Unit 2 respiratory
A client with tuberculosis asks the nurse why vitamin B6 (pyridoxine) is given with isoniazid (INH). What explanation should the nurse provide?
"Isoniazid interferes with the synthesis of this vitamin."
During admission a client appears anxious and says to the nurse, "The doctor told me I have lung cancer. My father died from cancer. I wish I had never smoked." What is the nurse's best response?
"You are concerned about your diagnosis."
Nose
1 L of moisture secreted/ day
Left lung
2 lobes
Right lung
3 lobes
C&S
Complete culture x48 hrs, all microbes
22 to 24 breaths/ min
Early school-aged child:
around the lungs) is an airtight vacuum (negative pressure)
Pleural cavity
Pulmonary angiography
Pulmonary arteries Nursing intervention include: Providing patient education informed consent Assessing allergies Assessing labs and renal function Post-procedure, providing recovery care
Quickest, also noninvasive method of assessing oxygen saturation levels in patients:
Pulse oximetry
allows some voluntary control over breathing when talking, singing, eating, or changing the rate of breathing.
cerebral cortex
Internal respiration
exchange of oxygen and carbon dioxide at the cellular level (within the cells)
controls the depth and rate of respirations.
medulla's respiratory center
work with the medulla to produce a normal breathing rhythm.
pons
Hemothorax
Bloody collapsed lung
DX tumors/ bleeding site, remove foreign body or mucus plugs, or obtain secretions for cytologic studies or culture
Bronchoscopy
A nurse is preparing to insert a nasogastric tube. During insertion, which response indicates that the client is experiencing difficulty?
Inability to speak
Pulse oximetry
Normal range is 95% or greater( clients without lung dz) Patient with lung dz the target level is 90% or greater (typically runs 88 to 92%) COPD
Spirometer
Not used by patient Measures pulmonary function
A client is admitted to the emergency department with a stab wound of the left thorax. The nurse should position the client:
On the left side with the head of the bed elevated
Accuracy is lower w/ diminishes peripheral perfusion, brightly lit environment, acrylic fingernail polish, dark-skin color
Pulse oximetry
Lung perfusion scan
Radioactive- albumin injected via IV
Thoracentesis
Record the appearance of fluid, the amount obtained, and thoracentesis site
A nurse works with a large population of immigrant clients and is concerned about the debilitating effects of influenza. Which action is the first line of defense against an emerging influenza pandemic?
Reporting surveillance findings to appropriate public health officials
ROME
Respiratory Opposite Metabolic Equal
A client with a long history of asthma is scheduled for surgery. What information should be included in preoperative teaching.
There is an increased risk of respiratory tract infection
Throat culture specimen
To lab asap, less than 30 min, bacterial specimens degrade and dehydrate on swab
Incentive spirometer
Used by patient to help maintain lung function
too much carbon dioxide in blood
Acidosis
After the removal of a cast from a fractured arm, an 82-year-old client is to receive physical therapy. In an older adult, mild exercise is expected to cause respirations to:
Increase to 24 breaths per minute
Blood gas determinations
Level of arterial blood gases Partial pressure of oxygen Partial pressure of carbon dioxide Hydrogen ion concentration (pH) of the blood
Closed water seal drainage
Most common method of reestablishing negative pressure, one or more catheters inserted into chest cavity
Hyperventilation
Respiratory alkalosis
20 to 22 breaths/ min
Teenagers
40 to 60 breaths/ min
Newborn
Pulmonary function test (PFT) preparation
No heavy meal before No smoking Assess breathing Record patients age, height, & weight
Helical scan
Invasive, consent form Faster <30 sec: patient able to hold one breath Contrast media, entire region images in few seconds after contrast media is injected( allergies shellfish, iodine)
bronchoscopy
Invasive: patient is considered a surgical patient Patient pre- medicated: Local anesthesia; general IV anesthesia (midazolam) Versed is used for conscious sedation gen anesthesia Medication can cause amnesia regarding the examination: inform patient prior to study to prevent concern later Local anesthetic spray to throat/ sometimes nose before inserting scope NPO until gag reflex returns
To evaluate the effectiveness of a chest tube inserted in a client with a pneumothorax, the nurse assesses for:
Return of breath sounds
Bronchoscopy complications
-swelling of the throat -difficulty swallowing - difficulty breathing - bleeding All of these complications can result in emergent interventions to maintain patent airways
The nurse is caring for a 75-year-old client that had radical head and neck surgery. Thirty minutes after awakening from anesthesia, the client becomes agitated, disoriented, and confused. The nurse should:
Administer the prescribed oxygen
14 to 20 breaths/ min
Adult
is @ atmospheric pressure (higher than pleural air)
Air in lungs
too much oxygen in blood
Alkalosis
A nurse auscultates a client's lungs and hears a fine crackling sound in the left lower lung during respiration. The nurse charts, "crackles and rhonchi in the left lower lung." What does this documentation represent?
An inaccurate interpretation
A healthcare provider prescribes a medication to be administered via a meter dose inhaler for a young adult with asthma. List in order the steps the nurse teaches the client to follow when using inhaler
Shake, exhale, hold upright, start breathing in
What technique should a nurse use when cleaning a tracheostomy tube that has a nondisposable inner cannula?
Apply a precut dressing around the insertion site with the flaps pointing upward.
A client is admitted to the hospital with a tentative diagnosis of pneumonia. The client has a high fever and is short of breath. Bed rest, oxygen via nasal cannula, an intravenous antibiotic, and blood and sputum specimens for culture and sensitivity (C&S) are prescribed. Place these interventions in the order in which they should be implemented.
Bed rest, oxygen, specimen, antibiotics
Lung scan
Contrast media/ via inhalation or injection Informed consent: explain procedure Referred as a "ventilation scan " to after patient inhales a special gas
The nurse is providing care during the immediate postoperative period for a client that had a radical neck dissection. The best method to assess for stridor is:
Correct1 Listen with a stethoscope over the trachea
While walking in a hallway, a client with a chest tube becomes confused and pulls the chest tube out. What is the nurse's immediate action?
Cover the opening with the cleanest material available
What should the nurse expect when assessing a client with pleural effusion
Crackles or Rhônchi at the posterior of the lungs
A client had thoracic surgery. The nurse should monitor for what clinical manifestations that may indicate acute pulmonary edema? Select all that apply.
Crackles, cyanosis, dyspnea, frothy sputum
Chest X-ray
Determines lung & heart abnormalities Alterations in structures & blood flow Identifies lesions, infiltrations, foreign bodies, or fluid Confirms pneumothorax, pneumonia, pleural effusion, & pleural edema
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). During assessment, the nurse expects to auscultate:
Diminished breath sounds
•Carbon dioxide, a waste product of metabolism is transported by the blood from the body's cells to pulmonary capillaries in three main forms:
Dissolution in plasma -In combination with proteins -By formation into bicarbonate ions in the blood
A client just had a thoracentesis. For which response is it most important for the nurse to observe the client
Expectoration of blood
Bronchoscopy patient post op
Explain coughing w/ minimal blood-tinged mucus(expected) Assess for & immediately report hemoptysis EX: dyspnea, wheezing, apprehension, decreased breath sounds Laryngeal edema; bronchospasms: pneumothorax: cardiac dysrhythmias, bleeding from biopsy site Tracheostomy may be required if obstruction occurs ( always have at bedside) Usually clear-liquids to soft foods x 24 hours
During a client's routine physical examination, a chest x-ray film reveals a lesion in the right upper lobe. What information in the client's history supports the health care provider's diagnosis of pulmonary tuberculosis? (Select all that apply.)
Fever, night sweats, blood tinged sputum
A client develops increased respiratory secretions because of radiation therapy to the lung, and the health care provider prescribes postural drainage. What client assessment leads the nurse to determine that the postural drainage is effective?
Has a productive cough
Postural drainage
Head-downward position is used during much of procedure - last approx. 15-20 min -striking client between shoulder blades with cupped hands or vibrating client improves drainage - performed BEFORE person eats and oral hygiene is offered after procedure
thoracentesis patient care
If patient unable to sit up: place on UNAFFECTED side w/ HoB @ 30 degrees - risk of intravascular fluid shift with resultant pulmonary edema - to prevent re-expansion pulmonary edema usually no more than 1000 mL of fluid is removed at one time
A nurse is caring for a client who experienced a crushing chest injury. A chest tube was inserted. Which observation indicates a desired response to this treatment?
Increased breath sounds
Bronchoscopy patient prep
Informed consent Diet: NPO, (per MD order), usually 6-8 hrs Mouth care provided immediately before procedure: infection control
After emergency surgery, the nurse teaches a client how to use a incentive spirometer. What client behavior indicates to the nurse that the spirometer is being used correctly
Inhaler deeply through mouthpiece, relaxes, and then exhales
The nurse provides instructions to a client who will be using an incentive spirometer postoperatively. During the client's return demonstration, the nurse concludes that the teaching has been effective when the client:
Inhales deeply through the mouthpiece, holds the breath for two seconds, and then exhales
The nurse reinforces instructions about how to use a nebulizer to a client with chronic obstructive pulmonary disease (COPD). The nurse concludes that additional teaching is needed when the client:
Inhales with the lips tightly sealed around the mouthpiece of the nebulizer
Several days after a client had a total laryngectomy, the health care provider prescribes a progressive diet as tolerated. What should the nurse do?
Keep suction apparatus readily available in case excessive respiratory secretions occur.
A client who had surgery for a laryngectomy is returned to the surgical unit from the postanesthesia care unit. Which position is most appropriate for the nurse to place the client at this time?
Lateral with the head slightly elevated and flexed
When assessing the breath sounds of a client with chronic obstructive pulmonary disease (COPD), the nurse hears coarse rhonchi. They are described best as:
Moist rumbling sounds that clear after coughing
Bronchoscopy patient post op
NPO -until gag reflex has returned(2-8 hrs) -offer ICE CHIPS & sips of water before givin food Vitals signs q 15 min, 30 min, and hour until stable HoB; 30 to 45 degrees( semi-fowlers) Offer throat lozenges( sore throat relief) once patient is taking food
X-ray
No jewelry or metal or patient during test Non invasive
Hypoxia
One most obvious six of hypoxia is SOB, earlier so is SOBOE or DOE Late signs- gasping, wheezing and or retractions of the eternal region/ intercostal spaces Earliest sign- Restlessness -cyanosis - gray skin - pale skin - decreased O saturation
A client with pulmonary tuberculosis is being treated at home. To help control the spread of the disease, the nurse instructs the client to:
Open the windows frequently to allow air to circulate throughout the house
CT
Painless/ non invasive: tiny radiation exposure Pre-test to offer explanations & lower ANXIETY: sedative may be ordered if not contraindicated
client develops subcutaneous emphysema after a chest injury with suspected pneumothorax. What assessment by the nurse is the best method for detecting this complication?
Palpating the neck or face.
A client is admitted to the hospital with a diagnosis of emphysema. What should the nurse include when teaching the client breathing exercises?
Perform diaphragmatic exercises to improve contraction of the diaphragm
A client with terminal cancer signs a do-not-resuscitate (DNR) order upon admission to the hospital. When the client goes into respiratory arrest a week later, the client is not resuscitated. Which factor does the nurse determine is most relevant to the legal aspects of a DNR order?
Policies of the agency establish the status of DNR orders
A client with emphysema has a history of smoking two packs of cigarettes a day. What is the best approach for the nurse to help the client stop smoking?
Suggest that the client limit smoking to one pack of cigarettes a day
External respiration (pulmonary respirations; breathing)
The exchange of oxygen (O2) for carbon dioxide (CO2) within the alveoli of the lungs
Pathological aspiration
The inhalation or movement of fluid, mucus, or unwanted substances into lungs: can result in resp compromise/ death
After surgery for cancer of the posterior pharynx, a client is receiving gavage feedings through a nasogastric tube. A family member asks why this is necessary. What is the nurse's best response?
Tube feedings promote healing by reducing the risk for infection."
Soft swishing sounds of breathing are heard when the nurse auscultates a client's chest. What term should be used when documenting this assessment?
Vesicular breath sounds
Effects of aging
increased rigidity of thorax and diaphragm •Decreased numbers of alveoli and diffusion ability •Decreased strength in breathing and coughing •The size of the chest wall decreases as a result of kyphosis and osteoporosis •Increased risk for pneumonia and circulatory disorders •Obstructive sleep apnea in overweight and inactive clients
