experiencing increased respiratory secretions and require intervention to assist in their removal chest percussion is indicated and appropriate for the client experiencing one thrombocytopenia two cystic fibrosis three osteoporosis or four spinal fracture and i'll give you a moment to think of your answer and the correct answer is two guys we're going to be doing chest percussion we're going to be trying to loosen up those secretions those mucus plugs on the patient that has cystic fibrosis why the patient has cystic fibrosis they create an excessive amount of mucus and that mucus is thick and it's not moving it clogs everything up and sometimes they produce it in the lungs sometimes they produce it in the pancreas and sometimes they can produce it in both okay so let me explain this to you let me go to the pancreas first i'm not talking about that that's not in the question but since i'm talking about i might as well explain it to you so let's say that patient that has cystic fibrosis they're um creating those excessive mucus plugs in the pancreas what happens is they're going to have to get pancreatic enzymes okay what is that remember your pancreas naturally produces enzymes that break down the food when the food gets in your small intestines right but the person with cystic fibrosis if they're creating creating those mucus plugs in the pancreas the pancreas is not making those enzymes anymore and so they have to every time they eat they have to sprinkle that powdered enzyme on their food so the food can get broken down once it gets into the small intestine they have to put those enzyme on i mean when i say food i mean even a snack anything that goes in their mouth it has to go with pancreatic enzymes why because their pancreas can't produce it anymore because of all that mucus now that same patient with cystic fibrosis let's say it's in the lungs same thing well not same thing with enzymes but same thing though the mucus is clogging up the lungs that patient's not going to be able to breathe so constantly that patient is going to need chest percussion so you can loosen up those secretions they need to be drinking lots of fluids to loosen up all of those mucus plugs so that they can cough it up okay so that's what cystic fibrosis is and that's why number two is a um answer okay look at number one thrombocytopenia patients making a little bit of platelets that has nothing to do with chest percussions okay if a patient has thrombocytopenia they're at risk for what bleeding because if you're not making platelets you're not clotting number three osteoporosis that's when your bones are porous that has nothing to do with needing chest percussion and of course um a spinal fracture same thing the correct answer is number two and i explain to you why let's move on to the next question the nurse is working on a pulmonary unit at the local hospital the nurses alert to one of the early signs of hypoxia in the clients which is one cyanosis two restlessness three decrease respiratory rate four decrease blood pressure and the correct answer is to high uh restlessness excuse me guys the number one the number one symptom of patient get becoming hypoxemic is a change in the level of consciousness the change in their cognition okay restlessness okay that's a symptom so you have a patient that was normally awake alert oriented they were acting normal not all of a sudden they're restless that's a sign of hypoxia okay that's one of the um biggest changes of biggest changes biggest signs of hypoxia when you see mental changes in the patient such as restlessness such as agitation such as confusion okay next question in teaching a client about an upcoming diagnostic test the nurse identifies that which one of the following uses an injection of contrast material one halter monitor two echocardiography three cardiac catheterization or four exercise stress test and the correct answer is cardiac catheterization that uses contrast media do not forget guys whenever a patient's going to get contrast media you better look through their chart look at their allergies make sure you ask the patient about allergies if that patient has an allergy to iodine if they have an allergy to shellfish you better call up the physician right away and let me explain to you what happens if that patient has an allergy to iodine or shellfish if that test is not absolutely necessary for them to live the patient's the doctor or the surgeon is going to be like oh well okay let's cancel it but on some occasions we have no choice even if the patient's allergic to iodine or shellfish if that patient um needs that test what happens is the doctor is going to order for you to give a bolus of fluid before and after and also a patient might get some benadryl okay but it's very important for you to know generally speaking patient um is getting contrast media such as a cardiac cath you better check and make sure they're not allergic to iodine and shellfish and if they are you have to call the physician right away now let's go over these other choices the halter monitor that's basically a portable ecg okay machine and the thing with the halter monitor you have to remember the patient can't get in the shower with it they can't get it wet okay so you have to teach that to the patient the echo basic basically that shows the heart's performance and number four the exercise stress test that actually shows how well the heart does under stress such as running on a treadmill it shows how well the body handles increased metabolic demands which obviously will happen if the patient's running next question at a community health fair the nurse informs the residents that the influenza vaccine is recommended for clients one only older than the age of 65 2 40 to 60 years of age three in any age group who have a chronic disease four who have an acute febrile illness and i'll give you a moment to think of your answer the correct answer is three in any age group who have a chronic illness and when i say chronic illness i mean like if they have asthma or copd sickle cell any patient that has a chronic illness they need to be the first one in line to get the flu shot why because their body cannot handle them getting the flu okay that might be enough to put them six feet under okay now number one you should have gotten rid of immediately because remember in my in my 11 tips to pass nclex video i told you guys about absolutes to stay away from them stay away from those answer choices that say only always never such as number one so you should have got rid of that immediately then you have number two ages four 40 to 60 years of age that's just wrong and then three excuse me and then four anyone who has an acute female illness actually no if a patient has um an illness with a fever they got a fever 101 or higher they can't get the vaccine okay they have to go ahead and heal and then they could get the vaccine afterwards so the correct answer is three next question the unit manager is orienting a new staff nurse and evaluates which of the following as an appropriate technique for nasal tracheal suctioning one placing the client in a supine position two preparing for a clean knot or non-sterile technique three suctioning the oropharyngeal area first then the nasal tracheal area four applying intermittent suction for about 10 seconds during catheter removal and the correct answer is four all of the other choices are just wrong okay but four let me explain this to you so you want to um when you're suctioning the patient you never suction going in you only suction coming out okay and when you suction coming out you're suctioning in a rotating fashion and you want to suction intermittently for about 10 to 15 seconds and you always want to hyper oxygenate the patient before and after you suction a couple other things you have to know about suctioning because lots of questions come from suctioning okay um so you hyper oxygenate the patient before and after suctioning you only suction coming out never going in when you do suction coming out you're going to do it in a rotating fashion intermittently 10 to 15 seconds oh and a maximum three passes some textbooks say two passes so um look to see which one your textbook says if you guys get a question on nclex about it it's going to be far off so it's not going to be two or three they're going to say something like five or six so you either know it or you don't okay so depending on your textbook two or three passes but then after that you have to allow your client to rest you can't just keep suctioning suctioning why because even though you're suctioning and you're helping getting rid of those secretions what else are you taking away from the client oxygen you're taking oxygen away from the client and that's why you have to hyper oxygenate them before and after each pass okay so after the second or third depending on your textbook allow that client to rest allow them to catch their breath and then you're going to assess them and if you have to suction again you're going to go ahead and start over the client has supplemental oxygen in place and requires suctioning to remove excess secretions from the airway to promote maximum oxygenation an appropriate action by the nurse is to one suction continuously for 30 second intervals two replace the oxygen and allow rest in between suction passes three increase amount of suction pressure to 200 or four complete a number of suctioning passes until the catheter comes back clear and you guys should know the answer because i already gave it to i just gave it to you guys so the correct answer is too you want to replace oxygen allow rest in between suctioning passes look at our other choices one says suction continuously for 30 second intervals well i just told you you want to suction intermittently and you want to do it 10 to 15 seconds so you know number one's wrong number three increase the amount of suction pressure to 200 no the highest you can go is to 120 okay so your suction you want it to be around 80 to 120 but 120 is a max so you're definitely not going to be doing 200 okay and then number four complete a number of sectioning passes until the catheter comes back absolutely not remember i told you depending on your textbook two maybe three passes and then that's it that client needs to rest you need to reassess them and then you can um suction them if needed next question a client with the chest tube in place is being transported via stretcher to another room closer to the nurse's station during the transport the collection unit bangs against the wall and breaks open the nurse immediately one clamps the two two tells the client to hyperventilate three raise the tubing above the client's chest level four places the end of the tube in a container of sterile water and the correct answer is four you're going to place the end of the tube in sterile water guys this is going to create um um the same seal as um the collection system okay because remember the collection system also had that water and you would see the the the gentle bubbling same thing okay so when you put that end of the tube in sterile water it creates the same seal as um the collection uh unit let's look at our other choices one clamping the tube uh no if you clamp that tube you know what you're gonna cause a pneumothorax you're gonna cause that lung to collapse so that's a no two tell the client to hyperventilate absolutely not if anything you can tell the client to um cough because coughing will help create that negative pressure that you want number three raising the two above the client's chest no that's not going to do anything what you want to do is put the end of that tube in sterile water okay and create a seal next question the client's experiencing a sinus dysrhythmia with a pulse of 82 beats per minute upon entering the room the nurse expects to find the client one extremely fatigued two complaining of chest pain three experiencing a fluttering sensation of the chest or four having no clinical signs based on assessment and the correct answers for guys remember when i told you sinus i want you to think normal even those you know um maybe if it's like for example if it's sinus bradycardia yes that heart rate's a low but it's still normal the patient doesn't have any symptoms when you see that word sinus i want you to think normal because the patient's not experiencing any symptoms and that's exactly what we have here with number four having no clinical signs based on the sense on the assessment the patients they're not symptomatic now let's look at our other choices one extremely fatigue you'd see that in a patient that has afib or a patient that's highly anemic two complaining of chest pain you see that in a patient that's having a myocardial infarction a heart attack right three patients experiencing a fluttering sensation in the chest that's something you've seen the patient experiencing atrial fibrillation afib okay next question a client submitted to the medical center with the diagnosis of right-sided heart failure an assessment of this client the nurse expects to find one dyspnea two confusion three dizziness or four peripheral edema and i hope you guys all got this answer correct because i think it was the first question i and i explained the difference between left-sided heart failure and right-sided heart failure with left-sided heart failure you'll see a long symptoms such as shortness of breath dyspnea crackles right but with right-sided heart failure you're going to see those generalized system symptoms you're going to see um the um uh symptoms of the system such as jugular vein distension such as facial edema such as peripheral edema which is number four okay those signs and symptoms of right-sided heart failure ascites okay next question the nurse is preparing to teach a group of adult women about the signs and symptoms of myocardial infarction a heart attack the nurse will include in the teaching plan the results of research that demonstrate women may experience specific symptoms such as one visual difficulties two epigastric pain three loss of motor function unit unilaterally or four right scapular discomfort and stiffness and the correct answer is to epigastric pain let me explain something to you guys even though twice is more does that twice is more twice as many twice as many men get heart attacks than women do more women die from heart attacks than men do so let me explain this to you i want to make sure you guys understand okay with men when they get heart attacks they get those classic symptoms they get that chest pain they feel like a elephant is standing on their chest okay that um pain it might radiate to their left arm their left jaw they get those classic symptoms of a heart attack so immediately they're like call 9-1-1 but with women the signs and symptoms of a heart attack in women are very vague okay they tend to be like oh you know what i'm having some real bad indigestion today they think it's gas they think it's acid okay don't have epigastric pain and they don't realize it's a heart attack because it's not the symptoms are not not as pronounced as it is for men so that's very important so you have to teach women that for them if you know if they have heart disease they have hypertension they have high cholesterol which puts them they're obese which puts them at risk for having a myocardial infarction you have to teach them hey if you're feeling really bad epigastric pain you may think it's indigestion but you need to seek help because it may be a heart attack okay so even though way more men get heart attacks than women way more women die from heart attacks than men just because their symptoms are not as pronounced so that's why the correct answer is number two epigastric pain okay next question the primary reason a client with chronic obstructive pulmonary disease often experiences fatigue and activity intolerance is related to one the increased presence of surfactant that results in sticky alveoli two the presence of chronic infections in the lung and bronchial tree excuse me three the extra energy that's needed to exhale the air from the damaged lungs or four the client's elevated anxiety related to the air hunger being experienced and i'll give you guys a moment okay the correct answer three the extra energy that's needed to exhale air from the damaged lungs so what happens is those patients that have um copd they lose their elastic recoil okay and so that's why you see those patients that has copd you see they look like they have the barrel chest right why are they walking around looking like this the reason they're looking like this is because all of that um copd that they're supposed to breathe out is still stuck in their lungs why they lost that elastic recoil to push out the copd okay so that's why you see them always walking around with the barrel chest okay that's why those patients if you check their um co2 levels remember normal co2 is 35 to 45 right they're going to be way past 45 why because instead of breathing off that co2 they're holding it all in that's why one of the important teachings you do with the copd patients you teach them how to exercise those lungs to get out the co2 how you teach them personal breathing you teach them to pretend like they're blowing out a candle and to go like this slowly exercising the lungs helping getting out that co2 right or you teach them to pretend that there's a pencil on the table and they need to move that pencil with their breath if they go like this are they going to move the pencil no they have to make their lips in a circular motion and blow like this in order to move the pencil that's called purse lip breathing and that's what you teach to the copd patient so that's why they're out of breath all the time they got all that all that um co2 in their lungs that they're trying to um move out all the time so that's why they're always so fatigued it makes sense next question pregnancy pregnancy affects a woman's oxygenation needs primarily because one the increased metabolic demands required to support the fetus two increased tendency to develop anemia as a result of low iron reserves three decreased ability to engage in physical exercise required to promote circulation or four the decreased lung capacity resulting from pressure of the uterus on the diaphragm and the correct answer is one the increased metabolic demands required to support the fetus because now you need to think about it oxygen is carried in hemoglobin hemoglobin is carried in blood the blood is pushed out by what the heart right so now that heart is responsible for pushing blood to provide oxygen not only to mommy but to the fetus so guess what the metabolic demands have increased and so that's an increased demand on the body specifically the heart and we're down to our last question the nurse is caring for a client who experienced a failed chest injury that's multiple rib fractures as a result of a motorcycle accident the nurse realizes that pain management for this client will directly impact the effectiveness of his respiratory functioning primarily because one pain increases metabolic needs thus increasing oxygen consumption two pain increases emotional distress which can lead to hyperventilation three pain will decrease the client's motivation to deep breathe contributing to shallow diminished inspirations four pain will decrease the client's ability to both relax and recuperate thus extending the period of recovery i'll give you a moment to think of your answer and the correct answer is three guys pain will decrease the client's motivation to debrief contributing to shallow diminished inspirations i want you to think about what happened so the patient got in a car accident they got a couple ribs that are broken right remember guys those ribs are what protects the lungs right but now you got flailed chest so you got one lung that's working just fine and you got one lung that's just kaput okay this patient is in pain but that lung that's now kaput you want it to um reinflate and so the patient has to do those lung exercises you want that patient to turn cough deep breathe you think that patient's going to want to deep breathe when they're in pain no let me tell you what they're going to do you're going to have them do those lung exercises and they're going to fake it they're going to be like and they're going to do it really shallow because it's painful why is it painful every time they take a deep breath remember that long that lung that rib is broken so it's every time that rib moves it's very painful for them so a priority for this patient before you try to get them to deep breathe you have to make sure that patients adequately medicated okay you have to make sure you get that pain level managed so they can deep breathe like they're supposed to so you can help that lung re-oxygenate i know i said last question but actually this is the last question i have one more i really want to do this question with you the nurse is preparing to discuss mis with a women's group which of the following assessment findings should be included when discussing the typically observed signs and symptoms in females experiencing an mi one originates both at rest and upon exertion two pain lasting longer than 30 minutes three pain radiating up to the left jaw four significant gastric gastric indigestion and you guys should know this answer because i talked to you about this ad nauseum the correct answer is for for women significant gastric indigestion so you make sure you teach that to women who are at risk for myocardial infarctions guys i hope you guys enjoyed this video i hope you guys learned a lot um thank you so much for joining me please do not forget if you haven't done so already please like comment and subscribe below and i'll see you guys next time