PAR nsg assessment

  1. What is the first thing to assess in a patient arriving in PARR?
    airway
  2. What is the best way to assess the patients' airway upon arrival to PARR?
    place stethoscope over trachea and listen for breath sounds
  3. Explain the difference in inserting an oral airway in a child, as compared to an adult
    • In young children, insert 'right side up' to avoid damage to soft palate.
    • In adult, insert 'upside down' and turn at back of throat
  4. What are 2 possible causes of no breath sounds on a patient admitted to PARR?
    • - malpositioned airway
    • - tongue obstruction
  5. Describe how to measure for an airway
    place flange by corner of lip. Line up tip with angle of jaw. Correct size - the tip doesn't extend past the jaw line.
  6. What is a complication of OPAs in semi-conscious or conscious patients?
    - vomiting and laryngospam
  7. List 2 practices for the right time to remove OPA
    • - patient awakes and can spit it out
    • - patient not fully awake but has some purposeful movement, nurse may remove.
  8. How often should an unconscious patient's VS be monitored in PARR?
    q 5 minutes
  9. Is it normal to hear air entry only on the upper lung field in an unconscious patient?
    yes
  10. List 3 types of patients who need ST segment monitoring
    • - unstable
    • - underlying cardiovascular or respiratory disease
    • - elderly or diabetic (at risk for silent ischemia)
  11. ST segment elevation indicates
    a) ischemia
    b) myocardial injury
    injury b
  12. ST segment elevation indicates
    a) ischemia
    b)myocardial injury
    a) ischemia
  13. Normal mean arterial pressure
    a) 60-90
    b) 70-100
    c) 70-105
    d) 50-105
    70-105
  14. Normal pulse pressure
    a) 20-40
    b) 40-60
    c) 60-80
    d) 40-80
    b 40-60
  15. Pulse pressure change represents


    A) increase or decrease in stroke volume
  16. If cuff is too small BP will be
    a) falsely elevated
    b) falsely low
    a)
  17. If cuff is too big BP will be
    a) falsely elevated
    b) falsely low
    b)
  18. If cuff is too above heart BP will be
    a) falsely elevated
    b) falsely low
    b
  19. When regaining consciousness does a patient respond first to tactile or verbal stimuli?
    tactil
  20. To be discharged from parr post-spinal/epidural the patient must
    1) block has receded by 2 or more dermatomes
    2) block has receded by 1 dermatome
    3) sensation has returned to lower limbs
    4) movement in legs is present
    5) can reposition self



    C) 1 4 5
Author
meowzart
ID
44413
Card Set
PAR nsg assessment
Description
basic nursing care in parr
Updated