Patho: Respiratory

.A home health nurse visits a client who has COPD and receives oxygen at 2 L/min via nasal cannula. The client reports difficulty breathing. Which of the following actions is the nurse's priority?

Assess the client's respiratory status

Which of the following is a manifestation of a simple closed pneumothorax?

Asymmetrical chest movements

A nurse is assessing a client who is 2 days postoperative and auscultates bilateral breath sounds, but absent breath sounds in the bases. The nurse should suspect which of the following postoperative complications?

Atelectasis

A nurse is assessing a client who has chronic respiratory insufficiency. Which of the following findings should the nurse expect as result of the long-term inadequate oxygenation?

Clubbing of the fingers

A nurse in the emergency department is assessing an older adult client who has community-acquired pneumonia. Which of the following findings should the nurse expect?

Confusion

Bronchioles

smallest branches of the bronchi; smooth muscle

Binding of oxygen to hemoglobin occurs in the lungs, whereas the reverse process, in which oxygen is released from hemoglobin, occurs in the:

tissues

Areas in the United States that show higher rates than the national rate of TB are areas that have a high incidence of:

HIV & homelessness

A nurse is providing discharge teaching about nutrition to the parents of a child who has cystic fibrosis (CF). Which of the following responses by the parents indicates an understanding of the teaching?

"We will give our child pancreatic enzymes with snacks and meals."

Which of the following statements is false?

Active TB must be treated in hospital for many months

The central chemoreceptors in the medulla are normally most sensitive to

Elevated CO2

Which of the following confirms the presence of active (reinfection) tuberculosis?

Identification of acid-fast bacilli in a sputum sample

A nurse is assessing a client who has developed atelectasis postoperatively. Which of the following findings should the nurse expect?

Increasing dyspnea, cyanotic, tachypnea

Which of the following statements does not apply to M. tuberculosis?

Infection is limited to the lungs Will spread to other organs

A nurse in a provider's office is assessing a client. The nurse should identify that which of the following findings are manifestations of pulmonary tuberculosis? (Select all that apply)

Night sweats, low grade fever, & blood in sputum

A nurse in a clinic is collecting a history from a client who reports that a member of his family just received a diagnosis of pulmonary tuberculosis. The nurse should expect that the provider will prescribe which of the following diagnostic tests first?

Nucleic acid amplification test (NAAT) - newer test; recommended by the CDC

Pulmonary hypertension

Patho = high blood pressure in the arteries to the lungs --> arteries become hard & narrow --> blood cannot flow to the lungs Most of the time it is idiopathic Risk = genetics Complication = quickly becomes right-sided heart failure S/S = SOB, dizziness, hypoxic, chest pressure, fatigue, distended jugular veins, edema

Which of the following is typical of progressive emphysema?

Residual lung volume increases

A nurse is giving a presentation at a community center about chronic bronchitis. Which of the following information should the nurse include as effective for preventing this disorder?

Smoking cessation

Lobar pneumonia is usually caused by:

Streptococcus pneumonia

The respiratory system in the brain that becomes active when increased ventricular effort is required is the:

Ventral respiratory group or the medulla

Ventilation lung disorder

cannot exchange gases

A nurse is teaching a client who has emphysema about self-management strategies. Which of the following statements by the client indicates an understanding of the teaching?

"I will follow a daily diet high in calories and protein." These patients are very skinny & malnourished

A nurse is admitting a client who has active tuberculosis to a room on a medical-surgical unit. Which of the following room assignments should the nurse make for the client?

A room with air exhaust directly to the outdoor environment

What happens in the lungs when the diaphragm and external intercostal muscles relax?

Air is forced out of the lungs - passive

What cause the expanded anteroposterior (A-P) thoracic diameter (barrel chest) in patients with emphysema?

Air trapping & hyperinflation

The production of yellowish-green, cloudy, thick sputum is often an indication of:

Bacterial infection

A nurse is assessing a client who has COPD. The nurse should expect the client's chest to be which of the following shapes?

Barrel

What does the term hemoptysis refer to?

Bright red streaks of blood in frothy sputum

A nurse is assessing a client who has pulmonary tuberculosis. Which of the following findings should the nurse expect?

Lethargy

A group of common chronic respiratory disorders characterized by tissue degeneration and respiratory obstruction is called:

COPD

What is the cause of chronic bronchitis?

Chronic irritation, inflammation, and recurrent infection of the larger airways "Blue boaters"

Which of the following statements describe the pathophysiology of adult respiratory distress syndrome? (select all that apply):

Damage leading to increased permeability of the alveolar capillary membranes & excessive fluid and protein interstitially and in the alveoli

.A nurse is caring for a client who has emphysema. Which of the following findings should the nurse expect to assess in this client? (Select all that apply.)

Dyspnea, barrel chest, clubbing, shallow respirations, tachycardia due to compensation

.A nurse is caring for a client who has pneumonia. Which of the following actions should the nurse take to promote thinning of respiratory secretions?

Encourage the client to increase fluid intake

A nurse is caring for a client who has chronic obstructive pulmonary disease (COPD). The client tells the nurse, "I can feel the congestion in my lungs, and I certainly cough a lot, but I can't seem to bring anything up." Which of the following actions should the nurse take to help this client with tenacious bronchial secretions?

Encouraging the client to drink 2 to 3 L of water daily

Which of the following distinguishes influenza from infectious rhinitis?

Influenza has a sudden onset with fever, marked muscle aching, and severe malaise

What is the most common cause of viral pneumonia?

Influenza virus Bacterial? Strep

A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan?

Instruct the client to use pursed-lip breathing.

A nurse is assessing a client who has postoperative atelectasis and is hypoxic. Which of the following manifestations should the nurse expect?

Intercostal retractions, tachypnea, tachycardia, anxious

A nurse is assessing a client who has asthma. Which of the following areas should the nurse evaluate as the most reliable indicator of central cyanosis?

Oral mucosa Conjunctivae for darker skin

pleural effusion

Patho = abnormal accumulation of fluid in the pleural space; causes increased pressure in the cavity --> increased hydrostatic pressure or decreased osmotic pressure in blood vessels There is so much fluid that the lungs cannot expand S/S = Dyspnea, chest pain, increased respiratory and heart rates, dullness to percussion & absence of breath sounds over the affected area, tracheal deviation & hypotension Treatment = treat underlying cause; chest tube

Emphysema

Patho = abnormal permanent enlargement of gas-exchange airways --> destruction of alveolar walls --> large pockets & holes --> surfactant is destroyed --> elasticity decreased & impaired expiration due to hyperinflation due to overcompensation from air trapping "pink puffer" S/S = dyspnea, hyperventilation/tachypnea, anorexia, fatigue, clubbing on the fingers, secondary polycythemia, barrel chest, the skin is pink-tinged due to high CO2 levels, wheezes, no productive cough Labs & Diagnostics = chest x-ray (damage will show up), pulmonary function test, oximetry, ECG ABG = CO2 is HIGH, O2 is LOW Hemoglobin = LOW Complication = turns into cor pulmonale, malnourished Treatment = pursed-lip breathing, avoidance of respiratory irritants, infections, and cessation of smoking

Pneumothorax

Patho = air in the pleural space around the lungs --> lung collapses = no breath sounds --> negative pressure loss; air leak Closed = idiopathic; spontaneous Open = puncture or suction Tension = CPR; ventilator; the most serious b/c air gets in but cannot get out Trauma = stab wound, MVA S/S = SOB, chest pain, unequal breath sounds & chest expansion Risk = trauma patients, smoking, CPR patients, ventilator use Treatment = chest tube

Pulmonary embolism

Patho = blood clot or mass that blocks the flow of blood through lung tissue --> blocking the pulmonary arterial bed Risk = DVT, obesity, immobility, surgery, advanced age Complications = a fib, stroke, hypotensive shock, pleural effusion, atelectasis, death Labs & Diagnostics = D-dimer, ultrasound, pulm. angiogram, CT scan X-ray can appear NORMAL S/S = dyspnea, tachycardia, tachypnea, productive cough that is blood-tinged, cyanotic, very fatigued, feeling of doom Treatment = PREVENTION

Cystic fibrosis (CF)

Patho = defect in the CFTR gene; autosomal recessive on chromosome 7; chloride & exocrine gland issues; abnormally thick mucous secretions into lungs & the pancreas --> fibrosis happens & is irreversible S/S = Steatorrhea, clubbing, failure to gain weight/diminished growth, nutritional deficits, salty skin, increased infections Complications = malnutrition, the potential for short life span, transplants Labs = sweat test (Na & chloride are ELEVATED) Treatment = chest therapy vest, pressure devices, nebulizers, gene therapy, lung transplant(s), take oral enzymes with food intake

Pulmonary edema

Patho = excess fluid within the alveoli & interstitial area which causes a decrease in oxygen diffusion; impaired gas exchange --> the inflammation causes increased capillary permeability Risk = inflammation in the lungs, decreased plasma protein levels, fluid volume excess, & pulmonary hypertension A complication of left-sided heart failure Labs = BNP is HIGH S/S = cough, orthopnea, rales, hemoptysis, hypoxemia, cyanosis, decreased O2, dyspnea Treatment = O2 therapy, positive-pressure mechanical ventilation, the upper body should be in an elevated position

Tuberculosis (TB)

Patho = infection; slow-moving, acid-fast bacillus & is very resistant; airborne so need negative airflow room; causes inflammation & necrosis happens; can spread to other organs Active - is contagious no matter what; secondary Latent - can be contagious, but normally is not, usually just able to see it in chest x-rays but isn't actually active; primary Risk = immigrants coming to America, living in an enclosed highly populated area (homeless shelters, jails, etc.), immunocompromised, alcoholics, drug users, low nutrition, HIV/AIDS S/S = chronic cough, sputum w/ blood, night sweats, low-grade fever, unexplained weight loss Labs & Symptoms = chest x-ray, CT scan, PPD or quantium blood test PPD tells if you have been exposed to TB at some point in your life! Treatment can be at home

Chronic bronchitis

Patho = inflammation & thickening of the bronchi --> limits airflow; cannot adapt to low O2 "blue boater" S/S = increased resp. rate, decreased breath sounds, wheezes, crackles, clubbing, neck vein distention, cyanotic, productive cough with sputum, pedal edema Labs & Diagnostics ABG = CO2 is HIGH & O2 is LOW Hemoglobin = LOW A complication of from right-sided heart failure - cor pulmonale

Asthma

Patho = periodic episodes of severe but reversible bronchial obstruction due to inflammation of the mucosa which creates mucous production; bronchoconstriction & increased secretions Acute = single episode Chronic = long term problem Extrinsic = acute episodes triggered by a type I hypersensitivity reaction to an inhaled antigen Intrinsic = stimuli target hyperresponsive tissues in the airway, initiating the acute attack S/S = wheezing, coughing, tight feeling in the chest, thick mucus, severe respiratory distress, breathing is rapid and labored, tachycardia, unable to talk Complications = status asthmaticus which will lead to death if not stopped, hypoxia develops, respiratory acidosis, respiratory failure Treatment = skin test for allergic reactions, avoidance of triggering factors, good ventilation at home/work/school, cardio: walking or swimming, controlled breathing techniques, inhalers, breathing treatments Risk = genes, allergies

COPD

Patho = progressive tissue degeneration & obstruction in the airway of the lungs; irreversible damage; lungs are slowly wearing away O2 levels are driving respiratory control Emphysema & chronic bronchitis S/S = clubbing, low O2 sat, hypercapnia, chronic hypoxia Complication = respiratory failure Risk = smoking

Acute respiratory distress syndrome (ARDS)

Patho = restrictive lung disorder; stiff lung; injury to the alveolar wall and capillary membrane --> prevents enough oxygen getting into the lungs & in the blood due to massive inflammatory responses --> capillaries become more permeable to chemical mediators; alveoli do not fill with just O2 --> severely impaired gas exchange "Drowning" in their own fluids Risk = shock, trauma, COVID, sepsis, burn patients, drowning victims, pneumonia, aspiration, pancreatitis, smoke inhalation Complications = death occurs 60% of the time; clotting & emboli form, impaired lung function for life if the patient survives S/S = Dyspnea/rales, restlessness, rapid and shallow respirations, tachycardia, decreased O2, productive cough with frothy sputum, cyanosis & lethargy Labs & Diagnostics = X-ray is a "WHITE OUT" Treatment = O2 therapy & mechanical ventilation, fluid restriction to help minimize alveolar edema, prone positioning

Pneumonia

Patho = when excess fluid appears on the lungs from an inflammatory response --> fluid builds up --> alveolar walls thicken --> impairs gas exchange/diffusion Bacterial/lobar = productive cough with blood; streptococcus Virus = flu; dry cough Can be hospital-acquired = immobility --> fluid pools, advanced age Complications = atelectasis, ARDS Labs = WBC is HIGH Sputum culture is POSITIVE X-ray can see FLUID BUILD UP (infiltrates) S/S = crackles/rales, fever, confusion, decreased O2, tachypnea, diminished breath sounds, tachycardia

Which of the following individuals is not considered to be at high risk for developing active tuberculosis?

Persons who experience acute asthma attacks

A nurse is planning care for a client who has acute respiratory distress syndrome (ARDS). Which of the following interventions should the nurse include in the plan?

Place in prone position

Which of the following activities does not require muscle contractions and energy?

Quiet expiration

A nurse is caring for a child who has a suspected diagnosis of cystic fibrosis. Which of the following diagnostic tests will confirm the diagnosis?

Sweat chloride test

Select the statement related to tuberculosis:

TB is usually caused by an acid-fast bacillus, resistant to many disinfectants

.A nurse is assessing a client who has hypoxia. Which of the following findings should the nurse expect?

Tachycardia, cyanotic

Restrictive lung disorder

a lung disorder caused by the limiting of air into the lungs

Persistent thick mucus in the bronchioles of a child with cystic fibrosis may cause (select all that apply):

air trapping, atelectasis, repeated infections, irreversible damage to lung tissue

diffusion

alveolar capillary membrane & gas exchange

affinity

an attraction to; oxygen's attraction to hemoglobin binding sites

Pursed lip breathing

reduces air trapping; stops alveoli from collapsing on themselves - breathe in for 2 counts & exhale for 4 counts - this pops alveoli back open

filtering

can the bad out of the lungs; mucus produced by goblet cells - cilia move things out - IgA cells prevent attachment of bacteria - macrophages eat particles

Obstructive lung disorder

condition blocking the flow of air moving out of the lungs

Right shift

decreases oxygen's affinity for hemoglobin - condition related to acidosis - did not drop off O2

Orthopnea is:

difficulty breathing when lying down

During an acute asthma attack, how does respiratory obstruction occur? (select all that apply):

edema of the mucosa & increased secretion of thick, tenacious mucus

In addition to effects on the lungs and pancreas, cystic fibrosis results in:

high sodium chloride content in saliva and sweat

Left shift

increase oxygen's affinity for hemoglobin - condition related to alkalosis - did not pick up O2

bronchus

one of the two tubes that connect the lungs with the trachea L = narrow & more horizontal R = shorter & wider, more vertical

SaO2

oxygen saturation

PaO2

partial pressure of oxygen

Hemoptysis is a significant sign of:

pulmonary edema