The nurses assigned to four clients in a long term care facility.
Which client has the highest risk for pulmonary edema?
Okay, we have a lot of key words in this one.
So, the nurse, that's me, is assigned to four clients.
And what's my setting?
Long term care facility?
All right, I've got a feeling of what that is.
These are people who couldn't live on their own, right.
They need some type of oversight, and care, and support,
but they're not sick enough to be in an acute care facility.
So like a hospital, in-patient.
So, I've got clients. I've got four of them.
I'm in a long term care facility.
Which client has the highest risk for?
Stop right there and make sure you're clear.
Pulmonary edema.
Okay, so really what this question is asking me,
who has the highest risk for pulmonary edema?
Now, it says the what?
The highest risk for pulmonary edema.
That's the key word that tells me.
Oh, more than one person might have a risk for pulmonary edema.
I have to pick the one that has the highest risk
for pulmonary edema.
Now, I know I'm doing that goofy,
because anything that will make things stick in your mind,
I'll do whatever it takes.
And I even hope when you're reading these questions in your own head,
you hear weird voices in your own mind
to make sure you don't miss a key component.
So that's the topic of the question.
You're looking for who has the highest risk for pulmonary edema?
We're going to bring those four patients in.
We're going to ask you to eliminate them one at a time
by asking yourself.
Is answer choice number one have the highest risk for pulmonary edema?
Well, first,
you're going to see if they have a risk for pulmonary edema.
And then you're going to compare that one
to the other three answer choices.
Now start at four, start at two, start at one,
we don't care.
As long as you work through each one.
And you compare those answers to each other.
You're going to get the best answer.
All right, I'll see in a couple of minutes.
Pause the video.
Take your time. Do your best.
And we'll come back and walk through the question together.
Hey, welcome back.
Hey, thank you for taking the time to do the work on your own.
That is really where your effort is going to pay off
into higher performance.
Now, number one.
A client who has right ventricular hypertrophy.
Are they at the highest risk for pulmonary edema?
Okay, well, if you have right ventricular hypertrophy,
what do you remember about the heart?
Remember, blood enters here.
You've got the right atrium, the tricuspid, the right ventricle.
Oh, if that right ventricles job is to push blood to the lungs.
If the pressures in the lungs are super high,
that right ventricle works harder, harder, harder.
And then sometimes it gets like overstretched
and it just can't still strong anymore.
So, I'm going to keep number one. Not ready to get rid of it yet.
Number two.
Compared to number one
is number two at a higher risk for pulmonary edema?
While client with pneumonia.
That means they've got some type of infection going on in their lung.
Is that the highest risk for pulmonary edema?
No. Because pulmonary edema is like fluid volume overload,
Now their lungs are going to sound junky, probably.
They're going to look kind of achy on an x-ray,
but I'm not as concerned about pulmonary edema
as I am with the client in number one for now.
Number three. A client who has congestive heart failure.
Oh yeah.
They have a risk of pulmonary edema.
In fact, that's the worst case scenario for somebody
with congestive heart failure.
So, compare number three to number one.
Yeah, a bigger problem than right ventricular hypertrophy
would be congestive heart failure.
Now, here's why.
If I know they have right ventricular hypertrophy,
things are going to start backing up, right?
Ventricle, on atrium, out to the rest of the body.
So we're not likely to see pulmonary edema
caused by right ventricular hypertrophy.
So someone has this right ventricular hypertrophy,
because their lung pressures were high.
Expect to look for fluid to have backed up to the rest of the body.
You know they have the bilateral edema in their extremities
and might have some issues with their liver.
Pulmonary edema is a problem when the left ventricle
can't push blood out to the rest of the all right.
So it starts backing up.
Well, it backs up from the left ventricle,
to the left atrium,
and back into the lungs.
That's why somebody with congestive heart failure
has a higher risk for pulmonary edema than number one.
So I'm keeping number three in there.
But I am not stopping there.
Because number four might be an even better answer. Let's look.
A client who has orthostatic hypotension
due to autonomic dysfunction.
Do they have a higher risk for pulmonary edema?
Okay, well, they're not having a good day, right?
If they have orthostatic hypotension,
what's going on?
Well, if they're laying down and they sit up too quickly,
or they're sitting and they stand up too quickly,
they can pass out. Right?
And that's because they've got an autonomic dysfunction going on.
Is that a good thing?
No.
Is it a safety factor?
Yes.
Is it the topic of the question?
No.
Right?
So if you don't make sure you do the work
to know the topic of the question,
you can get caught by one of these answers,
because it is definitely a safety problem.
Somebody has to be very careful about
going from lying to sitting,
and staying there for a while until their body stabilizes.
And then when they go from sitting to standing,
they have to do the same thing
and have something to study themselves.
That's a safety issue.
But that is not the question that's being asked.
And that's how you can pick -
Wow, a really cool answer for another question.
Not what you want.
It's number three, a client who has congestive heart failure.
Okay, we spend a lot of time talking about that one.
First off, whether you get it right or wrong,
let's not talk about that now.
I want you to think about
in our conversations and talking about the rationale.
Is there anything that you need to write down in your notebook
to remember?
Was it something about how the cause of right ventricular hypertrophy
is often high pressures in the lungs?
Was it something that when you have right ventricular hypertrophy
to the point that it's not effective,
that blood starts backing up into the right atrium,
and now to the rest of the body, right.
And issues with your liver.
You don't feel good GI
And you've got bilateral edema.
Is it pneumonia? When we talked about lung sounds?
What is it that you individually need to write in your notebook,
so that you'll remember it when you go over and review these notes?
See, that's the cool thing about studying together.
We're creating a study guide that is just for you.
Don't take somebody else's notes.
Do the work.
Make your own notes.
And this is going to make a fantastic study guide
that is individualized and personalized, just for you.
You're welcome.
Really, you're the one doing the hard work.
So, hang in there. Keep doing it. It's not fun.
But it can be
because when you start to see the results pay off,
you're going to fall in love with that notebook
and the work and effort that you're putting into it.
So, if you got it right, if you got it wrong,
what needs to go in your notes about the rationales of these questions?
Maybe some of the patho.
Do you understand why you pick the answer that you did?
Is there something missing?
What can you take from this question,
and apply to the next question or another question on your exam?
Ready?
Let's go do some more.