Chapter 30- Quiz #4 & Lecture Material
Patient & Family Education: Correct Inhaler Use w/o Spacer
1. Before each use, remove the cap and shake the inhaler according to the instructions in the package insert. 2. Tilt your head back slightly and breathe out fully. 3. Open your mouth and place the mouthpiece 1-2 inches away. 4. As you begin to breathe in deeply through your mouth, press down firmly on the canister of the inhaler to release one dose of medication. 5. Continue to breathe in slowly & deeply (usually over 5-7 seconds). 6. Hold your breath for at least 10 seconds to allow the medication to reach deep into the lungs and then breathe out slowly. 7. Wait at least one minute between puffs. 8. Replace the cap on the inhaler. 9. At least 1x per day, remove the canister and clean the plastic case & cap of the inhaler by thoroughly rinsing in warm, running tap water. 10. Avoid spraying in the direction of the eyes.
Patient & Family Education: Correct Inhalation Use w/ Space
1. Before each use, remove the caps from the inhaler & spacer. 2. Insert the mouthpiece of the inhaler into the non-mouthpiece end of the spacer. 3. Shake the whole unit vigorously 3-4 times. 4. FULLY exhale and then place the mouthpiece into your mouth, over your tongue, and seal your lips tightly around it. 5. Press down firmly on the canister of the inhaler to release one dose of medication into the spacer. 6. Breathe in slowly & deeply (if the spacer makes a whistling sound, you are breathing in TOO RAPIDLY). 7. Remove the mouthpiece from your mouth; and keeping your lips closed, hold your breath for at least 10 seconds and then breathe out slowly. 8. Wait at least one minute between puffs. 9. Replace the caps on the inhaler & the spacer. 10. AT LEAST 1x per day, clean the plastic case & cap of the inhaler by thoroughly rinsing in warm, running tap water (and at least 1x per week clean the spacer int he same manner).
ABG: pH Normal Range
7.35-7.45
A client with acute exacerbation of asthma has been admitted to the medical surgical unit for treatment. The client is reporting increased shortness of breath with inspiratory and expiratory wheezes. When planning care for this client, which medication will the nurse administer first? A. Albuterol-2 inhalations B. Fluticasone-2 inhalations C. Ipratropium-2 inhalations D. Salmeterol-2 inhalations
A. Albuterol-2 inhalations
Complications of COPD
COPD may results in hypoxemia, acidosis, respiratory infections, cardiac failure (for pulmonale = RIGHT SIDE), and/or cardiac dysrhythmias
The nurse on a medical surgical unit is planning bed assignments for a new admission who has cystic fibrosis (CF) and is infected with Burkholderia cepacia. Which of these room assignments is most appropriate for this client? A. A room with laminar air flow B. A room with a client who has Down syndrome and pneumonia C. A room with another client who has cystic fibrosis D. A private room with a bathroom
D. A private room with a bathroom
The nurse is assisting a health care provider with the removal of a chest tube. The nurse should instruct the client to take which action? A. Exhale slowly. B. Stay very still. C. Inhale and exhale quickly. D. Perform the Valsalva maneuver.
D. Perform the Valsalva maneuver.
Understanding a Peak Flow Meter
FAST exhalation rates = GREEN REDUCED exhalation rates = YELLOW SERIOUSLY REDUCED exhalation rated = RED
A patient uses a Peak Flow Meter at home to help them in knowing when to take their medications. What color would you teach the patient about as it signifies that they need to go to the EMERGENCY DEPARTMENT?
RED determines below 50% the patient's normal
Name a rescue bronchodilator drug for patients with asthma?
albuterol (SABA)
Name an anticholinergic drug for patients with asthma?
atrovent
Which bronchodilator is used in asthmatic patients every day, REGARDLESS of symptoms?
bronchodilator controller (ex. LABA)
Interventions for COPD Patients: Effective Coughing
encourage patient to cough several times or implement drug therapy (will be the same as asthmatic patients); we can provide humidification, fluid, & mucolytics for thick secretions and RT may percuss or use a vibrating chest machine (chest physiotherapy) to mechanically loosen secretions
What is the primary cause of COPD in the U.S.?
exposure to tobacco smoke
Curschmann's Spirals
found within the sputum of asthmatic patients
What is the typical O2 sat for a COPD patient?
high 80s-low 90s
Advanced/Chronic Emphysema
hypercarbia becomes an issue due to the affect on alveoli (bronchitis is where the airways are affected)
Lung Cancer Palliative Interventions
includes oxygen therapy, drug therapy, radiaiotng therapy, thoracentesis, dyspnea management, pain management, and possible the eventual need for hospice care (can be consulted to support BOTH the patient & family) which all purpose in comfort care to relieve symptoms
The leading cause of deaths worldwide is which type of cancer?
lung
Nursing Diagnoses
there are various pathophysiologic conditions which can be related to ineffective breathing patterns -Inability of air sacs to fill and empty properly in patients with Emphysema or Cystic Fibrosis. -Obstruction of the Air Passages in patients with Carcinoma, Asthma, or Chronic Bronchitis. -Accumulation of fluid in the air sacs in patients with Pneumonia. -Respiratory muscle fatigue in patients with COPD or Pneumonia.
Lung Cancer Palliative Interventions: Dyspnea Management
throughout eating and activity
Interventions for COPD Patients: Breathing Techniques
(ex. diaphragmatic breathing) where the patient places their hands on their abdomen in order to provide exhalation resistance and physical feeling of exhalation; pursed lip breathing is also common in COPD patients with Emphysema as it assists in the forcing of CO2 out of the body (patient may also be in a tripod position)
ABG: HCO3 Normal Range
21-28 mEq/L
ABG: PaCO2 Normal Range
35-45 mmHg
ABG: PaO2 Normal Range
80-100 mmHg (norm will be different in patients with asthma or other breathing issues)
Which statement by a client with chronic obstructive pulmonary disease (COPD) and a 10 pound (4.5 kg) weight loss indicates the need for additional follow-up instruction? A. "I should consume plenty of fluids with my meal." B. "I will try eating smaller more frequent meals." C. "I will try to eat more protein." D. "I will perform mouth care prior to eating."
A. "I should consume plenty of fluids with my meal."
The nurse is providing preoperative teaching for the client with lung cancer for whom a lobectomy is planned. Which of these does the nurse include in the preoperative education session? Select all that apply. A. "You will wake up with a drain in your chest which removes blood and allows the remaining lung to expand." B. "You will be able to get out of bed after the chest tube is removed." C. "Plan to request pain medication before your pain becomes severe." D. "You may have a tube in your throat connected to a mechanical ventilator to assist you with breathing." E. "You will need to lie on the operative side until the area of tissue removal heals."
A. "You will wake up with a drain in your chest which removes blood and allows the remaining lung to expand." C. "Plan to request pain medication before your pain becomes severe." D. "You may have a tube in your throat connected to a mechanical ventilator to assist you with breathing."
The nurse is caring for a client who has had a lobectomy and placement of a chest tube 8 hours ago. When performing an initial assessment, which of these requires immediate follow up? A. 200 mL red drainage from chest tube over 2 hours B. Client sleepy but able to be aroused B. 3 cm area of red drainage on the incisional dressing D. Report of pain at the chest tube insertion site
A. 200 mL red drainage from chest tube over 2 hours
A patient with a history of asthma is having shortness of breath. The nurse discovers that the peak flowmeter indicates a peak expiratory flow (PEF) reading that is in the red zone. What is the priority nursing action? A. Administer the rescue drugs. B. Take the patient's vital signs. C. Notify the patient's prescriber. D. Repeat the PEF reading to verify the results.
A. Administer the rescue drugs.
When caring for the client returning from thoracotomy and placement of a chest tube, the client reports severe pain. What does the nurse do first? A. Assess location and quality of pain. B. Call for the Rapid Response Team (RRT). C. Check the patency of the chest tubes. D. Call the health care provider.
A. Assess location and quality of pain.
Which signs/symptoms are indicators of an asthma attack? Select all that apply. A. Audible wheeze, especially on exhalation B. Muscle retraction between the ribs C. Decreased forced expiratory volume in the first second (FEV1) on flowmeter D. Eosinophils in the sputum E. Increased, then decreased arterial carbon dioxide (PaCO2) level
A. Audible wheeze, especially on exhalation B. Muscle retraction between the ribs C. Decreased forced expiratory volume in the first second (FEV1) on flowmeter D. Eosinophils in the sputum
The nurse is assessing a patient with a chest tube following a pneumonectomy. Which assessment finding requires intervention? A. Bandage around the posterior tube is loose. B. 2 cm of water is in the second chest tube chamber. C. The water in the water seal chamber rises and falls with inhalation/exhalation. D. Bubbling present in the water seal chamber when the patient coughs.
A. Bandage around the posterior tube is loose.
The charge nurse is making assignments for clients cared for on the intensive care stepdown unit. Which client will the charge nurse assign to the RN who has floated from the pediatric unit? A. Client with acute asthma episode who is receiving oxygen at FiO2 of 60% by non-rebreather mask B. Client with chronic pleural effusions who is scheduled for a paracentesis in the next hour C. Client with emphysema who requires instruction about correct use of oxygen at home D. Client with lung cancer who has just been transferred from the intensive care unit after a left lower lobectomy yesterday
A. Client with acute asthma episode who is receiving oxygen at FiO2 of 60% by non-rebreather mask
When caring for a client who had a lobectomy the nurse notes small bubbles in the water seal chamber of the disposable chest drainage device during coughing. Which of these reflects the appropriate action by the nurse? A. Document the finding in the medical record. B. Check the tube for blood clots. C. Briefly increase the amount of suction. D. Add additional sterile water to the water seal chamber.
A. Document the finding in the medical record.
A client has just been admitted to the intensive care unit after having a left lower lobectomy via video-assisted thorascopic surgery. Which of these prescriptions will the nurse implement first? A. Titrate oxygen flow rate to keep O2 saturation at or greater than 93%. B. Administer 2 g of cephazolin IV now. C. Give morphine sulfate 4 to 6 mg IV for pain. D. Transfuse 1 unit of packed red blood cells (PRBCs) over 2 hours.
A. Titrate oxygen flow rate to keep O2 saturation at or greater than 93%.
A client with COPD calls the pulmonary clinic reporting the last 24 hours the peak flow meter readings have been in the yellow range. Which of these interventions by the nurse is appropriate at this time? A. Use your prescription for rescue medication and retest yourself. B. This is a satisfactory reading, continue your present regimen. C. Go to the nearest emergency department. D. Increase your controller medication dose.
A. Use your prescription for rescue medication and retest yourself.
A client recently diagnosed with asthma has a prescription to use an inhaled medication with a spacer. The nurse evaluates the client has correct understanding of the use of an inhaler with a spacer when the client states which of these? Select all that apply. A. "I don't have to wait a minute between the two puffs if I use a spacer." B. "If the spacer makes a whistling sound, I am breathing in too rapidly." C. "I should rinse my mouth and then swallow the water to get all of the medicine." D. "I should shake the canister when I want to see whether it is empty." E. "I should hold my breath for at least ten seconds after inhaling the medication."
B. "If the spacer makes a whistling sound, I am E. "I should hold my breath for at least ten seconds after inhaling the medication."
The client says, "I hate this stupid COPD." What is the best response by the nurse? A. "Stopping smoking will help your lungs heal." B. "You sound fed up with managing your illness." C. "Does anyone in your family have COPD?" D. "Most clients get used to it after a few months."
B. "You sound fed up with managing your illness."
The nurse is caring for a group of patients on the pulmonary unit. Which patient is at greatest risk for having pulmonary hypertension (PH)? A. 29-year old male who is overweight B. 32-year-old female with a family history of PH C. 43-year-old male with history of right-sided heart failure D. 50-year-old female with history of blood clots in the pulmonary artery
B. 32-year-old female with a family history of PH
The nurse understands which is the primary risk factor for lung cancer? A. Air pollution B. Cigarette smoking C. Chronic exposure to asbestos D. Occupational radiation exposure
B. Cigarette smoking
The change-of-shift report has just been completed on the medical-surgical unit. Which client will the oncoming nurse plan to assess first? A. Client with chronic obstructive pulmonary disease (COPD) who is ready for discharge, but is unable to afford prescribed medications. B. Client with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate of 38 breaths/min. C. Hospice client with end-stage pulmonary fibrosis and an oxygen saturation level of 89%. D. Client with lung cancer who needs an IV antibiotic administered before going to surgery.
B. Client with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate of 38 breaths/min.
When caring for the client with chronic bronchitis, which of these interventions will assist the client in mobilizing secretions? A. Elevate the head of the bed 45 degrees B. Consume at least 2 liters of fluid daily C. Avoid triggers which cause coughing D. Assume the tripod position
B. Consume at least 2 liters of fluid daily
The nurse has assisted a health care provider (HCP) with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water-seal chamber after the tube is inserted. Based on this assessment, which action is most appropriate? A. Inform the HCP. B. Continue to monitor the client. C. Reinforce the occlusive dressing. D. Encourage the client to deep breathe.
B. Continue to monitor the client.
Which statements are correct regarding the drug management of asthma? Select all that apply. A. Long-acting beta agonists are indicated to relieve acute attack symptoms. B. Control therapy medications are used to prevent asthma attacks from occurring. C. Control therapy medications are used to reduce airway responsiveness. D. Reliever medications are used to stop an asthma attack once it has started. E. Anti-inflammatory medications are used to cause bronchodilation.
B. Control therapy medications are used to prevent asthma attacks from occurring. C. Control therapy medications are used to reduce airway responsiveness. D. Reliever medications are used to stop an asthma attack once it has started.
The nurse is providing teaching for a client who has been newly diagnosed with lung cancer and will be undergoing radiation therapy. Which of these points would be covered in the teaching session? Select all that apply. A. Hair loss will occur. B. Do not expose the site to sun. C. Loss of appetite may develop. D. Pain in the area is expected. E. Fatigue may occur. F. Changes in taste may occur.
B. Do not expose the site to sun. E. Fatigue may occur. F. Changes in taste may occur.
The nurse is monitoring the chest tube drainage system in a client with a chest tube. The nurse notes intermittent bubbling in the water seal chamber. Which is the most appropriate nursing action? A. Check for an air leak. B. Document the findings. C. Notify the health care provider. D. Change the chest tube drainage system.
B. Document the findings. (if continuous/excessive, then we would notify the provider)
While the Rapid Response Team is at the bedside, the patient's healthcare provider arrives. The provider writes several orders. Which order is most important for the nurse to implement immediately? A. Transfer to ICU B. Increase O2 to 3 L per nasal cannula C. ABGs 30 min after oxygen is increased D. Methylprednisolone sodium succinate (Solu-Medrol) 40 mg IVP
B. Increase O2 to 3 L per nasal cannula -Based on the patient's every SOB, the FIRST THING that needs to be done is to increase her oxygenation.
The nurse is educating the client with COPD who requires home oxygen therapy for discharge. Which of these teaching points takes the highest priority? A. Correct performance when setting up the oxygen delivery system B. Removing combustion hazards present in the home C. Understanding the signs and symptoms of hypoxemia D. Demonstrating how to use a pulse oximetry device
B. Removing combustion hazards present in the home
Based on the patient's COPD diagnosis, which clinical manifestations would the nurse expect to see when assessing this patient? (Select all that apply.) A. Bradycardia B. Shortness of breath C. Use of accessory muscles D. Sitting in a forward posture E. Barrel chest appearance
B. Shortness of breath C. Use of accessory muscles D. Sitting in a forward posture E. Barrel chest appearance
After receiving education on the correct use of emergency drug therapy for asthma, which statement by the client indicates a correct understanding of the nurse's instructions? A. "All asthma drugs help everybody breathe better." B. "I must carry my emergency inhaler when activity is anticipated." C. "I must have my emergency inhaler with me at all times." D. "Preventive drugs can stop an attack."
C. "I must have my emergency inhaler with me at all times."
The nurse is evaluating understanding of the treatment regimen for a client newly diagnosed with asthma. Which of these statements by the client indicates understanding of the regimen? A. "I will take albuterol when I go to sleep." B. "I will keep the rescue medication readily accessible on the first floor of my home." C. "I will take the long acting beta agonist even when my breathing seems OK." D. "I will immediately take the anti-inflammatory medication for an acute asthma attack."
C. "I will take the long acting beta agonist even when my breathing seems OK."
The school nurse is teaching a group of adolescents about risk factors for lung cancer and lung disease. Which of these would be included in the discussion? A. Alcohol consumption B. Cocaine use C. Cigarette smoking D. Heroin use
C. Cigarette smoking
The nurse in the clinic is following up on diagnostic testing for a client recently diagnosed with metastatic lung cancer and back pain. Which of these findings does the nurse expect to uncover? A. Hyperkalemia B. Hyperglycemia C. Hypercalcemia D. Hypernatremia
C. Hypercalcemia
What is a special consideration when placing a COPD patient on oxygen? What do we do if this occurs?
CO2 retention (why we start with the LOWEST LEVEL possible, such as a 2 mL cannula or accurate venturi); if this begins to happen, we need to implement the use of an NPPV biPAP or CPAP
The nurse is assessing a client admitted with status asthmaticus. The nurse finds a sudden absence of wheezing in the lung fields and sets which of these as the priority action? A. Education to prevent future exacerbations B. Administration of a bronchodilator C. Measures to reduce anxiety D. Activation of the rapid response team to secure an airway
D. Activation of the rapid response team to secure an airway
The nurse is providing education to a client with chronic bronchitis who has a new prescription for a mucolytic. Which of these will the nurse teach the client about the purpose of the medication? A. Mucolytics decrease secretion production. B. Mucolytics increase gas exchange in the lower airways. C. Mucolytics provide bronchodilation in clients with chronic obstructive pulmonary disease. D. Mucolytics thin secretions, allowing for easier expectoration.
D. Mucolytics thin secretions, allowing for easier expectoration.
The nurse caring for a client with a chest tube turns the client to the side and the chest tube accidentally disconnects from the water seal chamber. Which initial nursing action should the nurse take? A. Call the health care provider (HCP). B. Place the tube in a bottle of sterile water. C. Replace the chest tube system. D. Place a sterile dressing over the disconnection site.
D. Place a sterile dressing over the disconnection site.
A nurse is caring for a client with a chest tube drainage system. While the client is being assisted to sit up in bed in preparation for ambulation, the chest drainage system accidentally disconnects. Which is the initial nursing action? A. Call a respiratory therapist. B. Contact the health care provider (HCP). C. Encourage the client to perform the Valsalva maneuver. D. Place the end of the chest tube in a container of sterile water.
D. Place the end of the chest tube in a container of sterile water.
The nurse is preparing to administer oxygen to a client with chronic obstructive pulmonary disease (COPD) who has hypoxemia and hypercarbia. The nurse recognizes that a positive outcome to therapy has been achieved by which of these findings? A. The pCO2 is within normal range. B. The client's face is very pink. C. The client reports decreased distress. D. The oxygen saturation is between 88% and 90%.
D. The oxygen saturation is between 88% and 90%.
Non-Infectious Lower Respiratory Problems: Home Management (Medication Regimen)
Does the patient understand what medications they are on? What was ordered and is the patient taking it correctly? How much does the patient's medication cost? Does the patient take their SABA with them everywhere they go? SABA: RESUCE (ex. albuterol) LABA: DAILY MAINTENANCE/CONTROL (ex.
Cystic Fibrosis Priority Nursing Interventions: Infection Prevent
How can we protect our CF patients from hospital-acquired pulmonary infections? -We can provide our patients nutrition through pancreatic enzyme replacement, prevent & manage exacerbations, drug therapy, prevent infection, and education about contact with others (NO kissing, shaking hands, wash hands), etc.
Will all COPD patients retain CO2?
NO, not even when hypoxemia is present because CO2 diffused more easily across lung membranes (v. O2 diffusion)
Your patient with dyspnea may not be able to tolerate a bath. Can this be delegated to a UAP?
NO, we are NOT able to predict the results if this patient were to receive a bath
Cells depend on what to carry out their functions?
OXYGEN! Inadequate arterial oxygenation is manifested by cyanosis, a SLOW capillary refill > three seconds, and a chronic sign of clubbing finger nails (LATE SIGN = clubbing of the FINGERS)
Non-Infectious Lower Respiratory Problems: Drug Therapy (Anti-Inflammatories)
PO prednisone (ex. Solumedrol) will DECREASE THE IMMUNE SYSTEM so it requires tapering with discontinuation, also be sure to educate the patient that they are at an increase risk for infection and need to take this specific medication with food to prevent GI upset
You observe "tilting" of the ball on the chamber (moving up & down). Is this normal or does it need to be reported to the physician?
YES, tilting is normal but we need to continue to monitor if needed as AN ABSENCE may indicate an obstruction
Air Leaks & Kinking
a physician may ask to use hemostats to clip different parts of the drainage tubing (DOCUMENT EVERYTHING YOU DO) and "milking" may also be ordered by a physician which is needed to work out tubing clots to avoid clotting off; talk to the surgeon BEFOREHAND and check the policy BEFOREHAND to prevent any possible damage of the lung tissue
Signs & Symptoms of a Non-Infectious Lower Respiratory Problems Acute Exacerbation: Accessory Muscle Use
accessory muscles can be altered in the ribs, abdomen, and supraclavicular region
Anti-Inflammatories
all of these drugs help improve bronchiolar airflow and increase gas exchange by decreasing the inflammatory response of the mucous membranes in the airways (do NOT CAUSE BRONCHODILATION so they are NOT classified as bronchodilators); corticosteroids will disrupt production pathways on inflammatory mediators with the main purpose to prevent an asthma attack caused by inflammation or allergies (controller) drug
Interventions for COPD Patients: Improved Activity Tolerance
allow time for frequent rest breaks especially if the patient is able to ambulate, and use a pulse oximeter to identify WHEN the patient needs a break or to sit down
Cystic Fibrosis (CF)
an incurable, autosomal recessive genetic disease which affects many organs and impairs pulmonary function of our patients; we will refer these patients to genetic counselors if they have further questions
What are we NOT able to delegate to a UAP?
an unstable/complex patient, patient education, planning of care for a patient, and an assessment of a patient
Patient & Family Education: Asthma Self-Management
avoid potential environmental triggers (smoke, fireplaces, dust, mold, weather changes), avoid drug triggers (aspirin, NSAIDS, beta-blockers), avoid food that has been prepared with monosodium glutamate (MSG) or metabisulfite, use the bronchodilator inhaler 30 minutes before exercise to prevent or reduce bronchospasm with exercise-induced asthma, know proper technique & sequence when using a MDI, reduce stress & anxiety, learn relaxation techniques, adopt coping mechanisms, wash all bedding with hot water to destroy dust mites, monitor peak expiratory flow rates with a flow meter 2x daily, and know when to seek emergency care
COPD: Pulmonary Emphysema "Pink Puffer"
barrel chest indicative of emphysema which is caused by the use of accessory muscle to breathe, individuals with emphysema have to work harder to breathe even though the amount of O2 taken in is adequate to oxygenate their tissues
Non-Infectious Lower Respiratory Problems: Drug Therapy
based on step category depending on severity & treatment, but will include a bronchodilator (controller AND rescue), cholinergic antagonist, or an anti-inflammatory
Bronchodilators: Cholinergic Antagonists
cause bronchodilation by inhibiting the parasympathetic nervous system (PNS) which allows the sympathetic system to DOMINATE, releasing NE to activate beta2 receptors (purposes to relieve AND prevent asthma & improve gas exchange; if the patient uses a reliever drug they need to carry it with them at ALL TIMES as it can stop or reduce life-threatening bronchoconstriction, teach patient to shake MDI well before use as the drugs separate easily, increase daily fluid intake because the drugs cause xerostomia, observe for side effects (ex. blurred vision, eye pain, headache, nausea, palpitations, tumors, inability to sleep) which are systematic symptoms of OD that require intervention, and also teach the correct technique for using the MDI or DPI to ensure that the drug is reaching the site of action = ATROVENT
Bronchodilators
cause bronchodilation through relaxing bronchiolar smooth muscle by binding to and activating pulmonary beta2 receptors (will be a SABA, LABA, or Cholinergic Antagonist)
Bronchodilators: Long-Acting Beta2 Agonists (LABA)
causes bronchodilation through relaxing bronchiolar smooth muscle by binding to and activating pulmonary beta2 receptors, SLOW onset of action with a LONG DURATION, and primary use is the prevention of an asthma attack; teach patients to NOT use these drugs to relieve an attack as they have a slow onset of action, do NOT relieve acute symptoms, and also provide education on the correct technique for using the MDI or DPI to ensure that the drug is reaching the site of action = SEREVENT
Bronchial Asthma
causes the bronchiole to become obstructed on expiration due to muscle spasm, mucosal edema, and thick secretions
Interventions for COPD Patients: Breathing Techniques (Pursed-Lip Breathing)
close your mouth & breathe in through your nose, purse your lips (ex. whistling), breathe out slowly through your mouth without puffing your cheeks, spend AT LEAST twice the amount of time it took to breathe in, use abdominal muscles to squeeze out every bit of air possible, and remed to use this breathing exercise during any physical activity; ALWAYS inhale before beginning activity and exhale while performed it (NEVER HOLD YOUR BREATH)INCIS
Chronic Lung Disease
compensations will begin to occur with alteration of ABGs; worsening of chronic COPD will include a decreased amount of O2 in the blood (hypoxemia), increased amount of CO2 in the blood (hypercapnia), and then a progression to respiratory acidosis (increased paCO2 = metabolic alkalosis COMPENSATION)- we ALWAYS NEED to obtain baseline data
COPD: Chronic Bronchitis "Blue Bloater"
defined as insufficient oxygenation with chronic bronchitis, leading to generalized cyanosis and often a diagnosis of right-sided HF ("cor pulmonale")
Complications of COPD: Hypoxemia
defined as when the patient does NOT have enough oxygen getting to the heart, causing an increase in HR and stress-produced cardiac dysrhythmias
Non-Infectious Lower Respiratory Problems: Home Management (Peak Flow Meter)
determines the normal expiratory capability by showing a visual measurement for WHEN patients need to take their medications
Interventions for COPD Patients: Weight Loss Prevention
encourage "energy-focused" breathing, 4-6 small meals a day (frequent with less food), drinking after eating in order to avoid feeling full after liquid consumption, facilitation of a bronchodilator 30 minutes before meals, and consult a dietician to provide high calorie & high protein foods
The patient is in the ICU for 3 days and then transferred back to the pulmonary stepdown unit. She is still slightly short of breath with exertion. Her O2 saturation is 99% on oxygen at 2 L per nasal cannula. She denies any shortness of breath when resting during the assessment. The provider plans to discharge the patient on home oxygen in the morning. What should the nurse include in this patient's discharge teaching?
ensure that the patient understands any new medication regimens, instruct het to call 911 for severe respiratory distress, and should also be arranged with home health services as she is being discharged with home oxygen
Inflatable Chest Physiotherapy Vest
for high-frequency chest wall oscillation
Lung Cancer
has a poor long-term survival rate because it's diagnosed so late in its progression, bronchogenic carcinomas, stags to assess size/extend of disease, etiology (genetic risk), and may be managed surgically or non-surgically
Aerosol Inhaler w/ Spacer
if a patient is breathing TOO FAST, a whistling sound will occur
Interventions for COPD Patients: Breathing Techniques (Diaphragmatic/Abdominal Breathing)
if you can do so comfortably lie on your back with your knees bent or perform this exercise while sitting in a chair, place hands or a book on the abdomen to create resistance, and begin breathing from your abdomen while keeping your chest still (your hands or the book should rise & fall accordingly)
Lung Cancer Carcinomas: Late Stage Signs & Symptoms
include blood-tinged sputum, increased remits (tumor/fluid replacing air space), muffled heart sounds, dysrhythmias due to hypoxia, and unplanned weight loss/anorexia from loss of appetite
Non-Infectious Lower Respiratory Problems: Lab Diagnostics
includes ABGs, ELEVATED serum eosinophil counts, ELEVATED serum IgE levels, sputum containing eosinophils & mucous plugs w/ shaded epithelial cells AND diagnosed with a pulmonary function test (PFT)
ABG
includes PaO2, PaCO2, pH, and HCO3 (PaO2 will be different in patients with asthma or other breathing issues)
Wedge Resection
includes a video-associated thorascopic surgery (VAT) and removal the localized, diseased area; VAT is a minimally invasive approach as it includes three instrument incisions which are later replaced with a drain or chest tube
Signs & Symptoms of a Non-Infectious Lower Respiratory Problems Acute Exacerbation
includes audible wheezing, increased respiratory rate, wheezing louder upon exhalation (early), coughing, use of accessory muscles, breathing cycle is longer with prolonged exhalation (including requirement of more effort), and hypoxemia may lead to a decreased LOC
Chronic Obstructive Pulmonary Disease (COPD)
includes emphysema & chronic bronchitis which will be characterized by bronchospasm, dyspnea, and IRREVERSIBLE tissue damage which will increase in severity leading to eventual respiratory failure
Patient & Family Education: Asthma Self-Management (Seeking Emergency Care)
includes experiencing gray or blue fingertips or lips, difficulty breathing (walking or talking too), retractions (neck/chest/ribs), nasal flaring, failure of drugs to control worsening symptoms, or a PERF declining steadily after treatment OR a flow rate 50% below the usual flow rate
Lung Cancer Assessment
includes patient history, pulmonary & non-pulmonary manifestations, psychosocial assessment, and a diagnostics assessment as well
Cystic Fibrosis Priority Nursing Interventions
includes the focus on teaching about drug therapy, infection prevention, pulmonary hygiene, nutrition, and supplementation with vitamins
Interventions for COPD Patients
includes the implementation of improved oxygenation to reduce CO2 retention, breathing techniques, patient positioning, effective coughing, drug therapy, improved activity tolerance, suctioning, hydration, vibratory position expiratory pressure device (VPEPD), prevention of weight loss, minimizing anxiety, preventing respiratory infection, and even surgical management
Complications of COPD: Acidosis
increased levels of K+ cause dysrhythmias
Non-Infectious Lower Respiratory Problems: Home Management
involves adherence to the medication regimen, utilization of a peak flow meter, and knowing when to call the physician or when to go to the ED
Community-Based Care
involves home care management, long-term use of oxygen, pulmonary rehabilitation program, teachings for self-management, drug therapy, manifestations of infection, breathing techniques, relaxation therapy, and resources (ex. smoking cessation support group, ALA Better Breathers Club, meals on wheels)
Chest Tube Placement
it's easy for the drainage tubing to become kinked or pulled out of the patient upon movement, but if something is questioned, it needs to be reported to the physician, but the patient will also have a DAILY CHEST X-RAY in order to monitor the correct tubing position; a PRIORITY is ensuring system integrity such as that the drainage chamber is below chest level, change the system out if we're doubting it or it gets knocked over, it may be BOTH A/P chest tube that's separate or wired together so we need to label in order to avoid confusion, and assessing requiring securement of the connection with both dressing & tape
Interventions for COPD Patients: Minimizing Anxiety
listen to your patient and provide an anti-anxiety medication if needed (just like asthmatic patients), relaxation therapy may even be implemented as well if effective
Patient & Family Education: Dry Powder Inhaler (DPI) Self-Managemnet
loading = turn the device to the next dose, insert the capsule into the device, or insert the disk/compartment into the device and then after (or if does NOT require loading): 1. Read doctor's instructions for how fast you should breathe for your particular inhaler. 2. Exhale fully away from the inhaler. 3. Place your lips over the mouthpiece and breathe in forcefully (there is NO propellant int he inhaler; only your breath pulls the drug in). 4. Remove the inhaler from your moth as soon as you have breathed in. 5. NEVER exhale/breathe out into your inhaler. Your breath will moisten the powder, causing it to clump and NOT be delivered accurately. NEVER wash or place the inhaler in water. NEVER shake your inhaler. 6. Keep your inhaler in a day place at room temperature. 7. If the inhaler is preloaded, discard it after it's empty. 8. Because the drug is a dry powder and there's NO propellant, you may NOT feel, smell, or taste it as you inhale.
Non-Infectious Lower Respiratory Problems: Drug Therapy (Cholinergic Antagonist) OD Signs & Symptoms
make sure to monitor and report blurred vision, eye pain, headache, nausea, palpation, tremors, and inability to sleep
Anti-Inflammatories: Patient Education
make sure to teach patients to use the drug daily even when there are NO symptoms present (maximum effectiveness requires continued use for 48-72 hours dependent on regular use), use good mouth care, check mouth daily for lesions or drainage (these drugs reduce local immunity & increase the risk for local infections, ex. candida albicans/yeast), do NOT use these as reliever drugs because they have a slow onset of action and DO NOT RELIEVE ACUTE SYMPTOMS, correct technique for using the MDI or DPI to ensure that the drug is reaching the site of action, expected side effects (helps to reduce anxiety when they appear), avoid anyone with an URI because the drug reduces ALL protective inflammatory responses (increases risk for infection), avoid activities that lead to injury (blood vessels become more fragile = bruising & petechiae), take the medication with food to reduce the possible side effect of a GI ulceration, and also educate the patient to NOT suddenly stop taking the drug for any reason (the drug suppresses adrenal production of corticosteroids which are ESSENTIAL FOR LIFE) = ORAL PREDNISONE
Chest Tubes
may also be seen with CABG or open-heart patients since these tubes allow for chest re-exspansion, drainage of air & blood from the lung, and prevents air & fluid from returning back intro the chest
Chemotherapy agents may be toxic to which organ, having the potential to cause which emergency condition?
may be toxic to the heart causing a possible MI (why an EKG is required before initiation of chemotherapy)
Lung Cancer Palliative Interventions: Drug Therapy
may include a bronchodilator to open up the airways (ex. steroids)
Non-Infectious Lower Respiratory Problems
may include asthma, COPD (emphysema & chronic bronchitis), cystic fibrosis, occupational pulmonary disease (OPD), and lung
Non-Surgical Management of Lung Cancer
may include chemotherapy, targeted therapy, radiation therapy, or photodynamic therapy
Continuous/Excessive Bubbling in a Chest Tube's Water Seal
may indicate an air leak (intermittent is OKAY though, especially with coughing/sneezing/chest air is let out), make sure an air leak isn't already existing before the patient is in our care (ASSESS PATIENT BEFORE THEY LEAVE THEM- they can be aware of complications on your watch)
Radiation Therapy
may result in changes in taste or xerostomia
Interventions for COPD Patients: Infection Prevention
methods involve vaccinations (flu & pneumonia), incentive spirometer (IS) to exercise the lungs, and encouragement of coughing & deep breathing
Complications of COPD: Cardiac Failure
most commonly right-sided (known as cor pulmonale) which puts the patient at risk for edema throughout their body
When the COPD patient arrives to the unit, she is assessed and is in acute respiratory distress. Her respirations are labored and her respiratory rate is 34. She states that she is severely short of breath. Her oxygen saturation is 82% on O2 at 2 L via nasal cannula. Based on these findings, what should the nurse do next?
notify the raid response team (RRT) ASAP as these assessment findings indicate acute respiratory difficult; oxygen saturation should AT LEAST be at 90% on 2 L of a nasal cannula
Non-Infectious Lower Respiratory Problems: Lab Diagnostics (PFT)
observes forced vital capacity (FVC) which is known as the MAXIMUM FORCE of expiratory value within the first second (FEV1); allows us to look at lung capacity and how well muscles are working along with a comparison when a bronchodilator is in use
Chest Tube Removal
occurs at the bedside by the provider/surgeon when DRAINAGE IS MINIMAL, requires pain medication before the procure, needs a fluid removal kit for stitches, obtain preferred dressing for the site, and monitor for any possible complications
Complications of COPD: Respiratory Infections
often occurs with exacerbation (ex. "Blue Bloater") which includes a fever, requiring further inquiry about their sputum as green or yellow is indicative of an infection A. Has the sputum increased? B. Has the sputum changed color?
Why do patients need to know how to take their own/monitor their own pulse if they are prescribed a bronchodilator medication?
one of the side effects is tachycardia
A patient is having an acute asthma attack, requiring them to take their SABA too. Can they their LABA immediately after or what precautions should they be instructed to take?
patient will need to wait FIVE MINUTES after taking their SABA
Lung Reduction Post-Op Care
patients need bronchodilators, mucolytics, IS use 10x per hour while awake (Q1HR), cough out secretions, chest physiotherapy the FIRST DAY AFTER SURGERY, and an initial pulmonary assessment EVERY HOUR (stability-dependent) which is all followed by the physician's orders
Post-Removal Complications of Chest Tube
possible complications can be respiratory distress (collapse & fluid buildup), so we have the patient use of an IS every hour WHILE AWAKE, encourage coughing & deep breathing, "splinting" technique with a pillow/blanket (applies pressure on incision site), ambulating throughout recovery, and NEEDS PAIN MANAGEMENT after tube discontinuation (as well as to perform previously stated activities to prevent further issues later on)
Chemotherapy Complications
possible heart toxicity, hair loss, immunosuppression (increasing risk for infection), may decrease clotting factors (increases risk for bleeding), and the patient may also have an increasing clotting time because of a platelet decrease
Bronchodilators: Short-Acting Beta2 Agonists (SABA)
primary use is fast-acting reliever (rescue) drug to be used either during an asthma attack or just before engaging in activity that usually triggers an attack; teach patients to carry drug with them at ALL TIMES because it can stop or reduce life-threatening bronchoconstriction, monitor HR because excessive use causes TACHYCARDIA & other systemic symptoms, use it AT LEAST FIVE MINUTES BEFORE the other inhaled drugs to allow the bronchodilation effect to increase the penetration of the other inhaled drugs, and also teach the patient the correct technique for using the MDI or DPI to ensure that the drug is reaching the site of action = ALBUTEROL
Surgical Management of Lung Cancer
procedures include a lobectomy, pneumonectomy, segmentectomy, and a wedge resection
Which diagnostic test would we use for a patient with a non-infectious lower respiratory problem in order to determine if a bronchodilator would effect them (and how)?
pulmonary function test (PFT)
Interventions for COPD Patients: Patient Positioning
raising the head of the patient's bed will assist in stabilizing BP, increasing chest expansion, proper positioning of diaphragm, and relief of dyspnea
Community-Based Care: At-Home Oxygen Safety Measures
rehabilitation programs are on an outpatient basis, including dynspea and building activity tolerance assessment 30-11
Lobectomy
removal of a piece of the lung along with the tumor
Lung Cancer Palliative Interventions: Thoracentesis
removal of fluid in lung for comfort
Pneumonectomy
removal of the ENTIRE lung
What happens if the chest tube becomes dislodged?
requires sterile gauze at the bedside to cover it
Photodynamic Therapy
requires tumor accessibility by a bronchoscope to slough cells, also requires airway management from edema (patient will more than likely be in a CCU)
Non-Infectious Lower Respiratory Problems: Drug Therapy (Bronchodilator Rescue)
rescue drugs which purpose in STOPPING an attack ONCE IT HAS STARTED
Chest Tube PCA
retractors are used to keep the area open which usually requires the need for a PCA as it can be very painful, so the patient will probably have morphine PRN through an IV push
Chest Tube: Water Seal
seals the system with STERILE WATER to keep air from entering the chest, suction is connected to where the sterile-solution is inserted with a syringe, bottom port is another area of entry, and this is all determined by the chamber accordion (PHYSICIAN WILL LET US KNOW WITH AN ORDER)
Name a controller/maintenance bronchodilator drug for patients with asthma?
serevent (LABA)
Lung Cancer Palliative Interventions: Radiation
shrink the tumor to assist in management (NOT CURE)
A patient is exhibiting signs & symptoms of an acute exacerbation of a Non-Infectious Lower Respiratory Problem. A significant jump in which vital sign would require them to be seen by a provider ASAP?
significant jump in HR (anything greater than 20 bpm)
Name an anti-inflammatory drug for patients with asthma?
solumedrol (PO prednisone)
Lung Cancer Carcinomas
staged with TNM (tumor size/node involvement/metastasis), annual CT Scans for at-risk patients for better outcomes & early diagnosis, and knowledge of signs & symptoms; may require a tissue biopsy, cytology, and sometimes even a nodule biopsy
Which kind of therapy is implemented when a patient is diagnosed with late-stage lung cancer?
targeted
What are we ABLE to delegate to a UAP?
tasks which require NO judgment based on nursing knowledge & expertise, reasonably predictable tasks, and tasks that do NOT require complex observations or critical decisions to be made with respect to the nursing task
Cystic Fibrosis Manifestations
thick & sticky mucus in the lungs, pancreas, liver, salivary glands, and even testes which plug glands to cause organ atrophy & dysfunction whereas pulmonary symptoms include frequent respiratory infections, limited exercise tolerance, cough, sputum production, use of accessory muscles, and decrease in function
After assessing a new patient with a chest tube EVERY HOUR FOR 24 HOURS, we are then able to assess them how frequently?
typically every eight hours (or 1x per shift) as drainage subsides
When do we change a chest tube system?
we use the padded clamps when the chamber becomes full, make sure that the wound is covered with an air-tight dressing, output is measured hourly for THE FIRST 24 HOURS with new patients, and are monitored carefully (> 70/hour required notification); chest tubes may fill quickly depending on the patient
Pulmonary Arterial Hypertension (DRUG ALERT)
when a patient us undergoing IV Prostacyclin agents, be sure that the drug therapy is NEVER interrupted as deaths have been reported from interruptions that last even a few minutes; teach patients to always have a backup of medication and battery packs (go to the ED ASAP if infusion ever becomes interrupted)
Non-Infectious Lower Respiratory Problems: Drug Therapy (Bronchodilator Controller)
will purpose in preventive therapy (controller drugs) to reduce airway responsiveness in order to PREVENT asthmatic attacks
Non-Infectious Lower Respiratory Problems: Drug Therapy (Anti-Inflammatories)
works to reduce inflammation by causing BRONCHOCONSTRICTION; make sure to educate patients on oral care as they increase the risk for LOCAL INFECTION in the mouth through candida albicans (ex. thrust/yeast), so patients need to know to rinse their mouth after use with BOTH powders and inhalers
Non-Infectious Lower Respiratory Problems: Drug Therapy (Cholinergic Antagonist)
works to relieve & control exacerbations (ex. Atrovent) is used BOTH as a relief medication and for control, but the patient needs to be educated on RINSING their mouth as well as increasing fluid since this medication may cause xerostomia; ALSO MONITOR FOR OD
