Prepu 23

injection site of a client who has received a purified protein derivative test:

A 10-mm induration strongly suggests a positive response in this tuberculosis screening test; a 15-mm induration clearly requires further evaluation. A reddened area, 5-mm induration, and a blister aren't positive reactions to the test and require no further evaluation.

1.4 L

A client admitted with pneumonia has a history of lung cancer and heart failure. A nurse caring for this client recognizes that he should maintain adequate fluid intake to keep secretions thin for ease in expectoration. The amount of fluid intake this client should maintain is: 1.4 L. 2 L. 3 L. unspecified.

Pulmonary tuberculosis (TB) is treated primarily with anti-TB agents for 6 to 12 months.

A prolonged treatment duration is necessary to ensure eradication of the organisms and to prevent relapse.

From inspiratory wheezes may signal asthma,

Bilateral crackles may result in pulmonary congestion.

staphylococcal pneumonia

Influenza, an annual epidemic in the U.S., creates a significant increase in hospitalizations and an rise in the death rates from pneumonia and cardiovascular disease. Besides death, what is the most serious complication of influenza? staphylococcal pneumonia tracheobronchitis cardiovascular disease viral pneumonia

Absence of breath sounds in the right thorax

On auscultation, which finding suggests a right pneumothorax? Absence of breath sounds in the right thorax Inspiratory wheezes in the right thorax Bilateral inspiratory and expiratory crackles Bilateral pleural friction rub

Acute respiratory distress syndrome

The ICU nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following? Acute respiratory distress syndrome Lung cancer Bronchitis Tracheobronchitis

Rapid onset of severe dyspnea

The acute phase of ARDS is marked by a rapid onset of severe dyspnea that usually occurs less than 72 hours after the precipitating event

"You must consume

a diet rich in protein, such as chicken, fish, and beans."

In pneumothorax:

alveoli are deflated and no air exchange occurs in the lungs. Therefore, breath sounds in the affected lung field are absent.

Inhalation of coal dust and other dusts may cause :

black lung disease.

ARF is defined as a

decrease in arterial oxygen tension (PaO2) to less than 60 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO2) to >50 mm Hg (hypercapnia), with an arterial pH less than 7.35.

Clients need to keep their secretions thin by:

drinking 2 to 3 L of clear liquids per day.

ARF is defined as rapid

hours to weeks) deterioration of the glomerular filtration rate, associated with the accumulation of wastes such as urea and creatinine (aka _______)c

pleural friction

rub may indicate pleural inflammation.

A simple pneumothorax occurs

when air enters the pleural space through the rupture of a bleb or a bronchopleural fistula.

clinical manifestations of pulmonary contusions

are based on the severity of bruising and parenchymal involvement. The most common signs and symptoms are crackles, decreased or absent bronchial breath sounds, dyspnea, tachypnea, tachycardia, chest pain, blood-tinged secretions, hypoxemia, and respiratory acidosis. Patients with moderate pulmonary contusions often have a constant, but ineffective cough and cannot clear their secretions.

Complications include tracheobronchitis,

bacterial pneumonia, and cardiovascular disease, however staphylococcal pneumonia is the most serious complication.

The most frequent symptom of lung cancer is

cough or change in a chronic cough. People frequently ignore this symptom and attribute it to smoking or a respiratory infection. The cough may start as a dry, persistent cough, without sputum production. When obstruction of airways occurs, the cough may become productive due to infection.

Symptoms of PE

depend on the size of the thrombus and the area of the pulmonary artery occluded by the thrombus; they may be nonspecific. Dyspnea is the most frequent symptom; the duration and intensity of the dyspnea depend on the extent of embolization. Chest pain is common and is usually sudden and pleuritic in origin. It may be substernal and may mimic angina pectoris or a myocardial infarction. Other symptoms include anxiety, fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis, and syncope. The most frequent sign is tachypnea (very rapid respiratory rate).

Restlessness & confusion indicate

hypoxia, not an improvement in the client's condition.

The cause of pneumoconiosis

is Legionnaires' disease

A pneumothorax

is air in the pleural space.

A hemothorax

is blood within the pleural space

Fluid accumulating within the pleural space

is called a pleural effusion.

*Asbestosis* Most common cancer is broncogenic carcinoma, but incr risk for mesothelioma

is caused by inhalation of asbestos dust, which is frequently encountered during construction work, particularly when working with older buildings. Laws restrict asbestos use, but old materials still contain asbestos.

Consolidation

is lung tissue that has become more solid in nature as a result of the collapse of alveoli or an infectious process.

Ineffective airway clearance

is the priority nursing diagnosis for this client. Pneumonia involves excess secretions in the respiratory tract and inhibits air flow to the capillary bed. A client with pneumonia may not have an Ineffective breathing pattern, such as tachypnea, bradypnea, or Cheyne-Stokes respirations.

The nurse should institute droplet precautions,

isolate suspected and confirmed influenza patients in private rooms, or place suspected and confirmed patients together, and not allow visitors with symptoms of respiratory infection to visit the hospital to prevent outbreaks of influenza from occurring in health care settings.

Subcutaneous emphysema is the result of air

leaking between the subcutaneous layers. It is not a serious complication but is notable and reportable. Pink skin and blood in the collection chamber are normal findings. When two tubes are inserted, the posterior or lower tube drains fluid,whereas the anterior or upper tube is for air removal.

Pollen

may cause an allergic reaction.

Inhalation of silica

may cause silicosis, which results from inhalation of silica dust and is seen in workers involved with mining, quarrying, stone-cutting, and tunnel building.

A disease process is present.

nurse is reviewing a client's X-ray. The X-ray shows an endotracheal (ET) tube placed 3/4" (2 cm) above the carina and reveals nodular lesions and patchy infiltrates in the upper lobe. Which interpretation of the X-ray is accurate? The X-ray is inconclusive. A disease process is present. The ET tube must be advanced. The ET tube must be pulled back.

Dyspnea, the main symptom of PH

occurs at first with exertion and eventually at rest. Substernal chest pain also is common. Other signs and symptoms include weakness, fatigue, syncope, occasional hemoptysis, and signs of rightsided heart failure (peripheral edema, ascites, distended neck veins, liver engorgement, crackles, heart murmur). Anorexia and abdominal pain in the right upper quadrant may also occur.

Bronchial breath sounds over

the affected area occur during the acute phase of pneumonia; later, the affected area should be clear on auscultation.

Encouraging increased fluid intake

A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care? Turning the client every 2 hours Elevating the head of the bed 30 degrees Encouraging increased fluid intake Maintaining a cool room temperature

pulmonary arterial hypertension

A client presents to the ED reporting dyspnea on exertion and overall weakness. The client's pulmonary arterial pressure is 40/15 mm Hg. These symptoms indicate that the client may have which condition? pulmonary arterial hypertension restrictive lung disease asthma atelectasis

Pneumothorax

A client who has just had a triple-lumen catheter placed in his right subclavian vein complains of chest pain and shortness of breath. His blood pressure is decreased from baseline and, on auscultation of his chest, the nurse notes unequal breath sounds. A chest X-ray is immediately ordered by the physician. What diagnosis should the nurse suspect? Pulmonary embolism Myocardial infarction (MI) Heart failure Pneumothorax

"I'll stop being contagious when I have a negative acid-fast bacilli test."

A client who has started therapy for drug-resistant tuberculosis demonstrates understanding of tuberculosis transmission when he says: "My tuberculosis isn't contagious after I take the medication for 24 hours." "I'm clear when my chest X-ray is negative." "I'm contagious as long as I have night sweats." "I'll stop being contagious when I have a negative acid-fast bacilli test."

Asbestos

A client who works construction and has been demolishing an older building is diagnosed with pneumoconiosis. This lung inflammation is most likely caused by exposure to: asbestos. silica. coal dust. pollen.

A client with drug-resistant tuberculosis isn't contagious when he's had a negative acid-fast test.

A client with nonresistant tuberculosis is no longer considered contagious when he shows clinical evidence of decreased infection, such as significantly decreased coughing and fewer organisms on sputum smears. The medication may not produce negative acid-fast test results for several days. The client won't have a clear chest X-ray for several months after starting treatment. Night sweats are a sign of tuberculosis, but they don't indicate whether the client is contagious.

pH 7.28, PaO2 50 mm Hg

A nurse assesses arterial blood gas results for a patient in acute respiratory failure (ARF). Which results are consistent with this disorder? pH 7.46, PaO2 80 mm Hg pH 7.36, PaCO2 32 mm Hg pH 7.35, PaCO2 48 mm Hg pH 7.28, PaO2 50 mm Hg

15-mm induration

A nurse is assessing the injection site of a client who has received a purified protein derivative test. Which finding indicates a need for further evaluation? 5-mm induration Reddened area 15-mm induration A blister

Encourage breathing exercises.

A nurse is caring for a patient diagnosed with empyema. Which of the following interventions does a nurse implement for patients with empyema? Institute droplet precautions. Encourage breathing exercises. Place suspected patients together. Do not allow visitors with respiratory infection.

"It is all right if I have a grilled cheese sandwich with American cheese."

A patient taking isoniazid (INH) therapy for tuberculosis demonstrates understanding when making which statement? "I am going to have a tuna fish sandwich for lunch." "It is all right if I drink a glass of red wine with my dinner." "It is all right if I have a grilled cheese sandwich with American cheese." "It is fine if I eat sushi with a little bit of soy sauce."

pleural effusion

A physician stated to the nurse that the client has fluid in the pleural space and will need a thoracentesis. The nurse expects the physician to document this fluid as pleural effusion. pneumothorax. hemothorax. consolidation.

A miner can inhale dust causing silicosis or pneumoconiosis. development of an occupational lung disease.

A quarry worker is exposed to rock dust and silica.

Blood-tinged sputum

A victim has sustained a blunt force trauma to the chest. A pulmonary contusion is suspected. Which of the following clinical manifestations correlate with a moderate pulmonary contusion? Blood-tinged sputum Productive cough Bradypnea Respiratory alkalosis

Flail chest

A victim of a motor vehicle accident has been brought to the emergency room. The patient is exhibiting paradoxical chest expansion and respiratory distress. Which of the following chest disorders should be suspected? Flail chest Simple pneumothorax Pulmonary contusion Cardiac tamponade

TB indicates:

Class 1 is exposure but no evidence of infection. Class 0 is no exposure and no infection. Class 2 is a latent infection with no disease. Class 4 is disease, but not clinically active.

exposure and no evidence of infection.

Class 1 with regard to TB indicates no exposure and no infection. exposure and no evidence of infection. latent infection with no disease. disease that is not clinically active.

Increased restlessness

In a client with amyotrophic lateral sclerosis (ALS) and respiratory distress, which finding is the earliest sign of reduced oxygenation? Decreased heart rate Increased restlessness Increased blood pressure Decreased level of consciousness (LOC)

Miner, Rock quarry worker

In the prevention of occupational lung diseases, the nurse would direct preventive teaching to which high-risk occupations? Select all that apply. Banker Rock quarry worker Nurse Miner Mechanic Mechanic

Chest tube can be used to drain fluid and blood from the pleural cavity and to instill medication, such as talc, to the cavity.

Negative pressure must be maintained in the pleural cavity for the lungs to be inflated. An injury that allows air into the pleural space will result in a collapse of the lung.

Pneumothorax (air in the pleural space) is a potential complication of all central venous access devices

Signs and symptoms include chest pain, dyspnea, shoulder or neck pain, irritability, palpitations, light-headedness, hypotension, cyanosis, and unequal breath sounds. A chest X-ray reveals the collapse of the affected lung that results from pneumothorax. Triple-lumen catheter insertion through the subclavian vein isn't associated with pulmonary embolism, MI, or heart failure.

Coughing

The nurse is having an information session with a women's group at the YMCA about lung cancer. What frequent and commonly experienced symptom should the nurse be sure to include in the session? Copious sputum production Coughing Dyspnea Severe pain

Encourage breathing exercises.

The nurse teaches the patient with empyema to do breathing exercises as prescribed. The nurse should institute droplet precautions, isolate suspected and confirmed influenza patients in private rooms, or place suspected and confirmed patients together, and not allow visitors with symptoms of respiratory infection to visit the hospital to prevent outbreaks of influenza from occurring in health care settings.

Fibrotic changes in lungs

The occupational nurse is completing routine assessments on the employees where you work. What might be revealed by a chest radiograph for a client with occupational lung diseases? Fibrotic changes in lungs Hemorrhage Lung contusion Damage to surrounding tissues

Influenza type A is the most common cause of pneumonia.

Therefore, preventing influenza lowers the risk of pneumonia. Viral URIs can make the client more susceptible to secondary infections, but getting the flu is not a preventable action. Bacterial pneumonia is a typical pneumonia and cannot be prevented with a vaccine that is used to prevent a viral infection. Combined influenza with pneumonia is the major cause of death in the United States.

endotracheal (ET) tube placed 3/4" (2 cm) above the carina and reveals nodular lesions and patchy infiltrates in the upper lobe

This X-ray suggests tuberculosis. An ET tube that's 3/4" above the carina is at an adequate level in the trachea. There's no need to advance it or pull it back.

Increasing the client's intake of oral or I.V. fluids helps liquefy thick, tenacious secretions, and ensures adequate hydration.

Turning the client every 2 hours would help prevent atelectasis, but will not adequately mobilize thick secretions. Elevating the head of the bed would reduce pressure on the diaphragm and ease breathing, but wouldn't help the client with secretions.

Aspiration pneumonia

Which of the following is a potential complication of a low pressure in the endotracheal cuff? Aspiration pneumonia Tracheal bleeding Tracheal ischemia Pressure necrosis

Turn onto the affected side

Which technique does the nurse suggest to a client with pleurisy while teaching about splinting the chest wall? Turn onto the affected side. Use a prescribed analgesic. Avoid using a pillow while splinting. Use a heat or cold application.

Viruses like influenza are the most common cause of pneumonia."

A client at risk for pneumonia has been ordered an influenza vaccine. Which statement from the nurse best explains the rationale for this vaccine? "Getting the flu can complicate pneumonia." "Influenza vaccine will prevent typical pneumonias." "Influenza is the major cause of death in the United States." "Viruses like influenza are the most common cause of pneumonia."

pleural effusion.

A physician stated to the nurse that the client has fluid in the pleural space and will need a thoracentesis. The nurse expects the physician to document this fluid as consolidation. pleural effusion. pneumothorax. hemothorax.

continue to take antibiotics for the entire 10 days.

During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must: follow up with the physician in 2 weeks. continue to take antibiotics for the entire 10 days. turn and reposition himself every 2 hours. maintain fluid intake of 40 oz (1,200 ml) per day.

treatment of tracheobronchitis is largely symptomatic.

In most cases, Cool vapor therapy or steam inhalations may help relieve laryngeal and tracheal irritation. A primary nursing function is to encourage bronchial hygiene, such as increased fluid intake and directed coughing to remove secretions. Fatigue is a consequence of tracheobronchitis; therefore, the nurse cautions the client against overexertion, which can induce a relapse or exacerbation of the infection. The client is advised to rest.

Unresponsive arterial hypoxemia

The nurse is caring for a client with suspected ARDS with a pO2 of 53. The client is placed on oxygen via face mask and the PO2 remains the same. What does the nurse recognize as a key characteristic of ARDS? Unresponsive arterial hypoxemia Diminished alveolar dilation Tachypnea Increased PaO2

Encouraging a liberal fluid intake Instructing the client to move the legs in a "pumping" exercise Using elastic stockings, especially when decreased mobility would promote venous stasis Applying a sequential compression device

The nurse is planning the care for a client at risk of developing pulmonary embolism. What nursing interventions should be included in the care plan? Select all that apply. Encouraging a liberal fluid intake Instructing the client to move the legs in a "pumping" exercise Instructing the client to dangle the legs over the side of the bed for 30 minutes, four times a day Using elastic stockings, especially when decreased mobility would promote venous stasis Applying a sequential compression device

For a client with occupational lung diseases, a

chest radiograph may reveal fibrotic changes in the lungs. Hemorrhage, lung contusion, and damage to surrounding tissues are possibly caused by trauma due to chest injuries.

In clients with heart failure,

fluid intake shouldn't exceed 1.5 L daily.

As the acute phase of bacterial pneumonia subsides,

normal lung function returns and the PaO2 typically rises, reaching 85 to 100 mm Hg. A PaCO2 of 65 mm Hg or higher is above normal and indicates CO2 retention — common during the acute phase of pneumonia.

In chronic respiratory failure:

the loss of lung function is progressive, usually irreversible, and associated with chronic lung disease or other disease.

Intubate the client and control breathing with mechanical ventilation.

A client diagnosed with acute respiratory distress syndrome (ARDS) is restless and has a low oxygen saturation level. If the client's condition does not improve and the oxygen saturation level continues to decrease, what procedure will the nurse expect to assist with in order to help the client breathe more easily? Intubate the client and control breathing with mechanical ventilation Increase oxygen administration Administer a large dose of furosemide (Lasix) IVP stat Schedule the client for pulmonary surgery

The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher.

A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition? The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. The client exhibits restlessness and confusion. The client exhibits bronchial breath sounds over the affected area. The client has a partial pressure of arterial carbon dioxide (PaCO2) value of 65 mm Hg or higher.

The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher.

A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition? The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. The client has a partial pressure of arterial carbon dioxide (PaCO2) value of 65 mm Hg or higher. The client exhibits restlessness and confusion. The client exhibits bronchial breath sounds over the affected area.

Initiate oxygen therapy

A client who underwent surgery 12 hours ago has difficulty breathing. He has petechiae over his chest and complains of acute chest pain. What action should the nurse take first? Initiate oxygen therapy. Administer a heparin bolus and begin an infusion at 500 units/hour. Perform nasopharyngeal suctioning. Administer analgesics as ordered.

Ineffective airway clearance.

A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be: Risk for falls. Ineffective breathing pattern. Impaired tissue integrity. Ineffective airway clearance.

"You must consume a diet rich in protein, such as chicken, fish, and beans."

A nurse is preparing dietary recommendations for a client with a lung abscess. Which statement would be included in the plan of care? "You must consume a diet low in calories, such as skim milk, fresh fruits, and vegetables." "You must consume a diet high in carbohydrates, such as bread, potatoes, and pasta." "You must consume a diet low in fat by limiting dairy products and concentrated sweets." "You must consume a diet rich in protein, such as chicken, fish, and beans."

Negative

A nurse reading a chart notes that the client had a Mantoux skin test result with no induration and a 1-mm area of ecchymosis. How does the nurse interpret this result? Negative Positive Borderline Uncertain

production of an immune response

The Mantoux test is based on the antigen/antibody response and will show a positive reaction after an individual has been exposed to tuberculosis and has formed antibodies to the tuberculosis bacteria. Thus, a positive Mantoux test indicates the production of an immune response. Exposure doesn't confer immunity. A positive test doesn't confirm that a person has (or will develop) tuberculosis.

The tube will drain air from the space around the lung."

The client asks the nurse to explain the reason for a chest tube insertion in treating a pneumothorax. Which is the best response by the nurse? "Chest tube will allow air to be restored to the lung." "The tube will drain secretions from the lung." "Chest tubes provide a route for medication instillation to the lung." "The tube will drain air from the space around the lung."

The nurse teaches the client to splint the chest wall by turning onto the affected side.

The nurse also instructs the client to take analgesic medications as prescribed and to use heat or cold applications to manage pain with inspiration. The client can also splint the chest wall with a pillow when coughing.

Tachypnea

The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment? Cough Hemoptysis Syncope Tachypnea

Rapid onset of severe dyspnea

The nurse is assessing a client who, after an extensive surgical procedure, is at risk for developing acute respiratory distress syndrome (ARDS). The nurse assesses for which most common early sign of ARDS? Bilateral wheezing Cyanosis Inspiratory crackles Rapid onset of severe dyspnea

Stabbing pain during respiratory movement

The nurse is caring for a patient with pleurisy. What symptoms does the nurse recognize are significant for this patient's diagnosis? Dullness or flatness on percussion over areas of collected fluid Dyspnea and coughing Fever and chills Stabbing pain during respiratory movement

6 to 12 months

The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient? 3 months 3 to 5 months 6 to 12 months 13 to 18 months

Increasing fluid intake to remove secretions Encouraging the client to rest Using cool-vapor therapy to relieve laryngeal and tracheal irritation

The nurse is planning for the care of a client with acute tracheobronchitis. What nursing interventions should be included in the plan of care? Select all that apply. Increasing fluid intake to remove secretions Encouraging the client to rest Using cool-vapor therapy to relieve laryngeal and tracheal irritation Giving 3 L fluid per day Administering a narcotic analgesic for pain

Legs should not be dangled or feet placed in a dependent position while the client sits on the edge of the bed; instead, feet should rest on the floor or on a chair.v

The use of anti-embolism stockings or intermittent pneumatic leg compression devices reduces venous stasis. These measures compress the superficial veins and increase the velocity of blood in the deep veins by redirecting the blood through the deep veins. Having the client move the legs in a "pumping" exercise helps increase venous flow.

Client's signs and symptoms suggest pulmonary embolism

Therefore, maintaining respiratory function takes priority. The nurse should first initiate oxygen therapy and then notify the physician immediately. The physician will most likely order an anticoagulant such as heparin or an antithrombolytic to dissolve the thrombus. Analgesics can be administered to decrease pain and anxiety but administering oxygen takes priority. Suctioning typically isn't necessary with pulmonary embolism.

Pleurisy: result is severe, sharp, knifelike pain:

When the inflamed pleural membranes rub together during respiration (intensified on inspiration). The key characteristic of pleuritic pain is its relationship to respiratory movement. Taking a deep breath, coughing, or sneezing worsens the pain. Pleuritic pain is limited in distribution rather than diffuse; it usually occurs only on one side. The pain may become minimal or absent when the breath is held. It may be localized or radiate to the shoulder or abdomen. Later, as pleural fluid develops, the pain decreases.

The tissues give a crackling sensation when palpated.

While caring for a client with a chest tube, which nursing assessment would alert the nurse to a possible complication? Skin around tube is pink. Bloody drainage is seemed in the collection chamber. Absence of bloody drainage in the anterior/upper tube The tissues give a crackling sensation when palpated.

See if there are leaks in the system.

You are caring for a client status post lung resection. When assessing your client you find that the bubbling in the water-seal chamber for the chest tubes is more than you expected. What should you check when bubbling in the water-seal chamber is excessive? See if the chest tube is clogged. See if a kink has developed in the tubing. See if the wall suction unit has malfunctioned. See if there are leaks in the system.

Progressive loss of lung function associated with chronic disease

You are caring for a client with chronic respiratory failure. What are the signs and symptoms of chronic respiratory failure? Progressive loss of lung function associated with chronic disease Sudden loss of lung function associated with chronic disease Progressive loss of lung function with history of normal lung function Sudden loss of lung function with history of normal lung function

Client demonstrates understanding of how to prevent relapse when he states that he must continue taking the

antibiotics for the prescribed 10-day course. Although the client should keep the follow-up appointment with the physician and turn and reposition himself frequently, these interventions don't prevent relapse. The client should drink 51 to 101 oz (1,500 to 3,000 ml) per day of clear liquids.

Acute respiratory distress syndrome (ARDS)

can be thought of as a spectrum of disease, from its milder form (acute lung injury) to its most severe form of fulminate, life-threatening ARDS. This clinical syndrome is characterized by a severe inflammatory process causing diffuse alveolar damage that results in sudden and progressive pulmonary edema, increasing bilateral infiltrates on chest x-ray, hypoxemia unresponsive to oxygen supplementation regardless of the amount of PEEP, and the absence of an elevated left atrial pressure.

When a flail chest exists,

during inspiration, as the chest expands, the detached part of the rib segment (flail segment) moves in a paradoxical manner in that it is pulled inward during inspiration, reducing the amount of air that can be drawn into the lungs. On expiration, because the intrathoracic pressure exceed atmospheric pressure, the flail segment bulges outward, impairing the patient's ability to exhale.

Low pressure

in the cuff can increase the risk for aspiration pneumonia. High cuff pressure can cause tracheal bleeding, ischemia, and pressure necrosis.

Factors associated with the development of ARDS

include aspiration related to near drowning or vomiting; drug ingestion/overdose; hematologic disorders such as disseminated intravascular coagulation or massive transfusions; direct damage to the lungs through prolonged smoke inhalation or other corrosive substances; localized lung infection; metabolic disorders such as pancreatitis or uremia; shock; trauma such as chest contusions, multiple fractures, or head injury; any major surgery; embolism; and septicemia.

Cardiac tamponade

is compression of the heart resulting from fluid or blood within the pericardial sac.

A pulmonary contusion

is damage to the lung tissues resulting in hemorrhage and localized edema.

In ALS, an early sign of respiratory distress

is increased restlessness, which results from inadequate oxygen flow to the brain. As the body tries to compensate for inadequate oxygenation, the heart rate increases and blood pressure drops. A decreased LOC is a later sign of poor tissue oxygenation in a client with respiratory distress.

Patients taking INH:

should avoid foods that contain tyramine and histamine (tuna, aged cheese, red wine, soy sauce, yeast extracts), because eating them while taking INH may result in headache, flushing, hypotension, lightheadedness, palpitations, and diaphoresis. Patients should also avoid alcohol because of the high potential for hepatotoxic effects.

Dyspnea

x A patient is admitted to the hospital with pulmonary arterial hypertension. What assessment finding by the nurse is a significant finding for this patient? Ascites Dyspnea Hypertension Syncope