Respiratory Med Surg I

A client with chronic obstructive pulmonary disease (COPD) reports chest congestion, especially upon awakening in the morning. What should the nurse suggest to the client?

Use a humidifier in the bedroom. A humidifier will help liquefy secretions and promote their expectoration. Sleeping on pillows facilitates breathing; it does not relieve chest congestion. Nonproductive coughing should be avoided because it is irritating and exhausting. Deep breathing and coughing at night will not help relieve early-morning congestion.

Mucolytics

Acetylcysteine (Mucomyst) agents that destroy or dissolve mucus, degrade mucin, helpful in opening airways

Idiopathic Pulmonary Fibrosis

-Common restrictive lung disease -Highly lethal -Extensive fibrosis and scarring -Corticosteroids, other immunosuppressants mainstays of therapy

The nurse is caring for a client after a right pneumonectomy for cancer. As part of the assessment, the nurse palpates the client's trachea. What is the rationale for this assessment?

After a pneumonectomy, the mediastinum may shift toward the remaining lung, or the remaining lung may shift toward the empty space, depending on the pressure within the empty space. Either of these shifts will cause the trachea to move from its usual midline position; this is known as a mediastinal shift.

A nurse is a preceptor for an orientee (newly hired nurse). The orientee is providing postoperative care to a client who recently returned from a laryngoscopy. The orientee reminds the client not to eat or drink anything until instructed to do so. How does the preceptor evaluate the suitability of the instructions given to the client by the orientee?

Appropriate; oral intake after the procedure may result in aspiration Oral intake should not be attempted after the procedure until the return of the gag reflex. Even an alert person may choke and aspirate if eating or drinking is attempted while the pharyngeal wall is anesthetized. Although some slight irritation may occur after the procedure, there usually is no painful sequela. Clients do not receive general anesthesia for a laryngoscopy. The procedure does not produce a fluid deficit. The client needs to remain nothing by mouth.

The nurse plans interventions for a client with smoke inhalation based on a negative chest x-ray and arterial blood gases that show a PO 2 of 85 mm Hg, a PCO 2 of 45 mm Hg, and a pH of 7.35. Which interventions should the nurse anticipate will be prescribed? .

Coughing, deep breathing, humidified oxygen Coughing moves secretions toward the mouth to be expectorated. Deep breathing expands the alveoli and increases the amount of oxygen being delivered to the alveolar capillary beds. Humidified oxygen increases the amount of oxygen that is being delivered to the alveolar capillary beds. Bronchodilators are not indicated at this time because the x-ray, PCO 2, and pH are still within acceptable limits. Bronchial suctioning is not indicated at this time because the x-ray, PCO 2, and pH results are still within acceptable limits.

Forced Expiratory Volume in First Second (FEV1)

FEV1 is the volume of air that can forcibly be blown out in one second, after full inspiration.

status asthmaticus treatment

IV fluids, potent systemic bronchodilator, steroids, epinephrine, oxygen

During a follow-up visit three weeks after a laryngectomy, a client exhibits concern that the laryngectomy tube may become dislodged. What should the nurse teach the client to do if the tube becomes dislodged?

Keep calm because this is no immediate emergency. The client's concerns will be reduced if it is known that the stoma will stay open long enough so that another tube can be inserted easily. A permanent opening into the trachea is formed after two or three weeks, and a tube need not be reinserted promptly. The client is in no immediate danger, and it is not imperative to notify the healthcare provider at once. A permanent opening into the trachea is formed after two to three weeks and will not close quickly.

Which disorder would the nurse state is related to the tonsils?

Pharyngitis, or sore throat, is a common inflammation of the pharyngeal mucous membranes that often occurs with rhinitis and sinusitis.

Tuberculosis Manifestations

Progressive fatigue Lethargy Nausea Anorexia Weight loss Irregular menses Low-grade fever, night sweats Cough, mucopurulent sputum, blood streaks

xerostomia

abnormal dryness of the mouth resulting from decreased secretion of saliva

empyema

an accumulation of pus or infected fluid in the pleural cavity

cricothyroidotomy

an opening is made between the thyroid and cricoid cartilage and results in a tracheostomy - should not be done below 12 yrs of age - cannot place a tube larger than 6 mm diameter

erythroplakia

any red patch of tissue in the oral cavity that cannot be associated with inflammation small red spots inside the mouth and nasal cavity, indicating precancerous tissue red plaque- vascularized leukoplakia. Highly suggestive of squamous cell dysplasia.

paroxysmal nocturnal dyspnea (PND)

awakening from sleep with shortness of breath and needing to be upright to achieve comfort awakening in severe respiratory distress, usually associated with pulmonary edema

bronchovesicular

breath sound moderate pitch, moderate amplitude, inspiration=expiration, mixed

leukoplakia

chalky white, thick, raised patch on sides of tongue; precancerous

face tent

deliver 30-50% oxygen at 4-8 L/min

venturi mask

delivers 24-50% oxygen at 4-10 L/min

nonrebreather mask

delivers 95-100% oxygen 10-15 L/min

Chest tube for pneumothorax

removes air

Cor pulmonale

right ventricular hypertrophy and heart failure due to pulmonary hypertension Serious cardiac disease associated with chronic lung disorders, such as emphysema Right-sided heart failure arising from chronic lung disease

vesicular breath sounds

soft, fine, breezy, low-pitched sounds heard over peripheral lung tissue

Peak expiratory flow rate (PEFR)

the maximum amount of air expelled in forced expiration highest rate of flow sustained for 10 seconds or more at which air can be expelled from the lungs

Vital capacity

the maximum volume of air that can be exhaled after maximum inspiration

Total Lung Capacity

the maximum volume of air that the lungs can contain

diaphragmatic excursion

the movement of the thoracic diaphragm during breathing, should be equal or bilateral 3-5 cm can be 7-8 in well-conditioned person

Functional residual capacity

the volume of air remaining in the lungs at the end of normal exhalation.

methylxanthines

theophylline IV or oral; bronchodialator stimulant, primary use bronchodilation, CNS stimulation chemical class for theophylline and caffeine and theobromine

Forced Vital Capacity (FVC)

total amount of air expelled after a maximal inspiration

When is mechanical ventilation necessary?

ventilatory support is needed when the PaCO 2 is more than 40.

Asthma s/s

wheezing, coughing, dyspnea, and chest tightness

The nurse provides teaching to a client who will begin to receive tube feedings after a total laryngectomy. The nurse concludes that the teaching was understood when the client makes which statement about tube feedings?

"I will need tube feedings until healing of the incision is complete." Food should be avoided until the area is healed completely; this will keep the area from becoming irritated and contaminated. Because of the alterations in structure, the gag reflex is no longer present.

A client with the diagnosis of osteogenic sarcoma has metastasis to the lung. Which client statement about the concept of metastasis indicates that the nurse needs to follow up?

"I'm upset to know that the tumor may metastasize to my bones." The nurse needs to address the metastasis to the bones as this is a misconception and must be corrected. Osteogenic sarcoma is a primary malignant bone tumor. It has a high mortality rate because it often is diagnosed after it has metastasized to the lung.

Asthma lab assessment

-ABGs -arterial O2 may decrease during acute asthma attack -Arterial CO2 may decrease early in attack, increase later (indicates poor GE) -Allergic asthma: elevated serum eosinophil count, immunoglobulin E levels Sputum with eosinophils, mucous plugs, and shed epithelial cells

The nurse is interpreting responses to tuberculin skin testing in a 58-year-old client with end-stage kidney disease secondary to diabetes mellitus. Which finding would indicate a positive reaction?

An area of induration ≥10 mm would be a positive reaction in a client with end-stage kidney disease. The presence of acid-fast bacilli in the sputum indicates active tuberculosis. An area of induration ≥5 mm would be a positive reaction in clients with HIV infection, clients who are immunosuppressed, and in clients with organ transplants. The presence of reddened, flat areas does not indicate a positive reaction. These areas are not measured.

Drug Therapy for COPD

Beta-adrenergic agents Cholingeric antagonists methylxanthines corticosteroids NSAIDs Mucolytics

A nurse is caring for a client who is admitted to the hospital with severe dyspnea and a diagnosis of cancer of the lung. What does the nurse conclude is the probable cause of the severe dyspnea?

Bronchial obstruction or pleural effusion Proliferation of malignant cells may obstruct the bronchial tree or foster development of exudate in the pleural space, decreasing the availability of oxygen and increasing retention of carbon dioxide. A tumor of the lung does not cause abdominal distention or pressure. Fluid retention as a result of renal failure is not associated with cancer of the lung. Although anxiety associated with pain may increase the respiratory rate, it will not cause difficulty with breathing.

Barrel Chest

COPD-chronic overexpansion of lungs deformity of thorax Emphysema anterior to posterior diameter is 1:1 (NOT a normal finding) Seen in patients with Emphysema-COPD increased AP diameter, normal in infancy; often accompanies old age or chronic COPD

Corticosteroids

Corticosteroids do not cause urine discoloration; they do cause weight gain. Corticosteroids must be taken with milk or food to reduce gastrointestinal upset. Corticosteroids must not be stopped abruptly because of the risk of acute adrenal insufficiency; the medication will be tapered before it is discontinued. Long-term use of corticosteroids results in depressed immunity and may cause a greater risk for infection; therefore it is important to avoid large crowds of people and those with infections. It is important to avoid taking aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen because of the possibility of gastric irritation and possible gastric bleeding.

acute bronchitis s/s

Cough, fever, and fatigue

What clinical indicators should a nurse expect to identify in a client with acute respiratory distress syndrome (ARDS)? .

Crackles Atelectasis Hypoxemia Severe dyspnea Crackles occur as fluid leaks into the alveolar interstitial space. The alveoli collapse from surfactant dysfunction and infiltrate from inflammation. Arterial hypoxemia that does not respond to supplemental oxygen is a characteristic sign of ARDS. Severe dyspnea can occur 12 to 48 hours after the initial onset of ARDS, which usually is an inflammatory trigger.

subcutaneous emphysema

The presence of air in soft tissues, causing a characteristic crackling sensation on palpation.

What points should be considered when a client with a respiratory disorder undergoes a spiral-computed tomography (CT) scan to diagnose a pulmonary embolism?

The test involves the administration of a contrast medium. Clients should have their hydration levels assessed. Clients are instructed to lie still on a hard table. A contrast medium may be given intravenously when performing a spiral-computed tomography (CT). The nurse should make sure that the client is well hydrated before and after the procedure to help flush out the contrast medium. The nurse should instruct the client to lie still on the hard table and that the scanner will revolve around the body with clicking noises. The nurse should assess if the client is allergic to shellfish because the contrast medium used is iodine-based. The nurse should evaluate the client's blood urea nitrogen and serum creatinine before the test to assess renal function.

Cor pulmonale s/s

Tiring easily, shortness of breath with exertion, lower leg edema, chest pain, and heart palpitations

methemoglobinemia

a blood disorder in which an abnormal amount of methemoglobin, a form of hemoglobin, is produced Benzocaine topical anesthetic unique adverse effects chocolate brown blood **Notify Rapid Response

histoplasmosis

a systemic fungal disease caused by inhalation of dust contaminated by fungus Soil contaminated by bird or bat droppings also can transmit histoplasmosis, so farmers and landscapers are at a higher risk of contracting the disease. In the United States, histoplasmosis commonly occurs in the Mississippi and Ohio river valleys, though it can occur in other areas, too.

Interstitial Pulmonary Diseases

-Affects alveoli, blood vessels, surrounding support lung tissue -Restrictive disease; thickened lung tissue, reduced gas exchange, "stiff" lungs -Slow onset -Dyspnea most common manifestation

anteroposterior diameter

diameter from the back to the front chest

Fine crackles

fluid bubbling within the smaller airways and alveoli, usually attributable to pulmonary edema.

corticosteroids

hormonal agents that reduce tissue edema and inflammation associated with chronic lung disease

BOOP-bronchiolitis obliterans organizing pneumonia

Allows connective tissue plugs to form in the lower airways and in tissue between the alveoli Between 30 and 60 years Triggers-chemo therapy, sulfa drugs, cephalosporins, anti-seizure drugs, cocaine, amiodarone or the existing presence of a connective tissue disorder such as RA or lupus Most effective treatment is corticosteroids

A nurse is suctioning a client's airway. Which nursing action will limit hypoxia?

Apply suction only after catheter is inserted The negative pressure from suctioning removes oxygen as well as secretions; suction should be applied only after the catheter is inserted and is being withdrawn. Limiting suctioning with catheter to half a minute is too long; suctioning should be limited to 10 seconds. Lubrication will facilitate insertion and minimize trauma; it will not prevent hypoxia. The use of a sterile catheter helps prevent infection, not hypoxia.

Drug Therapy for Asthma

Based on Step Category -Preventative Therapy (Controller Drugs) (change responsiveness of of airway) -Rescue Drugs -bronchodilators (SABA and LABA; cholingeric antagonists, methylxanthines) -anti-inflammatory agents (corticosteroids, NSAIDs, leukotrine antagonists, immunomodulators)

A nurse is caring for a client who has chest tubes inserted to treat a hemothorax that resulted from a crushing chest injury. While planning care for a stationary chest tube drainage system, which purpose of the first chamber will the nurse consider?

Collect water

crepitus

Crackling sound produced when ends of bone rub against each other or against roughened cartilage. ALSO subcutaneous emphysema

When the oxygen dissociation curve goes to the left...

Decreased temperature and CO2 concentration; decreased glucose breakdown products increased pH (alkalosis) Slower unloading

status asthmaticus

Severe, life-threatening, acute episode of airway obstruction Intensifies once it begins, often does not respond to common therapy Patient can develop pneumothorax and cardiac/respiratory arrest

Which findings should the nurse expect to see in a client with chronic obstructive pulmonary disease?

Elevated levels of eosinophils Elevated levels of neutrophils Elevated levels of red blood cells Elevated levels of eosinophils, neutrophils, and red blood cells are often related to the excessive production of erythropoietin in response to a chronic hypoxic state and indicates possible chronic obstructive pulmonary disease. Elevated levels of partial arterial oxygen and peripheral capillary oxygen saturation are not associated with chronic obstructive pulmonary disease. However, elevated levels of partial arterial oxygen indicate possible excessive oxygen administration. Decreased levels of peripheral capillary oxygen saturation indicate possible impaired ability of hemoglobin to release oxygen to tissues.

The nurse suspects pneumonia in a client who underwent placement of an epistaxis catheter due to posterior nasal bleeding. Which activity of the client might have led to this condition?

Excessive application of petroleum jelly to the nares

LHF s/s

Fatigue, breathlessness, weakness, shortness of breath, and fluid accumulation in the lungs

Which pulmonary function test provides a more sensitive index of obstruction in smaller airways?

Forced expiratory flow over the 25% to 75% volume of the forced vital capacity Forced expiratory flow over the 25% to 75% volume of the forced vital capacity is the measure that provides a more sensitive index of obstruction in smaller airways. Forced vital capacity indicates respiratory muscle strength and ventilator reserve. Functional residual capacity is normal or decreased in restrictive pulmonary diseases and increased in obstructive pulmonary diseases. Forced expiratory volume in 1 second is reduced in certain obstructive and restrictive disorders.

flu s/s

Headache, muscle aches, fever, chills, fatigue, weakness, sore throat, cough, watery nasal discharge lasting for more than a week, nausea, vomiting, and diarrhea

subpleural bleb

Image result for Rupture of a subpleural bleb Pulmonary blebs are small subpleural thin walled air containing spaces, not larger than 1-2 cm in diameter. Their walls are less than 1 mm thick. If they rupture, they allow air to escape into pleural space resulting in a spontaneous pneumothorax.

A client is brought to the emergency department with deep partial-thickness burns on the face and full-thickness burns on the neck, entire anterior chest, and one arm. To assess for heat inhalation, the nurse first should observe for which finding?

Nasal discharge containing carbon particles Singed nasal hair and nasal discharges that contain carbon are warning signs of respiratory inhalation. Changes in chest x-ray findings are a late sign of respiratory problems. Sputum that contains particles of blood may be a sign of pneumonia or tuberculosis. Changes in arterial blood gases are late signs of respiratory problems.

Which method of oxygen delivery should a nurse anticipate will be prescribed for a client with a pulse oximetry reading of 65%?

Non rebreather mask

After surgery, a client reports sudden severe chest pain and begins coughing. The nurse suspects the client has a thromboembolism. What characteristic of the sputum supports the nurse's suspicion that the client has a pulmonary embolus?

Pink With a pulmonary embolus, there is partial or complete occlusion of pulmonary blood flow; when infarcted areas or areas of atelectasis produce alveolar damage, red blood cells move into the alveoli, resulting in hemoptysis. Clear sputum is associated with a viral infection. Green and yellow sputum are associated with a bacterial infection.

A client has a closed chest drainage system in place. What should the nurse do to determine the amount of chest tube drainage?

Refer to the date and time markings on the outside of the collection chamber. Marking the time and fluid level on the outside of the drainage collection chamber of the closed chest drainage system allows for measuring the output without interrupting the closed drainage system. Drainage is aspirated only if a specimen is needed. Routinely replacing the existing unit with a new system increases the risk of infection and is not cost-effective. Clamping the chest tube is contraindicated because it can precipitate a pneumothorax; opening the system destroys the sterility of the closed drainage system

Cor Pulmonae

Right ventricular hypertrophy caused by lung disease RHF caused by pulmonary disease; heavy workload cause right side of heart chambers to harden and thicken

Sarcoidosis

-Granulomatous disorder of unknown cause; affects lungs most often -Autoimmune response - Normally protective T lymphocytes increase and damage lung tissue -Corticosteroids are main therapy

Indicators of long-term Repiratory Inadequacy

-clubbing of fingers -weight loss -unevenly developed muscles -arms and legs may appear thin or poorly muscled -Neck and chest hypertrophied (COPD) -Decreased activity tolerance -skin and mucous membrane changes

Complications of COPD

-hypoxemia/tissue anoxia -acidosis -respiratory infections -cardiac failure, esp. cor pulmonae -cardiac dysrhythmias

Indicators of Acute Repiratory Inadequacy

-skin and mucous membrane changes -cyanosis -decreased activity tolerance

On a client's admission to a rehabilitation unit, the nurse gives the client, who is not immunocompromised, a purified protein derivative (PPD) of tuberculin to test for tuberculosis. Which client reaction indicates a positive response?

5-mm erythema with 10-mm induration Induration of 10 mm or greater is a positive test result in clients with effective immune systems. Erythema without induration is not considered a positive test result. Induration of 0 to 4 mm is not considered a positive test result. Induration of at least 5 mm is considered a positive reaction in individuals who are immunocompromised.

While a client with a fractured femur is being prepared for surgery, the client exhibits cyanosis, tachycardia, dyspnea, and restlessness. What should be the nurse's first action?

Administer oxygen by mask The client probably has a fat embolus; oxygen reduces surface tension of the fat globules and reduces hypoxia. Oxygen should be administered before the healthcare provider is called. Placing the client in the high-Fowler position causes hip flexion and stresses the fractured femur; the semi-Fowler position is preferred. The Trendelenburg position will further compromise the client's respiratory status because the pressure of the abdominal organs against the diaphragm will limit expansion of the thoracic cavity.

A nurse is caring for a group of clients on a medical-surgical unit. Which client has the highest risk for developing a pulmonary embolism?

An obese client with leg trauma An obese client with leg trauma has two risk factors for the development of pulmonary embolism: obesity and leg trauma. A pregnant client with acute asthma has one risk factor for the development of pulmonary embolism: pregnancy. A client with diabetes who has cholecystitis has one risk factor for the development of pulmonary embolism: diabetes. A client with pneumonia who is immunocompromised has no risk factors for the development of pulmonary embolism.

A client has chronic asthma. Which complication should the nurse monitor in this client?

Atelectasis As a result of narrowed airways, adequate ventilation of lung tissue is compromised, and alveoli may collapse.

PETCO2

partial pressure of end-tidal carbon dioxide Normal = between 20 and 40 mm hg

A nurse is caring for a client who had a bronchoscopy one hour ago. Which nursing action is most appropriate for assessing the return of the client's gag reflex?

Gently touching the pharynx with a tongue depressor is a safe and reliable method of testing the gag reflex. Talking can occur without the gag reflex. Giving the client a small swallow of water can cause choking and aspiration if the gag reflex has not returned. Stroking the posterior, not the anterior, portion of the tongue may elicit the gag reflex

Which condition can cause a client's partial pressure of end-tidal carbon dioxide (PETCO 2) to be 50 mmHg?

Normal PETCO 2 ranges from 20 to 40mmHg. Therefore a value of 50 mmHg is considered high and may be the result of hypoventilation. Tracheal extubation, pulmonary embolism, and total airway obstruction are all possible causes of decreased PETCO 2 values.

The oxygen saturation value of an African client measured through a pulse oximeter is 93%. What does the nurse infer from this reading?

Normal pulse oximeter values lie between 95% and 100%. Clients with darker skin normally have slightly lower SpO 2 values because of the deeper coloration of the nail bed.

Which test will the nurse check for the most accurate measurement of the client's respiratory status?

Oxygen saturation is a measure of the relationship between oxygen and hemoglobin; it measures the amount of oxygen available to tissues and provides a pulmonary assessment for clients at risk for hypoxia; pulse oximetry provides a continuous, noninvasive measurement of an individual's oxygen saturation. PO 2 is a measure of diffusion across the alveolar membrane. This value may decrease progressively in a heavy smoker; thus it is not the most accurate measure of this client's postoperative respiratory status.

A client newly diagnosed with tuberculosis has a productive cough. Which is the most appropriate nursing intervention to teach the client?

Use disposable tissues Sputum can be contained within disposable paper tissues that can then be discarded in fluid-impervious bags. Because clients initially diagnosed with tuberculosis (TB) typically are fatigued and nutritionally compromised, the best approach is to conserve energy and, as the client improves, gradually initiate an exercise program. Sodium restriction and weekly blood pressure monitoring are not necessary.

a client with a pulmonary embolus is intubated and placed on mechanical ventilation. when suctioning the endotracheal tube, the nurse should 1. apply suction while inserting the cathetr 2. hyperoxygenate with 100% oxygen before and after suctioning 3. use short, jabbing movements of the catheter to loosen secretions 4. suction two or three times in quick succession to remove the secretions

hyperoxygenate with 100% oxygen before and after suctioning Suctioning removes not only secretions but also oxygen, which can cause cardiac dysrhythmias; the nurse should try to prevent this by hyperoxygenating the client before and after Suctioning.

When the oxygen dissociation curve goes to the right...

increased: temperature, CO2 concentration decreased: pH (acidosis) Faster unloading!

Cholingeric antagonists

inhibit, enhance, or mimic the action of the neurotransmitter acetylcholine, the primary transmitter of nerve impulses within the parasympathetic nervous system In chronic obstructive pulmonary disease (COPD) and asthma, cholinergic mechanisms contribute to increased bronchoconstriction and mucus secretion that limit airflow.

bronchial breath sounds

loud, high-pitched, hollow sounds normally heard over the trachea and the large bronchi

rhonchi

low-pitched, musical, snoring, adventitious lung sound caused by airflow obstruction from secretions COPD, pneumonia, chronic bronchitis, cystic fibrosis HF, asthma, foreign body

inspiratory capacity

maximum volume of air that can be inhaled after maximum expiration

Beta-adrenergic agents

medications that relax muscles of the airways, which widen the airways and result in easier breathing. opposite function of beta blockers

NSAIDs

nonsteroidal anti-inflammatory drugs

supraglottic

referring to the upper airway.