N364 Respiratory

If you have had a chronic nagging cough for 6-8 weeks with an unknown cause what should you be thinking might be the cause

- TB - pertussis - chronic bronchitis

what are the signs/symptoms of flu

- abrupt onset - fever (not in everyone) - cough - runny/stuffy nose - headache - fatigue, chills, body aches - maybe diarrhea and vomiting

what are some characteristics about the dyspnea/SOB that you would want to know when assessing your patient?

- acute (may be recurrent) or chronic - important to determine circumstances when it occurs - associated symptoms - want to rule out pneumo and PE

what is the difference between acute, subacute, and chronic cough? what other characteristics of coughs are important to note?

- acute less than 3 wks - subacute 3-8 wks - chronic more than 8 wks Is it productive or non-productive? are there associated symptoms with the cough?

describe influenza... what is it caused by? when does it occur? how long is the incubation period? how long does it last?

- acute respiratory illness caused by influenza A or B viruses occuring in outbreaks and epidemics H1N1 is a type of A virus - mainly occurs in winter season - 1-4 day incubation period - self-limiting in general complication (uncomplicated) - symptoms may last 3-4 days but cough and malaise can last 1-2 weeks

who should get the pneumonia vaccine

- age 65 and older - high risk persons age 2-64; chronic illness (heart, lung, HIV, or compromised immune system) - current smokers

what characteristics of sputum should you note during assessment?

- amount - color - character (serous, mucoid, purulent) - viscosity (is it thick?) - odor, taste - inspect - sputum culture? (great in pneumonia if they aren't responding to current antibiotic therapy)

the gold standard of diagnosis in ______________ and ______________ are pulmonary function tests (PFT)

- asthma - COPD

why don't we do ABG in asthma

- b/c it is not an issue with CO2 build up it is a problem with inflammation and bronchoconstriction

possible complications associated with the flu

- bacterial pneumonia - ear infection - sinusitis - dehydration - worsening of chronic medical conditions CHF, DM, asthma, COPD, HIV

what things will you find during assessment for someone with pneumonia

- chills - increased temp - may have cough - tachypnea - pleuritic CP - back pain on side of pneumonia - rhonchi and wheezes - accessory muscle use - mental status changes (more common among elderly - b/c of hypoxia or CO2 buildup)

Oral cancer risk factors

- cigar, pipe smoker, chewing tobacco and snuff users - alcohol potentiates effect - vapers - make sure you get a really good social history

medications for cough

- codeine - tesalon pearls

what are the physical findings of the flu found upon assessment

- elevated temp - tachycardic (rapid pulse) - will improve as temp decreases - flushed skin - watery eyes - clear nasal dranage w/ minimal to moderate nasal obstruction - minimal pharyngeal erythema - tender anterior cervical nodes - non-productive cough - usually clear breath sounds - muscles tender upon palpation

what should you check for peripheral cyanosis?

- fingers - toes - pulses - capillary refill

what are warning signs of oral cancer

- hoarsness that doesn't go away - leukoplakia (white patches on tongue/throat) - erythroplakia (red patches on tongue/throat) *cannot be removed like thrush

when you hear wheezing what should you think

- inflammation - bronchoconstriction

what should you do if your patient has acute SOB

- listen to breath sounds - put on O2 if needed - neb if wheezing - check temp for infection - check labs - stat portable CXR - possible ABG

what medications/interventions can help with symptom relief related to the common cold? what should they not take if they have high BP?

- nettipot - humidifiers - antihistamines (decrease inflammation and opening airways) - nasal spray (addictive b/c of immediate symptom relief but can lead to rebound congestion) - if they have high BP be careful what they take they shouldn't take sudaphed

where is central cyanosis usually seen?

- nose - ears - sometimes around the mouth

If someone smokes what should you calculate? how is this done?

- pack per year history - amount smoked x time in years 2 ppd x 10 years = 20 pk year hx - this isn't always super accurate b/c they may smoke a variable amount

what is used in prevention of community acquired pneumonia or CAP

- pneumococcal vaccine (all adults over 65) - influenza vaccine

CXR will show you

- pnuemothorax - pulmonary edema if lungs are full enough - cardiomegally (heart failure) - atelectasis - pleural effusion - pneumonia

ABG are used when

- pts. with respiratory failure - COPD

what might cause hemoptysis

- pulmonary edema - esophageal varicies

Diagnostic tools commonly used in respiratory diagnosis

- radiological (CXR, CT scan, ventilation perfusion scan) - arterial blood gases - sputum analysis

what does cyanosis reflect? when should you pick up on cyanosis?

- reflects unsaturated Hgb 5-6 gms - you should pick up during peripheral cyanosis you should never have a patient with central cyanosis b/c you should have caught it earlier

what are the main etiologies of dyspnea?

- respiratory origin - cardiac origin - psychogenic origin (anxiety)

How to get an adequate respiratory history... what aspects of the history do you need to focus on?

- social history and occupational history are key b/c they may be exposed to environmental factors that affect the respiratory system - miners - hair dressers w/ aerosol hairspray - inhalation of aerosol products - family hx of lung cancer and asthma (genetic predisposition) - do they have seasonal allergies

what do pulmonary function tests do/tell us?

- spirometry: measures rate lung changes volume during forced breathing - flow and volumes: dynamic and static - gas exchange - determines if obstructive, restrictive, upper airway, neuromuscular disease pattern, obesity

what are the cardinal signs and symptoms of respiratory disease

- sputum - dyspnea/SOB - hemoptysis - wheezing - cyanosis - pleural effusion - chest pain

how is pneumonia immediately treated?

- start with IV broad spectrum antibiotic and obtain sputum culture for a more specific antibiotic therapy especially if they aren't responding to the broad spectrum - always start treatment right away but sometimes you may need to change the antibiotic

who often is the most sick with the flu and why?

- the very old and very young - dehydration, comorbidities, weakened immune systems OR secondary conditions to flu such as pneumonia or bacterial infection (sinus infection)

what are common issues with oral-laryngeal cancer

- the voice/speaking/communicating - come up with a way to facilitate this for the patient - they may have their voicebox removed or may just not be able to talk for some time - make sure they have a way to communicate - rehab for swallowing/eating

what do we do for patients with the flu?

- tylenol for fever (101.5 and up usually) - antiviral drugs to shorten the course of the flu by 1-2 days - supportive/symptom management

what are warning signs of laryngeal cancer

- varies depending on the region - hoarseness or pain swallowing - SOB w/ tumors obstructing airway

If patient has a possible PE but shouldn't have contrast dye associated with the CT what other scan can they have to diagnose the PE? why might the person not be able to have the contrast dye?

- ventillation perfusion scan - allergy, on metformin, renal failure, high creatinine

what is the worst thing when it comes to wheezing

- when you hear wheezing and then all of a sudden it stops - this would mean full bronchoconstriction and occlusion

when attempting to diagnose the flu what are common risk factors?

- working in environments with sick people - working with children - did they get the flu shot?

2. The nurse should identify which high-risk patients in the absence of a positive influenza laboratory test? Select all that apply. a. 86-year-old female with diabetes b. 39-year-old male construction worker c. 41-year-old male university professor d. 26-year-old daycare employee e. 50-year-old patient who is positive for human immunodeficiency virus

A D E

2. The nurse expects which initial assessment findings when a patient is admitted with a diagnosis of an acute asthma attack? Select all that apply. a. Wheezing b. Decreased pulse rate c. No use of accessory muscles of respiration d. Increased anxiety e. Inability to speak in full sentences

A DE

5. Which instructions should the nurse include in the discharge teaching plan of a patient newly diagnosed with asthma? Select all that apply. a. Pursed-lip breathing b. Possible triggers c. Signs and symptoms d. Using the incentive spirometer e. Using a peak flow meter

A B C E

5. The nurse should ensure that which reversal agent is readily available in case of active bleeding while a patient is receiving a heparin infusion? a. Vitamin K b. Protamine sulfate c. Flumazenil d. Naloxone

B

2. Which of these treatments would the nurse most likely expect to be prescribed for a patient who is diagnosed with influenza? Select all that apply. a. Antibiotics within first 48 hours b. Antivirals within 24 to 48 hours of symptom onset c. Adequate fluid intake to avoid dehydration d. Antipyretics and analgesics for fever and body aches

B C D

2. Which nursing actions are appropriate when caring for a patient diagnosed with tuberculosis? Select all that apply. a. Place on droplet precautions b. Humidify oxygen when administered c. Request dietary consult d. Offer family members N95 masks e. Medication teaching

B C E

4. A patient treated for a pulmonary embolism is being discharged from the hospital. Which patient teaching should the nurse include in the teaching plan? Select all that apply. a. Lab tests to check oral heparin effectiveness b. Exercise regimen recommended by provider c. Smoking cessation therapies or support group d. Diet rich in saturated fat e. Take prescribed medication at appropriate time

B C E

5. Which nursing interventions are recommended when caring for a patient who is diagnosed with influenza? Select all that apply. a. Placing patient in supine position b. Administering humidified oxygen c. Encouraging frequent ambulation d. Increasing fluid intake e. Obtaining cultures after antibiotics given

B D

2. Which of the following is the primary risk factor for pulmonary embolism? a. Smoking b. Heart disease c. Deep vein thrombosis d. Malignancy

C

3. The nurse should include which priority preventive measures when teaching a group of adults about preventing the spread of tuberculosis? a. Handwashing b. Annual vaccination c. Isolation d. Covering mouth when coughing

C

3. The nurse suspects a patient may be suffering from influenza when the patient complains of which symptoms? Select all that apply. a. Restlessness b. Mild rhinitis c. Myalgia d. Fever e. Sore throat

C D E

4. A newly diagnosed patient with asthma has recovered from an acute attack. The nurse analyzes possible triggers in the environment. Which most likely triggers should the nurse identify? Select all that apply. a. Patient walking in hallway two times today b. Gift basket in room containing boxed food items c. Fellow staff nurse in hallway wearing perfume d. Flower arrangement on patient's bedside table e. Visitor with pack of cigarettes in shirt pocket

C D E

5. Which expected outcomes should the nurse include in the plan of care for a patient treated for tuberculosis? Select all that apply. a. Oxygen saturation 90% on room air b. Complains of night sweats once per week c. Ability to maintain stable body weight d. Exhibits even and unlabored respirations e. Absence of cough and sputum production

C D E

5. Which signs and symptoms should the nurse associate with resolving viral influenza infection? Select all that apply. a. Oxygen saturation 90% on room air b. Oral temperature 99.8 degrees Fahrenheit c. Heart rate has returned to baseline d. Even and unlabored respirations e. Lungs clear on chest X-ray

C D E

1. Which discharge teaching should the nurse include in the teaching plan for a patient who was treated for tuberculosis? Select all that apply. a. "Family members should have chest x-rays done." b. "Stop medication when coughing subsides." c. "Persons living with you should have skin testing." d. "Use your best judgment in terms of your daily medications." e. "Maintain adequate nutrition."

C E

what is thoracentesis? what is a major concern?

Insertion of a large bore needle through the chest wall into the pleural space to obtain specimen for diagnostic evaluation, remove pleural fluid, or instill medications into the pleural space. - you could go too far and puncture the lung --> pneumo

1. Which assessment findings would the nurse most likely expect in a patient diagnosed with a pulmonary embolism? Select all that apply. a. High ventilation/low perfusion b. Increased cardiac output c. Decreased pulmonary vascular resistance d. Pulmonary hypertension e. Reduced left ventricular preload

A D E

CT scan will show you

- Pulmonary Embolism (you have to use contrast dye for this)

what types of symptoms do you anticipate patients complaining of that have respiratory infections or airway disease?

- SOB - cough etc.

how do you decide whether or not to admit pt with pneumonia

- CURB 65 criteria C- confusion (1pt) U- uremia (1pt) R- respiratory rate (1pt) B- low blood pressure (1pt) Age 65 and up - Curb 65> 2 pts more intensive treatment

how is pneumonia diagnosed

- CXR will show area of consolidation, pulmonary infiltrates - sputum culture to identify microorganism - WBC and ESR elevated

1. What is the nurse's first action when admitting a patient complaining of night sweats and rust-colored sputum to the hospital? a. Place the patient in a private room b. Prepare patient for chest X-ray c. Perform PPD (purified protein derivative) skin test d. Fit the patient for an N95 mask respirator

A

3. Which type of medication is used to maintain daily control of asthma? a. Anti-inflammatories b. Anticholinergics c. Bronchodilators d. Vasodilators

A

4. A patient diagnosed with influenza requires further patient teaching when making which statement? a. "I will take the antiviral medication until I feel better." b. "I should try to rest and drink plenty of fluids." c. "I need to see if someone can cover my shift at work." d. "I plan on getting the flu vaccination from now on."

A

5. Which instruction should the nurse provide to a patient who has just received a PPD (purified protein derivative)? a. Return to the clinic in 48 - 72 hours to have the test read b. Take antiviral medication as prescribed c. Massage the subcutaneous injection site d. There may be a very small amount of bleeding on the forearm

A

1. A patient asks the nurse if it is safe to return to work after suffering from influenza. Which questions should the nurse ask the patient? Select all that apply. a. "When was the last time you had any fever?" b. "Are you having any difficulty breathing?" c. "How much do you weigh now?" d. "Have you used a bleach solution on all household and personal items?" e. "Are any of your family members sick?"

A B

4. A patient is diagnosed with influenza in the clinic and is sent home to recover. Which patient teaching should the nurse provide to the patient? Select all that apply. a. Take an antipyretic for fever b. An analgesic can be taken for body aches c. Take antivirals if symptoms are not improved in 1 week d. You may return to work if fever is below 101.5 degrees Fahrenheit e. Avoid contact with others for up to 48 hours

A B

1. Which assessment findings would the nurse most likely expect in a patient diagnosed with asthma? Select all that apply. a. Wheezing b. Alveolar collapse c. Bronchospasm d. Bronchial edema e. Dilated airways

A C D

3. The nurse should include which preventive measures when teaching a group of adults about prevention of influenza? Select all that apply. a. Handwashing b. Vigorous exercise while ill c. Annual vaccination d. Covering mouth when coughing

A C D

1. The nurse should closely monitor for signs and symptoms of a pulmonary embolism in a patient with which risk factors? Select all that apply. a. Post-knee surgery b. Underweight c. Smoker d. Chronic heart disease e. Truck driver

A C D E

3. The nurse suspects a patient to have a pulmonary embolism. Which of the following common signs and symptoms would support the nurse's belief? Select all that apply. a. Hemoptysis b. Decreased heart rate c. Dyspnea with accessory muscle use d. Unilateral lower extremity edema e. Cough

A C D E

5. When providing patient teaching to a patient with asthma, what should the nurse identify as risk factors for future potential exacerbations? Select all that apply. a. Secondhand smoke b. Long, hot showers c. Perfumes d. Stress e. Pet dander

A C D E

3. The nurse suspects a patient may be suffering from primary progressive tuberculosis infection when the patient complains of which symptoms? Select all that apply. a. Fatigue b. Sore throat c. Weight loss d. Nonproductive cough e. Night sweats

A C E

4. The nurse is caring for a patient with a diagnosis of active tuberculosis. Which symptoms does the nurse expect this patient to exhibit? Select all that apply. a. Fever b. Abdominal rigidity c. Abnormal breathing sounds d. Hypothermia e. Decreased oxygen saturation

A C E

1. What is the nurse's best action when admitting a patient diagnosed with influenza to the hospital? a. Place the patient in a semi-private room b. Avoid placing a mask on the patient when in the hallway c. Start intravenous line and restrict PO fluid intake d. Place the patient on droplet precautions

D

2. During an acute asthma attack, the nurse should expect which finding? a. Increased peak flow reading b. Increased incentive spirometer reading c. Patient able to breathe comfortably d. Wheezing on auscultation

D

2. Which of these assessment findings would the nurse most likely expect when a patient is diagnosed with latent tuberculosis infection? Select all that apply. a. Cough b. Fever c. Fatigue d. Asymptomatic

D

3. The nurse caring for a patient diagnosed with asthma enters the hospital room as the patient complains of chest tightness, has audible wheezing, and pulse oximetry displays a reading of 90% on room air. Which medication should the nurse anticipate administering first? a. Oral anti-inflammatory b. Inhaled anticholinergic c. Oral antihistamine d. Inhaled bronchodilator

D

4. A nurse caring for a patient diagnosed with tuberculosis requires further teaching when the charge nurse makes which observation? a. Nurse wears N95 mask during patient care b. Patient transported to radiology while wearing a mask c. Visitors wear snug-fitting surgical masks d. Patient wears mask when visiting family in waiting area

D

4. A nurse is caring for a patient diagnosed with asthma who has not responded to repeated, frequent doses of bronchodilators. The patient also reports chest tightness, wheezing, dry cough, shortness of breath, and respiratory distress. What condition is this patient most likely experiencing? a. Cystic fibrosis b. Heart failure c. Chronic obstructive pulmonary disease d. Status asthmaticus

D

4. The nurse should review which lab study to indicate the presence of a thrombus in the body? a. Arterial blood gas b. Prothrombin time c. B-type natriuretic peptide d. Plasma d-dimer

D

5. The nurse is caring for a hospitalized patient being treated with heparin for a pulmonary embolism. The most recent activated partial thromboplastin time (aPTT) is 3.0 times the normal value. What is the nurse's best action? a. Administer an additional heparin bolus b. Increase the rate of infusion c. Continue the current rate of infusion d. Decrease the rate of infusion

D

1. A patient has diminished breath sounds after receiving an albuterol nebulized treatment for asthma. What are the nurse's priority actions? Select all that apply. a. Obtain a 12-lead ECG b. Request a beta blocker c. Document the finding d. Notify the healthcare provider e. Provide mechanical ventilation, if ordered

D E

what is the medication for wheezing

SABA (neb or handheld inhaler) - for all acute wheezing regardless if it is COPD, asthma, pneumonia etc.

a cough is always _______________ but can be related to ________________

always abnormal - can be related to multiple different disease processes or diagnoses

What do arterial blood gases measure?

amount of oxygen and carbon dioxide levels in the blood

what does your hemoglobin need to be for good perfusion?

at least 9

2. A patient diagnosed with a pulmonary embolism is receiving a heparin infusion. Which lab should the nurse monitor in order to adjust the rate of infusion? a. Prothrombin time b. Partial thromboplastin time c. Platelet count d. Hemoglobin and hematocrit

b

3. A patient presents to the emergency department with symptoms of a pulmonary embolism. What is the nurse's first action? a. Obtain 12-lead ECG b. Administer IV saline c. Apply oxygen d. Start heparin infusion

c

during bronchoscopy people are under ____________ b/c of this what should you watch for post intervention?

conscious sedation - Assess the airway! (don't eat or drink prior to procedure) assess for gag reflex and make sure that they can swallow - the medications given relax the muscles in their throat - make sure they swallow so that they don't aspirate - swallow study/test protocol either done by RN or OT

What is pleural effusion? what often causes it?

fluid in the pleural space - heart failure and renal failure - volume overload and fluid backing up into lungs and pleural space

what imbalance of respiratory gases would you expect to see in a COPD patient? what can this cause? how do they try to compensate?

high CO2 levels --> respiratory acidosis - try to breath quicker to blow off more CO2

if you have a patient that does not have a history of anxiety but suddenly becomes anxious this may be the first signs of ____________

hypoxia - you are anxious b/c you can't breath

what is wheezing

musical respiratory sounds that may be audible to both the patient and to others - may be heard on inspiration or expiration

wheezing suggests _______________. All that wheeze is not ___________ all that wheeze is _________________

partial airway obstruction asthma obstruction

what conditions call for a sputum analysis? what does this help with?

pneumonia TB confirmation of diagnosis help choose correct antimicrobial therapy

explain the range of amount of blood in sputum associated with hemoptysis What should you do if there are massive amounts of hemoptysis?

ranges from blood streaking of sputum to massive hemoptysis (100-600 mL over 24 hrs) - massive is medical emergency, admit to ICU, clear the airway, bronchoscopy (looking at bronchus to see the source of bleeding)

when should you get your flu shot

september to october at the latest

who is most at risk for complications associated with the flu

the immunosuppressed

what is typically given for fever

tylenol unless they have liver problems

what is uremia

urea in the blood