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Nursing Exam 6- Oxygenation
Terms in this set (143)
A patient is presenting with chronic obstructive pulmonary disease. The patient has a chronic productive cough with dyspnea on excretion. Arterial blood gases show a low oxygen level and high carbon dioxide level in the blood. On assessment, the patient has cyanosis in the lips and edema in the abdomen and legs. Based on your nursing knowledge and the patient's symptoms, you suspect the patient suffers from what type of COPD?
C. Chronic bronchitis
C. Chronic bronchitis
***The answer is C. The key words to let you know the patient is experiencing chronic bronchitis are: cyanosis and edema in the abdomen and legs. Remember chronic bronchitis is sometimes referred to as "blue bloaters".
A patient with emphysema may present with all of the following symptoms EXCEPT?
A. Barrel chest
B. Hyperinflation of the lungs
***The answer is C. Patients with emphysema present with HYPERventilation. The body will try to compensate for the low oxygen blood levels and will cause the patient to hyperventilate. Remember emphysema patients are sometimes called "pink puffers". They will have a barrel chest (due to the use of accessory muscles for breathing), hyperinflation of the lungs (due to damage of the alveoli sacs and creation of air sacs), and hypercapnia (high carbon dioxide levels).
The term" blue bloaters" is used to describe patients with?
A. Pulmonary hypertension
B. Left-sided heart failure
C. Chronic Bronchitis
C. Chronic Bronchitis
***The answer is C. "Blue bloaters" is used to describe patients with chronic bronchitis, and the term "pink puffers" is used to describe patients with emphysema.
A patient is newly diagnosed with COPD due to chronic bronchitis. You're providing education to the patient about this disease process. Which statement by the patient indicates they understood your teaching about this condition?
A. "If I stop smoking, it will cure my condition."
B. "Complications from this condition can lead to pulmonary hypertension and right-sided heart failure."
C. "I'm at risk for low levels of red blood cells due to hypoxia and may require blood transfusions during acute illnesses."
D. "My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than low oxygen levels.
B. Complications from this condition can lead to pulmonary HTN and right sided HF
An alarm beeps notifying you that one of your patient's oxygen saturation is reading 89%. You arrive to the patient's room, and see the patient comfortably resting in bed watching television. The patient is already on 2 L of oxygen via nasal cannula. The patient is admitted for COPD exacerbation. Your next nursing action would be:
A. Continue to monitor the patient
B. Increase the patient's oxygen level to 3 L
C. Notify the doctor for further orders
D. Turn off the alarm settings
A. Continue to monitor the patient
You are providing teaching to a patient with chronic COPD on how to perform diaphragmatic breathing. This technique helps do the following:
A. Increase the breathing rate to prevent hypoxemia
B. Decrease the use of the abdominal muscles
C. Encourages the use of accessory muscles to help with breathing
D. Strengthen the diaphragm
D. Strengthen the diaphragm
Diaphragmatic breathing helps strengthen the diaphragm because it has become flatten due to the hyperinflation of the lungs. Due to the flattening of the diaphragm, the body is unable to breathe with ease and must use the accessory muscles to compensate. Therefore, diaphragmatic breathing helps DECREASE the breathing rate to prevent hypoxemia, INCREASES the use of the abdominal muscles RATHER than accessory muscles and strengthens the diaphragm.
A patient with severe COPD is having an episode of extreme shortness of breath and requests their inhaler. Which type of inhaler ordered by the physician would provide the FASTEST relief for the patient based on this particular situation?
The answer is D. The patient would best benefit from a SHORT-ACTING bronchodilator to help with the shortness of breath. The only short-acting bronchodilator listed is Albuterol. Spiriva is a long-acting bronchodilator. Symbicort is a combination of long-acting bronchodilator and corticosteroid. Salmeterol is a long-acting bronchodilator.
Which of the following statements are incorrect about discharge teaching that you would provide to a patient with COPD? Select-all-that-apply:
A. "It is best to eat three large meals a day that are relatively low in calories."
B. "Avoid going outside during extremely hot or cold days."
C. "It is important to receive the Pneumovax vaccine annually."
D. "Smoking cessation can help improve your symptoms."
The answers are A and C. The patient needs to eat high calorie and protein rich meals that are small but frequent. The Pneumovax is definitely recommended for patients with COPD but is given every 5 years (not annually).
A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler. How should the patient take this medication?
A. The patient should use the medications every 2 hours for acute episodes of shortness of breath.
B. The patient should use the Spiriva first and then 5 minutes later the Pulmicort.
C. The patient should use the Pulmicort first and then the Spiriva 5 minutes later.
D. The patient should use the medications at the same exact time, regardless of the order.
The answer is B. The patient should use the bronchodilator first which is the Spiriva to open the airways and THEN the Pulmicort which is a corticosteroid. Using the inhalers in this order will allow the corticosteroid to work properly after the lung fields are opened due to bronchodilation.
In regards to previous question, which action by the patient demonstrates they know how to properly use this medication?
A. The patient rinses their mouth after using the Spiriva inhaler.
B. The patient rinses their mouth after using the Pulmicort inhaler.
C. The patient dispenses of the inhalers.
D. The patient coughs 2 times after using the Pulmicort inhaler.
The answer is B. The patient should rinse the mouth after using any type of corticosteroid inhalers (here Pulmicort is the corticosteroid not Sprivia) to remove the medication from the mouth. If left in the mouth, the patient can develop thrush.
A patient with COPD is reporting depression and thoughts of suicide. The patient states, "I just feel like ending it all." You assess the patient's health history and note that the patient was recently started on which medication that could cause this side effect:
The answer is C. Roflumilast is a phosphodiestrace-4 inhibitor that is used in the treatment of patients with severe COPD due to chronic bronchitis. This medication can caused increased suicidal thoughts, and the patient should be monitored for this while taking Roflumilast.
A patient is ordered at 1400 to take Theophylline. You're assessing the patient's morning lab results and note that the Theophylline level drawn this morning reads: 15 mcg/mL. You're next nursing action is to?
A. Administer the dose at 1400 as ordered
B. Notify the physician for further orders
C. Hold the 1400 dose
D. Collect another blood sample to confirm the level
The answer is A. A normal Theophylline level is 10-20 mcg/mL...therefore the level is normal and the nurse should administer the dose at 1400 as ordered.
You are providing care to a patient with COPD who is receiving medical treatment for exacerbation. The patient has a history of diabetes, hypertension, and hyperlipidemia. The patient is experiencing extreme hyperglycemia. In addition, the patient has multiple areas of bruising on the arms and legs. Which medication ordered for this patient can cause hyperglycemia and bruising?
The answer is A. Prednisone is a corticosterioid and can cause hyperglycemia and brusing.
True or False: Tuberculosis is a contagious bacterial infection caused by mycobacterium tuberculosis and it only affects the lungs.
Answer: FALSE....tuberculosis is a contagious bacterial infection caused by mycobacterium tuberculosis that affects the lungs AND other systems of the body like the joints, kidneys, brain, spine, liver etc.
A 55-year old male patient is admitted with an active tuberculosis infection. The nurse will place the patient in ___________________ precautions and will always wear _____________________ when providing patient care?
A. droplet, respirator
B. airborne, respirator
C. contact and airborne, surgical mask
D. droplet, surgical mask
The answer is B. A patient with ACTIVE TB is contagious. The bacterium, mycobacterium tuberculosis which causes TB, is so small that it can stay suspended in the air for hours to days. Therefore, the nurse will place the patient in AIRBORNE precautions. In addition, a special mask must be worn called a respirator (also referred to as an N95 mask.....a surgical mask does NOT work with this condition).
Which statement is correct regarding mycobacterium tuberculosis?
A. This bacterium is an anaerobic type of bacteria.
B. It is an alkali bacterium that stains bright red during an acid-fast smear test.
C. It is known as being an aerobic type of bacteria.
D. It's an acid-fact bacterium that stains bright green during an acid-fast smear test.
The answer is C. Mycobacterium tuberculosis is AEROBIC (it thrives in conditions that are high in oxygen), and it is an ACID-FAST bacterium, which means when it is stained during an acid-fast smear it will turn BRIGHT RED
Your patient with a diagnosis of latent tuberculosis infection needs a bronchoscopy. During transport to endoscopy, the patient will need to wear?
A. N95 mask
B. Surgical mask
C. No special PPE is needed
D. Face mask with shield
The answer is C. Patients with a latent tuberculosis infection are NOT contagious. Therefore, no special PPE is needed for the patient during transport. HOWEVER, if the patient had ACTIVE tuberculosis they would need to wear a surgical mask during transport.
You are assessing your newly admitted patients who are all presenting with atypical signs and symptoms of a possible lung infection. The physician suspects tuberculosis. So, therefore, the patients are being monitored and tested for the disease. Select all the risk factors below that increases a patient's risk for developing tuberculosis:
B. Liver failure
C. Long-term care resident
E. IV drug user
G. U.S. resident
The answers are C, D, E, and F. Remember from our lecture we discussed the risk factors for developing TB and to remember them I said remember the mnemonic "TB Risk". It stands for tight living quarters (LTC resident, prison, homeless shelter etc.), below or at the poverty line (homeless), refugee (especially in high risk countries), immune system issue such as HIV, substance abusers (IV drugs or alcohol), Kids less than the age of 5....all these are risk factors.
Your patient is diagnosed with a latent tuberculosis infection. Select all the correct statements that reflect this condition:
A. "The patient will not need treatment unless it progresses to an active tuberculosis infection."
B. "The patient is not contagious and will have no signs and symptoms."
C. "The patient will have a positive tuberculin skin test or IGRA test.
D. "The patient will have an abnormal chest x-ray."
E. "The patient's sputum will test positive for mycobacterium tuberculosis."
The answers are B and C. The patient WILL need medical treatment to prevent this case of LBTI from developing into an active TB infection later on. The patient will NOT have an abnormal chest x-ray or a positive sputum test. This is only in active TB.
A 52-year old female patient is receiving medical treatment for a possible tuberculosis infection. The patient is a U.S. resident but grew-up in a foreign country. She reports that as a child she received the BCG vaccine (bacille Calmette-Guerin vaccine). Which physician's order below would require the nurse to ask the doctor for an order clarification?
A. PPD (Mantoux test)
B. Chest X-ray
C. QuantiFERON-TB Gold (QFT)
D. Sputum culture
The answer is A. Patients who have received the BCG vaccine will have a false positive on a PPD (Mantoux test), which is the tuberculin skin test. The BCG vaccine is a vaccine to prevent TB. It is given in foreign countries to children to prevent TB. Therefore, the person has already been exposed to the bacteria via vaccine and will have a false positive. A QuantiFERON-TB Gold test is a better option for this patient. It is a blood test.
You're teaching a group of long-term care health givers about the signs and symptoms of tuberculosis. What signs and symptoms will you include in your education?
A. Cough for a minimum of 6 weeks
B. Night sweats
C. Weight gain
G. Chest pain
The answers are B, D, E, F, and G. Option A is wrong because a cough should be present for 3 weeks or more (NOT 6 weeks). Option C is wrong because the patient will experience weight LOSS (not gain).
A patient has a positive PPD skin test that shows an 8 mm induration. As the nurse you know that:
A. The patient will need to immediately be placed in droplet precautions and started on a medication regime.
B. The patient will need a chest x-ray and sputum culture to confirm the test results before treatment is provided.
C. The patient will need an IGRA test to help differentiate between a latent tuberculosis infection versus an active tuberculosis infection.
D. The patient will need to repeat the skin test in 48-72 hours to confirm the results.
The answer is B. A positive PPD result does NOT necessarily mean the patient has an active infection of TB. The patient will need a chest x-ray and sputum culture to determine if mycobacterium tuberculosis is present and then treatment will be based on those results. The IGRA test does NOT differentiate between LTBI or an active TB infection. Patients are placed in airborne precautions (NOT droplet) if they have ACTIVE TB.
A patient has a PPD skin test (Mantoux test). As the nurse you tell the patient to report back to the office in _________ so the results can be interpreted?
A. 24-48 hours
B. 12-24 hours
C. 48-72 hours
D. 24-72 hours
C. 48-72 hours
A 48-year old homeless man, who is living in a local homeless shelter and is an IV drug user, has arrived to the clinic to have his PPD skin test assessed. What is considered a positive result?
A. 5 mm induration
B. 15 mm induration
C. 9 mm induration
D. 10 mm induration
The answer is D. 15 mm induration is positive in ALL people regardless of health history or risk factors. However, for patients who are homeless (living in homeless shelter) and are IV drug users, a 10 mm or more is considered positive.
The physician orders an acid-fast bacilli sputum culture smear on a patient with possible tuberculosis. How will you collect this?
A. Collect 2 different sputum specimens 12 hours apart
B. Collect 3 different sputum specimens (one in the morning, afternoon, and at night)
C. Collect 3 different sputum specimens on 3 different days
D. Collect 2 different sputum specimens on 2 different days
The answer is C. This is how an AFB sputum culture is collected.
A patient receiving medical treatment for an active tuberculosis infection asks when she can starting going out in public again. You respond that she is no longer contagious when: select all that apply
A. She has 3 negative sputum cultures
B. Her signs and symptoms improve
C. She has completed the full medication regime
D. Her chest x-ray is normal
E. She has been on tuberculosis medications for about 3 weeks
The answers are A, B, and E. These are all criteria for when a patient with active TB can return to public life (school, work, running errands). Until then they are still contagious and must stay home in isolation.
As the nurse you know that one of the reasons for an increase in multi-drug-resistant tuberculosis is:
A. Incorrect medication ordered
B. Increase in tuberculosis cases nationwide
C. Incorrect route of drug ordered
D. Noncompliance due to duration of medication treatment needed
The answer is D. Patients must be on medication treatment for about 6-12 months (depending on the type of TB the patient has). This leads to noncompliant issues. DOT (directly observed therapy) is now being instituted so compliance is increased. This is where a public health nurse or a trained DOT worker will deliver the medication and watch the patient swallow the pill until treatment is complete.
Your patient, who is receiving Pyrazinamide, report stiffness and extreme pain in the right big toe. The site is extremely red, swollen, and warm. You notify the physician and as the nurse you anticipated the doctor will order?
A. Calcium level
B. Vitamin B6 level
C. Uric acid level
D. Amylase level
The answer is C. This medication can increase uric acid levels which can lead to gout. The patient's signs and symptoms are classic findings in a gout attack.
You note your patient's sweat and urine is orange. You reassure the patient and educate him that which medication below is causing this finding?
The answer is D. This medication will cause body fluids to turn orange.
A patient with active tuberculosis is taking Ethambutol. As the nurse you make it priority to assess the patient's?
B. mental status
C. vitamin B6 level
The answer is D. This medication can cause inflammation of the optic nerve. Therefore, it is very important the nurse asks the patient about their vision. If the patient has blurred vision or reports a change in colors, the MD must be notified immediately.
A patient taking Isoniazid (INH) should be monitored for what deficiency?
A. Vitamin C
C. Vitamin B6
The answer is C. This medication can lead to low Vitamin B6 levels. Most patients will take a supplement of B6 while taking this medication.
A patient is taking Streptomycin. Which finding below requires the nurse to notify the physician?
A. Patient reports a change in vision.
B. Patient reports a metallic taste in the mouth.
C. The patient has ringing in their ears.
D. The patient has a persistent dry cough.
The answer is C. This medication can be very toxic to the ears (cranial nerve 8). Therefore, it is alarming if the patient reports ringing in their ears, which could represent ototoxicity.
A patient with asthma is prescribed to take inhaled Salmeterol and Fluticasone for long-term management of asthma. You observe the patient taking these medications. Which option below best describes the correct order in how to take these medications?
A. The patient inhales the Salmeterol first and then waits 5 minutes before inhaling the Fluticasone.
B. The patient inhales the Fluticasone first and then waits 5 minutes before inhaling the Salmeterol.
C. The patient inhales the Salmeterol first and then waits 1 minute before inhaling the Fluticasone.
D. The patient inhales the Fluticasone and immediately inhales the Salmeterol.
The answer is A. The bronchodilator inhaler (Salmeterol) is administered first to open up the airways. Then the patient is to wait five minutes and then administer the corticosteroid (Fluticasone). The bronchodilator will open the airways so the corticosteroid can easily enter the airways to decrease inflammation.
Your assisting your patient who has asthma to bed. The patient is experiencing a frequent cough and chest tightness. You auscultate the patient's lung fields and note expiratory wheezes. The patient's peak flow rate is 78% less than their best peak flow reading. Which medication will provide the patient with the fastest relief from these signs and symptoms of an asthma attack?
The answer is C. During an asthma attack, the patient needs a medication that will quickly open the airways. Medications that are best for this include short-acting bronchodilators, such as Albuterol, short-acting beta agonists. Another type of short-acting bronchodilator is an anticholinergic bronchodilator called Ipratropium (this is given if a patient can't tolerated short-acting beta agonists like Albuterol). Theophylline is a bronchodilator but given orally and is NOT for quick relief. Tiotropium is a bronchodilator, as well, but is a LONG-ACTING anticholinergic bronchodilator. Cromolyn is an inhaled nonsteroidal anti-allergy medication that doesn't provide quick relief.
You assist your patient with using their inhaler. The inhaler contains the medication Budesonide. Before administering the inhaler, you will want to connect what device to the inhaler to help decrease the patient from developing ________?
A. Peak flow meter; pneumonia
B. Incentive spirometer; thrush
C. Spacer; thrush
D. Peak flow meter; mouth sores
The answer is C. Budesonide is a corticosteroid. Inhaled corticosteroids can cause thrush. Therefore, it is important to connect a spacer to the inhaler before usage to help prevent the patient from developing thrush and for the patient to gargle and rinse the mouth with water.
A patient with asthma is receiving a nebulizer of Cromolyn. The patient reports a burning sensation in the nose along with a horrible taste in their mouth. As the nurse you will?
A. Immediately stop the nebulizer
B. Re-adjust the nebulizer
C. Call a rapid response because the patient is having a potential anaphylactic reaction to the medication.
D. Reassure the patient this is a temporary side effect of this medication.
The answer is D. Cromolyn can temporarily cause the following side effects during administration: sneezing, burning in nose, itchy/watery eyes, bad taste in mouth. Reassure the patient that these are temporary side effects of this medication.
Your patient's asthma is poorly controlled. The patient reports using their rescue inhaler 4 times a week. In addition, the patient's asthma is not responding to other treatments. The physician orders the patient to take a medication that works by blocking the role of the immunoglobulin IgE. This describes which medication below?
The answer is B. Omalizumab blocks the role of the immunoglobulin IgE, which will decrease the allergic response...hence asthma attacks. It is given subcutaneously and used when a patient's asthma is poorly controlled and other treatments are not working. It is NOT used for quick relief. It is important the patient receives NO LIVE vaccines while receiving this medication
You're providing discharge teaching to a patient who was admitted with asthma. You discussed the early warning signs of an asthma attack and ask the patient to list some of them. Select all the correct early warning signs verbalized by the patient:
A. Easily fatigued with physical activity
B. Reduced peak flow meter reading
C. Chest retractions
E. Wheezing with activity
F. Nighttime coughing
G. No relief with short-acting bronchodilator inhaler
The answers are A, B, E, and F. These are all early warning signs an asthma attack is imminent. Options C, D, and G are signs and symptoms of an active asthma attack that requires medical treatment.
Select all the correct options that represent the pathophysiology of an asthma attack.
A. The smooth muscle surrounding the alveoli constricts, limiting oxygenation.
B. The mucosa lining experiences severe inflammation.
C. The goblet cells within the mucosa lining produce excessive amounts of mucous.
D. Too much carbon dioxide is exhaled due to hyperventilation and the patient experiences respiratory alkalosis.
The answers are B and C. Option A is wrong because the smooth muscle surrounding the BRONCHI AND BRONCHIOLES CONSTRICTS (not alveoli), limiting oxygenation. Option D is wrong become the patient does NOT experience respiratory alkalosis but respiratory ACIDOSIS. During an asthma attack, the patient is unable to exhale fully and air trapping occurs. Therefore, gas exchange does NOT occur, leaving carbon dioxide to build up in the blood and NO oxygen to enter the bloodstream. The CO2 builds up in the system and oxygen saturations drop....hence acidosis. Remember CO2 is acidic.
Your educating a patient how to use a peak flow meter to help monitor the status of their asthma. Which statement by the patient demonstrates they understand how to use the device?
A. "This device will help keep my lungs strong so I don't have another asthma attack."
B. "I will inhale as hard as I can while using the device."
C. "I will use this device at the same time, either in the morning or before bedtime, and compare the readings with my personal best reading."
D. "I will notify the doctor if my peak flow rating is 90% or more than my personal best peak flow."
The answer is C. This option is correct. Option A is wrong because this device monitors how controlled a patient's asthma is and if it is getting worst. It doesn't make the lung stronger. Option B is wrong because the patient exhales as hard as they can onto the device. Option D is wrong because a flow rate of 90% of the personal best peak flow is a good reading.
Select all the following that can trigger an asthma attack:
E. Cold, windy weather
F. Beta agonist
The answers are A, B, D, E, and G. Caffeine has the same properties as theophylline, which is a bronchodilator and is not known to cause asthma. In addition, beta adrenergic blockers that are nonselective (NOT beta agonist...which are used to treat asthma) can cause an asthma attack.
A patient has exercise-induced asthma. Which of the following actions can the patient perform to help prevent an attack during exercise. Select all that apply:
A. Avoid warming up before exercise.
B. Administer a short-acting beta agonist before exercise.
C. Administer a short-acting beta agonist after exercise.
D. Avoid exercising when experiencing a respiratory illness.
The answer are B and D. Option A is wrong because the patient should warm up for at least 10-15 minutes before exercising, and option C is wrong because the beta agonist should be administered BEFORE exercise (not after).
Your patient with asthma is taking Theophylline. Which product below should the patient avoid consuming?
The answer is A. Caffeine has the same properties as Theophylline and can increase the effects the drug.
Which medication below blocks the function of Leukotriene for the treatment of asthma?
The physician orders the patient to start taking Omalizumab. How will you administer this medication as the nurse?
A patient received a nebulizer of Albuterol. What is a side effect of this medication?
D. Feeling cold
A patient is admitted with a chest wound and experiencing extreme dyspnea, tachycardia, and hypoxia. The chest wound is located on the left mid-axillary area of the chest. On assessment, you note there is unequal rise and fall of the chest with absent breath sounds on the left side. You also note a "sucking" sound when the patient inhales and exhales. The patient's chest x-ray shows a pneumothorax. What type of pneumothorax is this known as?
A. Closed pneumothorax
B. Open pneumothorax
C. Tension pneumothorax
D. Spontaneous pneumothorax
The answer is B. This description is of an open pneumothorax. An open pneumothorax happens when there is an opening in the chest wall ( from a gun shot, stabbing etc.) that creates a passage between the outside air and intrapleural space. This allow air to pass back and forth during inspiration and expiration. The body will shunt air through the opening in the chest well instead of the trachea (if the opening on the chest is large enough) which will create a "sucking" sound.
In regards to the patient in the question above, which of the following options below is a nursing intervention you would provide to this patient?
A. Place the patient in supine position
B. Place a non-occlusive dressing over the chest wound
C. Place a sterile occlusive dressing over the chest wound and tape it on three sides
D. Prepare the patient for a thoracentesis
The answer is C. The nursing intervention would be to place a sterile occlusive dressing over the wound and tape it on 3 sides (leaving one side NOT taped). This will allow exhaled air to leave the opening but seal over the opening when inhaling (hence not letting pressure build in the intrapleural space and prevent a tension pneumothorax).
A patient is diagnosed with a primary spontaneous pneumothorax. Which of the following is NOT a correct statement about this type of pneumothorax?
A. It can be caused by the rupture of a pulmonary bleb.
B. It can occur in patients who are young, tall and thin without a history of lung disease.
C. Smoking increases the chances of a patient developing a spontaneous pneumothorax.
D. It is most likely to occur in patients with COPD, asthma, and cystic fibrosis.
The answer is D. All options are correct about primary spontaneous pneumothorax EXCEPT D. This describes SECONDARY spontaneous pneumothorax not primary.
Which of the following is a LATE sign of the development of a tension pneumothorax?
C. Tracheal deviation
The answer is C. With a tension pneumothorax, you will quickly see hypotension, tachycardia, and dyspnea as the mediastinum shifts from the extra pressure in the intrapleural space on the affected side. A late sign of a tension pneumothorax is that the trachea will eventually shift to the unaffected side.
While caring for a patient with a suspected pneumothorax, you note there are several areas on the patient's skin that appear to be "bulging" out. These "bulging" areas are located on the patient's neck, face, and abdomen. On palpation on these areas, you note they feel "crunchy". When charting your findings you would refer to this finding as?
A. Subcutaneous paresthesia
B. Pigment molle
C. Subcutaneous emphysema
C. The answer is C. This known as subcutaneous emphysema or subcutaneous crepitation.
You're providing care to a patient with a pneumothorax who has a chest tube. On assessment of the chest tube system, you note there is no fluctuation of water in the water seal chamber as the patient inhales and exhales. You check the system for kinks and find none. What is your next nursing action?
A. Keep monitoring the patient because this is a normal finding.
B. Increase wall suction to the system until the water fluctuates in the water seal chamber.
C. Assess patient's lung sounds to assess if the affected lung has re-expanded.
D. Notify the physician.
The answer is C. It is normal for the water seal chamber to tidal up and down as the patient breathes in and out. If there is no fluctuation of water in the water seal chamber there may be a kink in the tubing or the lung has re-expanded. Therefore, it is important to check the system for kinks and if there are none then check the patient's lung sounds to see if lung sounds are present on the affected side (hence the lung has re-expanded).
A patient is receiving mechanical ventilation with PEEP. The patient had developed a tension pneumothorax. Select ALL the signs and symptoms that can present with this condition:
B. Jugular Venous Distention
D. Tracheal deviation
The answers are A, B, D, and F. Hypotension, JVD, tracheal deviation, and tachypnea can all be present in a tension pneumothorax. The other options are not usually present.
A patient has a chest tube for treatment of a pneumothorax in the left lung. Which finding during your assessment requires immediate nursing intervention?
A. The water seal chamber has intermittent bubbling.
B. The patient has slight tracheal deviation to the right side.
C. The water seal chamber fluctuates while the patient inhales and exhales.
D. The patient complains of tenderness at the chest tube insertion site.
The answer is B. A patient with a chest tube is at risk for a tension pneumothorax due to the risk of pressure building up in the intrapleural space. Therefore, the nurse would want to monitor the patient for this and if tracheal deviation is present this is a major sign a tension pneumothorax. All the other options are normal findings. The water seal chamber will have intermittent (not excessive) bubbling because of the air that will be leaving the intrapleural space. The water seal chamber will flucutate up and down when the patient breathes in and out, and it is normal for the patient to have tenderness at the insertion site of the chest tube.
Which statement is CORRECT about a tension pneumothorax?
A. This condition happens when an opening to the intrapleural space creates a two-way valve which causes pressure to build up in the space leading to shifting of the mediastinum.
B. A tension pneumothorax is a medical emergency and is treated with needle decompression.
C. Tracheal deviation is an early sign of a tension pneumothorax
D. An open pneumothorax is the only cause of a tension pneumothora
The answer is B. The only correct statement about a tension pneumothorax is option B. Option A is wrong because this condition happens when an opening to the intrapleural space creates a ONE-way (not two-way) valve which causes pressure to build up in the space leading to shifting of the mediastinum. Option C is wrong because tracheal deviation is a LATE (not early) sign of a tension pneumothorax. Option D is wrong because not only can an open pneumothorax cause a tension pneumothorax but a closed or spontaneous pneumothroax can as well.
A patient receiving treatment for a pneumothorax calls on the call light to tell you something is wrong with their chest tube. When you arrive to the room you note that the drainage system has fallen on its side, and there is a large crack in the system. What is your next PRIORITY?
A. Place the patient in supine position and clamp the tubing.
B. Notify the physician immediately.
C. Disconnect the drainage system and get a new one.
D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.
The answer is D. A new system needs to be obtained, however, in order to maintain a water seal until the new system arrives you will need to place the tubing 1 inch in sterile water or sterile saline to regain a water seal.
Select ALL the options that are TRUE about chronic bronchitis and emphysema:
A. Patients with chronic bronchitis have the ability to fully exhale but have limited airflow.
B. Emphysema and chronic bronchitis are irreversible.
C. An incentive spirometer is used to diagnose both chronic bronchitis and emphysema.
D. Patients with chronic bronchitis are sometimes referred to as "blue bloaters, while patients with emphysema are sometimes referred to as "pink puffers".
The answers are B and D. Option A is wrong because patients with chronic bronchitis DON'T have the ability to fully exhale AND have limited airflow as well. Option C is wrong because SPRIOMETRY is used to diagnose chronic bronchitis and emphysema.
True or False: Patients with emphysema experience hypoventilation as a compensatory mechanism to help increase oxygen levels and decrease carbon dioxide levels in the body.
The answer is FALSE. Patients with emphysema experience HYPERventilation as a compensatory mechanism to help increase oxygen levels and decrease carbon dioxide levels in the body.
Which of the following is most commonly found in a patient with emphysema?
A. Barrel chest
C. V/Q mismatch
D. Excessive productive cough
The answer is A. Cyanosis, V/Q mismatch, and excessive productive cough are found in chronic bronchitis.
In which of the following conditions below is there a matched V/Q defect?
A. Chronic Bronchitis
The answer is B. Emphysema patients have a matched V/Q defect mainly due to a damaged capillary bed where there is poor ventilation (V) and poor perfusion (Q)...hence there is matched ventilation and perfusion.
True or False: V/Q mismatch is found in chronic bronchitis.
The answer is TRUE. Patients with chronic bronchitis have a mismatched V/Q because the capillary bed works properly (this is not the case in emphysema) however ventilation is poor due to obstruction from mucous and inflammed bronchioles. So, there is poor ventilation but sufficient perfusion.....hence it is mismatched.
Which of the following is NOT a treatment for chronic bronchitis or emphysema?
The answer is D. Metoprolol is a beta blocker used to treat heart conditions. Albuterol, Spirvia, and Theophylline are types of bronchodilators which are used to treat chronic bronchitis & emphysema.
In which of the following conditions below do the alveolar sacs lose elasticity which can lead to "air-trapping":
A. Chronic Bronchitis
Patients with chronic bronchitis and emphysema can MOST COMMONLY experience what type of acid-base imbalance?
A. High oxygen level and high carbon dioxide level
B. Low oxygen level and low carbon dioxide level
C. High oxygen level and low carbon dioxide level
D. Low oxygen level and high carbon dioxide level
D. Low oxygen level and high carbon dioxide level
***Low oxygen levels and high carbon dioxide levels (respiratory acidosis) are found in patients with chronic bronchitis and emphyesma.
Which of the following is NOT a sign and symptom of chronic bronchitis?
A. Productive cough
B. Shortness of breath
D. Barrel chest
D. Barrel chest
***Barrel chest is most commonly found in patients with emphysema.
True or False: Hyperinflation of the lungs leads to diaphragm flattening.
A patient is presenting with mild symptoms of pneumonia. The doctor diagnoses the patient with "walking pneumonia". From your nursing knowledge, you know this type of pneumonia is caused by what type of infectious agent?
B. Streptococcus pneumoniae
C. Mycoplasma pneumoniae
A patient was admitted to the intensive care unit 48 hours ago for treatment of a gunshot wound. The patient has recently developed a productive cough and a fever of 104.3 'F. The patient is breathing on their own and doesn't require mechanical ventilation. On assessment, you note coarse crackles in the right lower lobe. A chest x-ray shows infiltrates with consolidation in the right lower lobe. Based on this specific patient scenario, this is known as what type of pneumonia?
A. Aspiration pneumonia
B. Ventilator acquired pneumonia
C. Hospital-acquired pneumonia
D. Community-acquired pneumonia
The answer is C. The key words to let you know this is hospital-acquired pneumonia and NOT community-acquired is that the patient was admitted with a gunshot wound AND has been hospitalized for 48 hours. If the patient presents with signs and symptoms of pneumonia 48-72 hours after admission it is classified as hospital-acquired. This is not ventilator acquired because the patient is not on mechanical ventilation and there is nothing in the scenario that leads us to think it is aspiration pneumonia.
Which of the following patients are MOST at risk for developing pneumonia? Select-all-that-apply:
A. A 53 year old female recovering from abdominal surgery.
B. A 69 year old patient who recently received the pneumococcal conjugate vaccine.
C. A 42 year old male with COPD and is on continuous oxygen via nasal cannula.
D. A 8 month old with RSV (respiratory syncytial virus) infection.
The answers are A, C, and D. Risks factors for pneumonia include: recent surgery, lung disorder (ex: COPD), and viral infection (ex: RSV). Option B is a preventive measure in preventing pneumonia.
You're caring for a patient with pneumonia. The patient has just started treatment for pneumonia and is still experiencing hypoxemia. You know that respiratory acidosis is very common with patients with pneumonia. Which arterial blood gas readings below represent respiratory acidosis that is NOT compensated?
A. pH 7.29, PaCO2 55, HCO3 23, PO2 85
B. pH 7.48, PaCO2 35, HCO3 22, PO2 85
C. pH 7.20, PaCO2 20, HCO3 28, PO2 85
D. pH 7.55, PaCO 63, HCO3 19, PO2 85
The answer is A. This is the only ABG result that represents respiratory acidosis.
Which of the following are typical signs and symptoms of pneumonia? Select-all-that-apply:
B. Coarse crackles
C. Oxygen saturation less than 90%
D. Non-productive, nagging cough
E. Elevated white blood cells
F. Low PCO2 of less than 35
The answers are B, C, E, and G. These are typical signs and symptoms of pneumonia. Stridor is not very common. A PRODUCTIVE cough that can be nagging is very typical, and there is usually a HIGH PCO2 of 45 or greater due to the lungs retaining carbon dioxide.
You're educating a patient with pneumonia on how to deep breathe by using an incentive spirometer. Which of the following is the correct way to use this device?
A. Encourage the patient to use it twice a day.
B. The patient exhales into the device rapidly and then coughs.
C. The patient inhales slowly from the device until no longer able, and then holds breath for 6 seconds and exhales.
D. The patient rapidly inhales 10 times from the device and then exhales for 6 seconds.
The answer is C. The patient will inhale slowly from the device until no longer able, and then hold breath for 6 seconds and exhale. The patient should use the device at least 10 times every 1-2 hours while awake
A 72 year-old male patient who is diagnosed with bilateral lower lobe pneumonia is admitted to your unit. The patient has a history of systolic heart failure and arthritis. On assessment, you note the patient has a respiratory rate of 21, oxygen saturation 93% on 2L nasal cannula, is alert & oriented, and has a productive cough with green/yellowish sputum. Which of the following nursing interventions will you provide to this patient based on your assessment findings and the patient's diagnosis? Select-all-that-apply:
A. Keep head-of-the-bed less than 30 degrees at all times.
B. Collect sputum cultures.
C. Encourage 3L of fluids a day to keep secretions thin.
E. Provide education about receiving the Pneumovax vaccine every 5 years.
The answers are B and E. You would not keep the head-of-bed less than 30 degrees because this impedes breathing and increases the risk of aspiration. Also, since the patient has systolic heart failure you would NOT encourage 3L of fluids per day because the patient would not tolerate the extra fluid. However, in normal situations (if a patient does not have heart failure etc.) you would want to encourage fluids to keep secretions thin.
You're providing discharge teaching to a patient who was admitted for pneumonia. You are discussing measures the patient can take to prevent pneumonia. Which of the following statements by the patient indicates they did NOT understand your education material?
A. "I'll use hand sanitizer regularly while I'm out in public."
B. "It is important I don't receive the Pneumovax vaccine since I'm already immune to pneumonia."
C. "I will try to avoid large crowds of people during the peak of flu season."
D. "It is important I try to quit smoking."
The answer is B. All the other options are correct statements regarding the prevention of pneumonia. However, option B is incorrect because although the patient has had pneumonia they should still receive the Pneumovax vaccine to prevent other forms of pneumonia.
A patient is admitted with pneumonia. Sputum cultures show that the patient is infected with a gram positive bacterium. The patient is allergic to Penicillin. Which medication would the patient most likely be prescribed?
C. Pencillin G
The answer is A. Marcolides are used to treat gram-positive bacterial infections and are used in patients with penicillin allergies. Penicillin G is a penicillin antibiotic and would not be used because of the patient's allergy. In addition, usually if a patient is allergic to penicillin there is an increased chance they are allergic to cephalosporin....therefore it would not be used as well.
A 25 year-old female patient with pneumonia is prescribed Doxycycline. What question is important to ask the patient prior to administration of this medication?
A. "Do you take birth control pills?"
B. "Are you allergic to Penicillin?"
C. "Are you allergic to eggs?"
D. "Do you have a history of diabetes?"
The answer is A. Doxycycline is part of the Tetracycline antibiotic family. This medication can decrease the effectiveness of birth control pills. Since the patient is female and within child-bearing age, the question should be asked if she is taking birth control pills so you can educate her on using another form of birth control to prevent pregnancy.
Select all the medications used to treat pneumonia that are narrow-spectrum?
The answers are A and D. These are the only options that are considered narrow spectrum antibiotics which means they target specific family of bacteria.
A patient is admitted with rupture of the Achilles tendon. The patient was recently treated with antibiotics for pneumonia. Which of the following medications below can cause this adverse effect?
The answer is B. Fluroquinolones can cause tendon rupture along with c.diff infection and cardiac arrhythmia such as prolonged QT interval.
A patient is being discharged home on Doxycyline for treatment of pneumonia. Which statement by the patient indicates they understood your education material?
A. "I will wear sunscreen when outdoors."
B. "I will avoid green leafy vegetables while taking this medication."
C. "I will monitor my blood glucose regularly due to the side effects of hypoglycemia."
D. "I will take this medication with a full glass of milk."
The answer is A. Doxycycline increases the skin's sensitivity to the sun, so the patient should wear sunscreen when outdoors. Also, the patient should not take this medication with antacids or milk products because this affects the absorption of the medication. Options B and C are incorrect statements.
You are about to hang a bag of intravenous Vancomycin for a patient who has severe pneumonia. Which statement by the patient causes you to hold the bag of Vancomycin and notify the doctor immediately?
A. "I'm seeing yellow halos around the light."
B. "My mouth tastes like metal."
C. "My head hurts."
D. "I have this constant ringing in my ears."
The answer is D. Vancomycin can cause ototoxicity. Roaring or ringing in the ears are a possible sign/symptom of this adverse effect. Option A happens with Digoxin toxicity. Options B and C are vague and are not a common adverse reaction to Vancomycin.
You're providing care to a patient who is being treated for aspiration pneumonia. The patient is on a 100% non-rebreather mask. Which finding below is a HALLMARK sign and symptom that the patient is developing acute respiratory distress syndrome (ARDS)?
A. The patient is experiencing bradypnea.
B. The patient is tired and confused.
C. The patient's PaO2 remains at 45 mmHg.
D. The patient's blood pressure is 180/96.
The answer is C. A hallmark sign and symptom found in ARDS is refractory hypoxemia. This is where that although the patient is receiving a high amount of oxygen (here a 100% non-rebreather mask) the patient is STILL hypoxic. Option C is the answer because it states the patient's arterial oxygen level is remaining at 45 mmHg (a normal is 80 mmHg but when treating patients with ARDS a goal is at least 60 mmHg). Yes, the patient can be tired and confused from a low oxygen level BUT this question wants to know the HALLMARK sign and symptom.
You're teaching a class on critical care concepts to a group of new nurses. You're discussing the topic of acute respiratory distress syndrome (ARDS). At the beginning of the lecture, you assess the new nurses understanding about this condition. Which statement by a new nurse demonstrates he understands the condition?
A. "This condition develops because the exocrine glands start to work incorrectly leading to thick, copious mucous to collect in the alveoli sacs."
B. "ARDS is a pulmonary disease that gradually causes chronic obstruction of airflow from the lungs."
C. "Acute respiratory distress syndrome occurs due to the collapsing of a lung because air has accumulated in the pleural space."
D. "This condition develops because alveolar capillary membrane permeability has changed leading to fluid collecting in the alveoli sacs."
The answer is D. ARDS is a type of respiratory failure that occurs when the capillary membrane that surrounds the alveoli sac becomes damaged, which causes fluid to leak into the alveoli sac. Option A describes cystic fibrosis, option B describes COPD, and option C describes a pneumothorax.
During the exudative phase of acute respiratory distress syndrome (ARDS), the patient's lung cells that produce surfactant have become damaged. As the nurse you know this will lead to?
C. upper airway blockage
D. pulmonary edema
B- The answer is B. Surfactant decreases surface tension in the lungs. Therefore, the alveoli sacs will stay stable when a person exhales (hence the sac won't collapse). If there is a decrease in surfactant production this creates an unpredictable alveoli sac that can easily collapse, hence a condition called ATELETASIS will occur (collapse of the lung tissue) when there is a decrease production in surfactant.
A patient has been hospitalized in the ICU for a near drowning event. The patient's respiratory function has been deteriorating over the last 24 hours. The physician suspects acute respiratory distress syndrome. A STAT chest x-ray is ordered. What finding on the chest x-ray is indicative of ARDS?
A. infiltrates only on the upper lobes
B. enlargement of the heart with bilateral lower lobe infiltrates
C. white-out infiltrates bilaterally
D. normal chest x-ray
The answer is C. This is a finding found in ARDS....pronounce white-out infiltrates bilaterally.
You're providing care to a patient who was just transferred to your unit for the treatment of ARDS. The patient is in the exudative phase. The patient is ordered arterial blood gases. The results are back. Which results are expected during this early phase of acute respiratory distress syndrome that correlates with this diagnosis?
A. PaO2 40, pH 7.59, PaCO2 30, HCO3 23
B. PaO2 85, pH 7.42, PaCO2 37, HCO3 26
C. PaO2 50, pH 7.20, PaCO2 48, HCO3 29
D. PaO2 55, pH 7.26, PaCO2 58, HCO3 19
The answer is A. This option demonstrates respiratory alkalosis. In the early stages of ARDS (exudative) the patient will start to enter in respiratory alkalosis. The patient starts to have tachypnea (the body's way of trying to increase the oxygen level but it can't). They will have a very low PaO2 level (normal PaO2 is 80 mmHg), the blood pH will become high (normal is 7.35-7.45) (alkalotic). In the late stage, the patient can enter into respiratory acidosis.
A patient is on mechanical ventilation with PEEP (positive end-expiratory pressure). Which finding below indicates the patient is developing a complication related to their therapy and requires immediate treatment?
A. HCO3 26 mmHg
B. Blood pressure 70/45
C. PaO2 80 mmHg
D. PaCO2 38 mmHg
The answer is B. Mechanical ventilation with PEEP can cause issues with intrathoracic pressure and decrease the cardiac output (watch out for a low blood pressure) along with hyperinflation of the lungs (possible pneumothorax or subq emphysema which is air that escapes into the skin because the lungs are leaking air).
You are providing care to a patient with a chest tube. On assessment of the drainage system, you note continuous bubbling in the water seal chamber and oscillation. Which of the following is the CORRECT nursing intervention for this type of finding?
A. Reposition the patient because the tubing is kinked.
B. Continue to monitor the drainage system.
C. Increase the suction to the drainage system until the bubbling stops.
D. Check the drainage system for an air leak.
D- Continuous bubbling in the water seal chamber is NOT normal and indicates there is an air leak. However, oscillation of the water in the water seal chamber is normal.
patient is receiving positive pressure mechanical ventilation and has a chest tube. When assessing the water seal chamber what do you expect to find?
A. The water in the chamber will increase during inspiration and decrease during expiration.
B. There will be continuous bubbling noted in the chamber.
C. The water in the chamber will decrease during inspiration and increase during expiration.
D. The water in the chamber will not move.
C- When a patient is receiving mechanical ventilation the water in the water seal chamber will oscillate oppositely than if the patient were breathing on their own. Therefore, the water in the chamber will decrease during inspiration and increase during expiration.
What type of chest tube system does this statement describe? This chest drainage system has no water column to control suction but uses a suction monitor bellow that balances the wall suction and you can adjust water suction pressure using the rotary suction dial on the side of the system. It allows for higher suction pressure levels, has no bubbling sounds, and water does not evaporate from it as with other systems.
A. Mediastinal chest tube system
B. Dry suction chest tube system
C. Wet suction chest tube system
D. Dry-Wet suction chest tube system
The patient in room 2569 calls on the call light to tell you something is wrong with his chest tube. When you arrive to the room you note that the drainage system has fallen on its side and is leaking drainage onto the floor from a crack in the system. What is your next PRIORITY?
A. Place the patient in supine position and clamp the tubing.
B. Notify the physician immediately.
C. Disconnect the drainage system and get a new one.
D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.
You're assessing a patient who is post-opt from a chest tube insertion. On assessment, you note there is 50 cc of serosanguinous fluid in the drainage chamber, fluctuation of water in the water seal chamber when the patient breathes in and out, and bubbling in the suction control chamber. Which of the following is the most appropriate nursing intervention?
A. Document your findings as normal.
B. Assess for an air leak due to bubbling noted in the suction chamber.
C. Notify the physician about the drainage.
D. Milk the tubing to ensure patency of the tubes.
A patient is recovering from a pneumothorax and has a chest tube present. Which of the following is an appropriate finding when assessing the chest tube drainage system?
A. Intermittent bubbling may be noted in the water seal chamber.
B. 200 cc of drainage per hour is expected during recovery of a pneumothorax.
C. The chest tube is positioned at the patient's chest level to facilitate drainage.
D. All of these options are appropriate findings.
The answer is A. It is normal to find intermittent (NOT CONTINUOUS) bubbling in the water seal chamber if the patient is recovery from a pneumothorax. Remember that a pneumothorax is an AIR leak between the lung and chest wall....therefore air will escape into the water seal chamber causing intermittent bubbles.
While helping a patient with a chest tube reposition in the bed, the chest tube becomes dislodged. What is your immediate nursing intervention?
A. Stay with the patient and monitor their vital signs while another nurse notifies the physician.
B. Place a sterile dressing over the site and tape it on three sides and notify the physician.
C. Attempt to re-insert the tube.
D. Keep the site open to air and notify the physician.
B. Place a sterile dressing over the site and tape it on three sides and notify the physician.
A patient is about to have their chest tube removed by the physician. As the nurse assisting with the removal, which of the following actions will you perform? Select-all-that-apply:
A. Educate the patient how to take a deep breath out and inhale rapidly while the tube in being removed.
B. Gather supplies needed which will include a petroleum gauze dressing per physician preference.
C. Place the patient in Semi-Fowler's position.
D. Have the patient take a deep breath, exhale, and bear down during removal of the tube.
E. Pre-medicate prior to removal as ordered by the physician.
F. Place the patient is prone position after removal.
B, c, D, E
A patient with a chest tube has no fluctuation of water in the water seal chamber. What could be the cause of this?
A. This is an expected finding.
B. The lung may have re-expanded or there is a kink in the system.
C. The system is broken and needs to be replaced.
D. There is an air leak in the tubing.
True or False: During inhalation, the diaphragm contracts upward to create positive pressure in the chest which allows the body to inhale oxygen.
The answer is FALSE. During inhalation, the diaphragm contracts DOWNWARD to create NEGATIVE pressure in the chest which allows the body to inhale oxygen.
What is a peak flow meter and what do you teach the patient?
It measures the highest volume of airflow during forced expiration
Take deep breath, place lips around the mouth piece and blow hard and fast out
What to teach pt to prevent pnemonia?
- PNA vaccine every 5 years
65 years and older
19-64 who are immune compromised
This occurs when a normal or elevated blood sugar at bedtime, a decrease at 2-3am to hypoglycemic levels and subsequent increased blood sugar in AM. This is called?
TX: decrease evening dose of intermediate acting insulin, or have bedtime snack
What does a diabetic diet consist of?
Balanced cars, proteins and fats
Decrease intake of high caloric foods
Family teaching with unconscious patient?
Inject 1mg of glucagon SQ or IM
Nursing diagnosis for Diabetes:
- actual FVD
- altered nutrition
- potential for infection
- knowledge deficit
Foot care R/T diabetic patients:
- podiatrist for nail clippings
- cotton socks
- proper fitting shoes
- no chemicals
- nothing that cuts circulation
- inspect feet daily
Rationale for increased risk of cardiovascular disease in diabetic pt:
Overtime, increase blood glucose can damage blood vessels and the nerves that control your heart and blood vessels
Lab results that show compliance with diabetes:
A1C- 6-7% shows good control
Assessment of pt with pneumothorax:
- Chest pain; cyanosis
- overt tachycardia and tachypnea
- low BP
- low SpO2
- absent breath sounds on unaffected side
- subq emphysema
- expansion of chest unequal
- air hunger, agitation
- profuse diaphoresis
What is a chest tube and what is it used for?
- tube inserted into pleural space to remove air or fluid and to help lung re-expand
- Used for pneumothorax and pleural effusion
Assessment of resolved pneumothorax:
If water no longer fluctuating this could mean lung re-expand
Water seal AKA wet suction
- Requires sterile fluid be instilled into water seal and suction chambers
- has positive and negative pressure release valves
- intermittent bubbling indicates that system functioning properly
Best classifications of medications for asthma attack?
Bronchodilators- beta agonist
SABA- "Albuterol" fast relief
Rapid, onset, severe persistent asthma that does not respond to conventional therapy is known as what?
Nursing interventions for pt with emphysema:
- monitor respiratory system- lung sounds, sputum production
- monitor o2 sat- keep o2 at 88-93%
- administer o2 and breathing to per order
- teaches pursed lip breathing
- nutrition needs (increase calories and protein)
- vaccines up to date
- how to take meds and side effects
Pursed lip breathing teaching:
Breathe in slow through nose for 2 counts, keeping mouth closed. Take a normal breath, pucker or "purse" lips as if your whistling when breathing out slowly
Ethambutol- monitor vision changes- can cause inflamed optic nerve or peripheral neuropathy
Isoniazid - monitor liver function and neurotoxicity, decreases vit b 6 levels
Pyrazinamide- monitor Uric acid, liver, and kidney function, GI upset common
Rifampin- educate on body fluids turning orange
Streptomycin- monitor hearing- ototoxicity
Room placement for active TB pts:
Negative pressure room
When is a pt with TB not contagious?
- 3 negative sputum cultures
- 3 weeks of meds
- S/sx improving
Rationale for suction on chest tube?
Collects drainage and prevents air from re-entering
Treatment for dislodged chest tube?
Cover with sterile dressing, tape on 3 sides
Rationale for tracheal suctioning:
Performed to help clear airway secretions
What actions would you implement to control anxiety?
- explain procedure
- means of communication
- call light within reach
Preventing aspiration PNA:
Exercise and diabetes:
- check ketones- if positive and blood sugar >250, do not exercise
- check BS before, during, and after
- eat 15g carb snack prior to exercise
What is chest physiotherapy?
Includes postural drainage, chest percussion, vibration and breathing retraining
Goals of CPT: remove bronchial secretions, improve ventilation and increase efficiency of respiratory muscles
The nurse administers theophylline (Theo-Dur) to a client. To evaluate the effectiveness of this medication, which of the following drug actions should the nurse anticipate?
1. Suppression of the client's respiratory infection.
2. Decrease in bronchial secretions.
3. Relaxation of bronchial smooth muscle.
4. Thinning of tenacious, purulent sputum.
Theophylline (Theo-Dur) is a bronchodilator that is administered to relax airways and decrease dyspnea. Theophylline is not used to treat infections and does not decrease or thin secretions.
A nurse notes that a client has kyphosis and generalized muscle atrophy. Which of the following problems is a priority when the nurse develops a nursing plan of care?
3. Ineffective coughing and deep breathing.
4. Difficulty chewing solid foods.
In kyphosis, the thoracic spine bends forward with convexity of the curve in a posterior direction, making effective coughing and deep breathing difficult. Although the client may develop other problems because respiratory status deteriorates when pulmonary secretions are not adequately cleared from airways, ineffective coughing and deep breathing should receive priority attention.
Which information will the nurse include in the patient teaching plan for a pt receiving rifampin for treatment of TB?
Your urine, sweat and tears will be orange colored
When teaching the patient who is receiving standard multi drug therapy for TB about possible toxic effects of the antitubercular medications, the nurse will give instructions to notify the health care provider if the pt develops:
Yellow tinged skin- non infectious hepatitis is a toxic effect of isoniazid (INH), rifampin and pyrazinamide
A patient who has a right-sided chest tube following a thoracotomy has continuous bubbling in the suction-control chamber of the collection device. The most appropriate action by the nurse is to :
A. Document the presence of a large air leak
B. Obtain and attach a new collection device
C. Notify the surgeon of a possible pneumothorax
D. Take no further action with the collection device
These are used to enhance deposition of the medication in the lung and help patient coordinate activation of the pMDI with inspiration:
Given yearly as an injection with inactivated virus
These are used routinely in patients with chronic respiratory disorders to aid diagnosis
Performed to assess the extent of dysfunction, response to therapy, and as screening tests in certain jobs
Used prior to surgery for thoracic and upper abd surgery
Test done by using spirometer that has a volume collecting device attached to a recorder
Pulmonary function tests
Exercise and asthma
- warm up 10-15 mins prior to exercising
- take short acting inhaler before exercise
- no exercise when sick
- wear scarf when cold, breath through nose
This device measures the highest volume of airflow during forced expiration.
Have pt take a deep breath, place lips around mouth piece and blow hard and fast out
Green= 80-100% personal best
Yellow= 60-80% personal best
Red= < 60% personal best
Prevention of PNA:
PNA vaccine every 5 years
2 TYPES OF VACCINE:
PCV13- protects against 13 types of pneumococcal bacteria
- given to adults >65 y/o and 19-64 who are immunocompromised
PPSV23- protects against 23 types of bacteria
- given same as above
- Provide resources for pt to take home when ready to quit
- counseling, community based cessation classes
- printed educational materials
- meds to aid in help quitting
Inadequate excretion of CO2 with inadequate ventilation
- can cause tachycardia, dyspnea with rapid shallow respiration's, increased BP, mental cloudiness, decreased deep tendon reflexes, diaphoresis, warm flushed skin, hyperkalemia, nausea, vomiting
PH= < 7.35
caused by hyperventilation; "blow off" CO2, H+ decreases, pH increases
PH= > 7.45
WHAT TO LOOK FOR:
- dyspnea and increased respiration's
- possible EKG changes ( hypokalemia, hypocalcemia, hypomagnesemia)
Ph- less than 7.35
HCO3= less than 22
- depresses the CNS and, if untreated, can lead to arrhythmia, coma, and cardia arrest
What to look for:
- signs and symptoms of hyperkalemia ( abd cramps, diarrhea, muscle weakness)
- decreased DTRs
- warm dry skin
- anorexia, nausea, and vomiting
- confusion and decreased LOC
- dull headache
- kussmauls respiration's (rapid, deep)
Lab tests show:
ECG changes due to hyperkalemia (TALL T WAVES, Prolonged PR intervals, wide QRS complexes)
pH > 7.45
HCO3 > 26
What cases it?
- hypokalemia (use of diuretics, or other drugs)
- excessive acid loss from GI tract ( vomiting, pyloric stenosis, nasogastric suctioning)
- Cushing disease
- overcorrection of acidosis
- kidney disease
What to look for:
- nausea and vomiting
- hyperactive reflexes, muscle twitching and tetany
- apathy and confusion
Nursing Diagnosis for kyphosis and muscle atrophy R/T oxygenation:
Impaired airway R/T decreased lung capacity/expansion
PNA- Ineffective airway clearance- INTERVENTIONS
- increased HOB
- cough, deep breathing
- use incentive spirometer
Nursing diagnosis for chronic bronchitis:
Impaired gas exchange R/T obstructed airways
Ineffective airway clearance
Highest priority for tension pneumothorax:
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