Test 2 - Gas exchange, asthma, pulmonary embolism, anemia, pneumonia, cystic fibrosis

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A 2-year-old has just been diagnosed with CF. The parents ask the nurse what early respiratory symptoms they should expect to see in their child. Which is the nurse's best response?

"You can expect your child to develop wheezing respirations."

A female child with CF is hospitalized with constipation. The parent asks the nurse what will need to be done to relieve the child's constipation. Which is the nurse's best response?

"Your child will likely be given GoLYTELY to relieve her constipation."

ProTime (prothrombin)

11-13.5 seconds

sodium (Na) level

136-145

Serum albumin level

3.5-5

potassium (k) level

3.5-5

Asthma triad:

Nasal polyps asthma sensitivity to aspirin and NSAIDs

The nurse is administering oral glucocorticoids to a patient with asthma. What assessment finding would the nurse identify as a therapeutic response to this medication?

No observable respiratory difficulty or shortness of breath over the last 24 hours. (Glucocorticoids (corticosteroids) decrease inflammation and prevent bronchospasm in the patient with asthma.)

pneumococcal vaccine

PCV13, bacterial pneumonia for 65 or older adults

what is the recommendation when a patient has Tb and then family members also test positive for Tb?

person with a positive TST should have a chest x-ray to assess for active TB disease. Individuals with a diagnosis of TB must be reported to the public health authorities for identification and assessment of contacts and risk to the community.

cystic fibrosis can sometimes be initially diagnosed as what

pneumonia

LLL Crackles started up after it was diminished breath sounds

position patient on right side

what is asthma called for children at times and why

reactive airway disease because they can outgrow it

symptoms of asthma

recurrent episodes of wheezing, breathlessness, cough, and tight chest expiration prolonged

why are corticosteroids recommended for patient with respiratory condition?

reduce swelling and mucus production, bronchial hyperresponsiveness antiinflammatory

why give pancreatic enzymes to cystic fibrosis patient?

the pancreas also makes thick mucus that blocks the release of enzymes needed for proper digestion Unless a snack is pure sugar (such as a clear popsicle, hard candy or fruit juice),

A patient has severe exacerbation of asthma, what's the most concern to the nurse is:

unable to speak and sweating profusely

who is more likely to have asthma, women or men

women, 76% more likely

Primary Prevention for impaired gas exchange

• Infection control • Smoking cessation • immunizations • preventing postoperative complications

treatment for tuberculosis

• Isoniazid • Rifampin (Rifadin, Rimactane) • Ethambutol (Myambutol) • Pyrazinamide • Adherence is difficult, taken simultaneously -hard on liver so cut out alcohol, make ligaments looser *Types of drugs* o Antihistamine o Decongestants o Glucocorticoids o brochodilators

nursing interventions for patient with difficulty with gas exchange.

• nutrition therapy • positioning • Chest physiotherapy • Postural drainage • Oxygen therapy devices • Airway suctioning • Endotracheal tubes and tracheostomy tubes • Mechanical intubation • Chest tube management - smoking cessation

symptoms of acute asthma exacerbation

◦ High fever ◦ chills ◦ generalized flu symptoms ◦ pleuritic pain ◦ productive cough ◦ leukocytosis similar to pneumonia

anemia symptoms

*pallor*, jaundice, pruritis glossitis, cheilitis hemoglobin for severity

triggers for asthma

-allergens -exercise, cold induced -air pollutants -occupation - may take long time -respiratory infection - Increase inflammation and hyper-responsiveness of the tracheobronchial system -nose and sinus problems - rhinitis and nasal polyps -drugs and food additives - salicylates -Gastroesophageal Reflux Disease -emotional stress

creatinine level

0.6-1.5

INR

0.8-2 if on blood thinner - 2-3 if risk for clot formation - 2.5-3.5

urine specific gravity level

1.010-1.025

Magnesium level

1.7-2.2

Phosphorus level

2.4-4.1

HCO (bicarbonate)

22-26 metabolic

PaCO

35-45

in asthma, inflammatory mediators cause early or late phase response?

early phase response

best oral iron supplement

ferrous sulfate in acidic environment

When a patient is screened for Tb, when does the Tb test need to be read?

48-72 hours after administration

yellow zone for peak flow in asthma

50-80% of personal best caution, asthma is being triggered

pH level

7.35-7.45

BUN level

8-25

PaO

80-100

Calcium level

9-10.5

The nurse would anticipate that which of the following patients will need to be treated with insertion of a chest tube?

A patient experiencing a problem with a pneumothorax. -When air is allowed to enter the pleural space, the lung will collapse and a chest tube will be inserted to remove the air and reestablish negative pressure in the pleural space

Highest mortality rate of nosocomial infections

hospital acquired pneumonia

side effects for asthma patient who's taking short acting beta agonist

increased heart rate, shakiness, cramping, anxiety, breathlessness

goal for asthma

keep oxygen sat at 90 or above

Nurse suspects development of a pleural effusion upon finding what

localized absence of breath sounds

pulmonary embolism affects upper or lower lobes more?

lower lobes

best diagnostic test for asthma

ABGs

What is cystic fibrosis

lungs and digestive system become clogged with thick sticky mucus. Symptoms usually start in early childhood and include: persistent cough. recurring chest and lung infections. poor weight gain elevated NaCl

Tuberculosis involves what 2 organs of body?

lungs and kidneys

Hct (hematocrit)

male: 42-52% female: 37-47%

Hb (hemoglobin)

male:14-18 female:12-16

once you test positive for TB, you take the test again?

no, positive for life ( take chest x-ray every year)

asthma - quick relief medication

Anticholinergics (emergency) Systemic corticosteroids Short acting beta agonists (bronchodilators) Inhaled short-acting beta2-agonist (for acute asthma)

When evaluating the concept of gas exchange, how would the nurse best describe the movement of oxygen and carbon dioxide?

Gas moves from an area of high pressure to an area of low pressure across the alveolar membrane

anticoagulation for pulmonary embolism

Heparin - subq recommended in stomach Antidote - protamine sulfate Coumadin - oral Antidote - vitamin K

diagnostic tests for pulmonary embolism

D-dimer *Spiral (helical) CT scan* - most frequent Ventilation-perfusion (V/Q) scan Pulmonary angiography

Niox Mino

Measures fractional exhaled nitric oxide - increased in asthma patients

Nursing care for patient is scheduled for a bronchoscopy

NPO

nursing interventions for patient with difficulty with gas exchange. how could increasing fluid intake help this patient?

Fluids help minimize mucosal drying and maximize ciliary action to move secretions

asthma - long term control medication

Inhaled corticosteroids (ICSs) - most effective Long-acting beta2-agonists Cromolyn sodium or neocromil - alternative Leukotriene modifiers - alternative Immunotherapy - alternative for age 12 Anti-IgE and Theophylline

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The patient tells the nurse he is having a "hard time breathing." His respiratory rate is 32 breaths per minute, his pulse is 120 beats per minute, and the oxygen saturation is 90%. What would be the best nursing intervention for this patient?

Initiate oxygen via a nasal cannula, and begin at a flow rate of 3 L/min. -The normal respiratory drive is a person's level of carbon dioxide (CO2) in the arterial blood. The COPD patient had compensated for his chronic high levels of CO2, and his respiratory drive is dependent on his oxygen levels, not his CO2 levels

A 7-month-old is taken to the pediatrician's office with a low-grade fever, nasal congestion, and a mild cough. Which should the nursing care management of this child include?

Instilling saline nose drops and bulb suctioning

A patient is having the arterial blood gas (ABG) measured. What would the nurse identify as the parameters to be evaluated by this test?

Status of acid-base balance in arterial blood Partial pressure of oxygen and carbon dioxide

Which of the following statements about the inheritance of CF is most accurate?

The child of a mother who has CF and a father who is a carrier of the gene for CF has a 50% chance of acquiring CF

The parents of a 5-week-old have just been told that their child has CF. The mother had a sister who did of CF when she was 19 years of age. The parents are sad and ask the nurse several questions about CF and the current projected life expectancy. What is the nurse's best initial intervention?

The nurse should listen to the parents and be available to them anytime during the day to answer their questions

The parent of an 18-year-old with CF is excited about the possibility of the child receiving a double lung transplant. What should the parent understand?

The transplant will not cure the child of CF but will allow the child to have a longer life

The nurse caring for a female pediatric client with cystic fibrosis sends a stool for analysis. The results show an excessive amount of azotorrhea and steatorrhea (excessive fat and protein). What does the nurse realize about the laboratory values?

They reflect that the patient is not compliant with taking her enzymes

The parent of a 10-month-old with CF asks the nurse how to meet the child's increased nutritional needs. Which is the nurse's best suggestion?

You may need to change your child to a higher-calorie formula

for a pt with cystic fibrosis, when is the best time to do the child's chest physiotherapy (CPT) in relation to eating?

You should do the first CPT 30 minutes before feeding the child breakfast.

A 5-year-old female is diagnosed with pharyngitis. The child is complaining of throat pain. which of the following statements by the mother indicates that she needs more education regarding the care and treatment of her daughter's throat pain?

a."I will have my daughter gargle with warm saline three times a day." b."I will offer my daughter ice chips several times a day." c."I will give my daughter Tylenol every 4 to 6 hours as needed." d.*"I will give my daughter her amoxicillin until all doses of the antibiotic are gone."*

if a patient has a bronchodilator and a steroid inhaler both ordered, which would be used first?

bronchodilator

big risk factor for pulmonary embolism

deep vein thrombosis

most common symptom of pulmonary embolism

dyspnea/shortness of breath


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