Oxy/Circ Practice 1

Several hours after admission of a child to the pediatric unit with laryngotracheobronchitis (viral croup), the nurse determines that tachypnea and tachycardia, accompanied by intercostal and substernal retractions and increased restlessness, have developed. What is the priority nursing action? a. Suctioning secretions from the trachea b. Dislodging mucus by striking the back c. Reporting the respiratory status to the practitioner d. Increasing the concentration of oxygen being delivered

c. Reporting the respiratory status to the practitioner These are signs of increasing hypoxia; intubation may be necessary to maintain an open airway. The signs are not indicative of increased secretions; suctioning could precipitate sudden laryngospasm. Striking the back is ineffective against laryngeal spasms. The inflammation is preventing the oxygen from reaching the lungs; increasing the amount of oxygen will not be effective until the inflammation is reduced.

What physiologic alteration does the nurse expect when assessing a 6-month-old infant with bronchiolitis (respiratory syncytial virus [RSV])? a. Decreased heart rate b. Intercostal retractions c. Increased breath sounds d. Prolonged expiratory phase

d. Prolonged expiratory phase Infectious and mechanical changes narrow the bronchial passages and make it difficult for air to leave the lungs. As a result of increased respiratory effort and decreased oxygen exchange, tachycardia may develop. Intercostal retractions are unlikely because of overinflation of the chest with air and shallow, rapid breathing. Breath sounds may be diminished because of swelling of the bronchiolar mucosa and filling of the lumina with mucus and exudate.

Isoniazid (INH) is prescribed as a prophylactic measure for a client whose spouse has active tuberculosis (TB). Which statements made by the client indicate that there is a need for further teaching? Select all that apply. "I plan to start taking vitamin B6 with breakfast." "I'll still be taking this drug six months from now." "I sometimes allow our children to sleep in our bed at night." "I know I also have tuberculosis because the skin test was positive." "I plan to attend a wine tasting event this evening."

"I'll still be taking this drug six months from now." Correct 3 "I sometimes allow our children to sleep in our bed at night." Correct 4 "I know I also have tuberculosis because the skin test was positive." Correct 5 "I plan to attend a wine tasting event this evening." The children are at an increased risk because the client's spouse has TB; the children should be screened as members of the household. The positive skin test indicates that the client has been exposed to the bacilli and developed antibodies, not necessarily the disease itself; further diagnostic studies are indicated. Wine contains tyramine and histamine, which when taken concurrently with INH can cause headache, flushing, and a drop in blood pressure; these should be avoided when taking INH. Pyridoxine (vitamin B6) should be taken to prevent neuritis, which is associated with INH. The prophylactic drug therapy will be continued for six to 12 months.

Patho of TB

Tuberculosis is a highly communicable disease caused by Mycobacterium tuberculosis. The process of infection in tuberculosis starts by formation of granulomatous inflammation by tuberculosis bacillus in lungs. This granulomatous inflammation then becomes surrounded by collagen, fibroblasts, and lymphocytes. The necrotic tissue then turns into a granular mass, called a caseation necrosis, which occurs in the center of the lesion. Then the areas of caseation undergo resorption, degeneration, and fibrosis. Finally, the necrotic areas undergo calcification or liquefaction.

A client with tuberculosis is to begin combination therapy with isoniazid, rifampin, pyrazinamide, and streptomycin. The client says, "I've never had to take so much medication for an infection before." How will the nurse respond? a. "This type of organism is difficult to destroy." b. "Streptomycin prevents side effects of the other drugs." c. "You'll only need to take the medications for a couple of weeks." d. "Aggressive therapy is needed because the infection is well advanced."

a. "This type of organism is difficult to destroy." Multiple drugs are administered because of the concern regarding drug resistance. Streptomycin sulfate is an antibiotic; it does not prevent the side effects of other drugs used in therapy. Multiple antitubercular drugs are necessary for an extended period, approximately 6 to 8 months depending on the individual. Aggressive therapy may increase anxiety and may not be needed even when the infection is well advanced

What evidence of tuberculosis is provided by the radiograph? a. Cavities caused by caseation b. Sensitized T cells c. Presence of acid-fast bacilli d. Microscopic primary infection

a. Cavities caused by caseation Cavities are evident on radiograph. Necrotic lung tissue may liquefy, leaving a cavity (cavitation), or granulose tissue can surround the lesion, become fibrous, and form a collagenous scar around the tubercle (Ghon tubercle). Sensitized T cells are determined by a positive reaction to a tuberculin skin test, not on radiograph; a skin test only determines the presence of antibodies; it does not confirm active disease. Presence of acid-fast bacilli may be determined by a sputum culture, not by radiograph. Microscopic primary infection may be so small it does not appear on a radiograph.

A 3-year-old child with the diagnosis of tetralogy of Fallot is brought to the United States by a charitable organization for cardiac surgery. What should the nurse expect when conducting an admission assessment of the child? a. Clubbing of fingers b. Increased temperature c. Slow, irregular respiration d. Subcutaneous hemorrhages

a. Clubbing of fingers Hypoxia leads to poor peripheral circulation; clubbing occurs as a result of additional capillary development and tissue hypertrophy of the fingertips. A fever is not expected unless the child has an infection or is dehydrated; the data do not indicate this. The child's respiratory rate will be increased, not decreased. The child's problems are related to decreased oxygenation, not to a clotting deficiency.

The parents of a child with spasmodic croup ask why their child is receiving humidified oxygen. What effect of humidified oxygen should the nurse include in the explanation? a. It helps prevent drying of membranes. b. It provides a mode of giving inhalant drugs. c. It increases the surface tension of the respiratory tract. d. It provides an environment free of pathogenic organisms.

a. It helps prevent drying of membranes. Cool mist helps reduce inflammation and edema of the upper respiratory tract. Inhalant drugs are administered with the use of a nebulizer. The mist has no effect on surface tension in the respiratory tract. Eliminating pathogenic organisms is not the purpose of humidified oxygen.

A 5-month-old infant is admitted with a diagnosis of respiratory syncytial virus (RSV) infection. The infant's condition suddenly deteriorates, and a dose of epinephrine is prescribed to relieve bronchospasm. For what side effect of the medication should the nurse assess the infant? a. Tachycardia b. Hypotension c. Respiratory arrest d. Central nervous system depression

a. Tachycardia Epinephrine stimulates beta- and alpha-receptors; its actions include increasing heart rate and blood pressure and inducing bronchodilation. Increased blood pressure, not hypotension, is a potential side effect. Epinephrine relieves respiratory problems; it does not cause respiratory arrest. Epinephrine stimulates, not depresses, the central nervous system.

The nurse is caring for a client with tuberculosis. Which suggestions from the nurse will be beneficial for the client? Select all that apply. a. "Take the daily dose during daytime." b. "Avoid exposure to any inhalation irritants." c. "Eat foods that are rich in protein, vitamins C and B." d. "Cover the mouth and nose with a tissue when coughing or sneezing." e. "Avoid sputum specimens for 2 to 4 weeks once drug therapy is initiated."

b. "Avoid exposure to any inhalation irritants." c. "Eat foods that are rich in protein, vitamins C and B." d. "Cover the mouth and nose with a tissue when coughing or sneezing." A client with tuberculosis should avoid exposure to any inhalation irritants because these can cause further lung damage. To increase physical stamina, the client should eat a well-balanced diet that includes foods that are rich in iron, protein, and vitamins C and B. While coughing or sneezing, the client should cover the mouth and nose with a tissue to prevent spread of infection. A client with tuberculosis should take the daily dose at nighttime to prevent nausea. Sputum specimens are usually needed every 2 to 4 weeks once the drug therapy is initiated. When the results of three consecutive sputum cultures are negative it indicates that the client is no longer infectious.

A nurse is reviewing the prescriptions for a 2-year-old child who has been admitted to the pediatric unit with acute laryngotracheobronchitis (croup). What is the rationale for the prescription to administer oxygen by way of a nasal cannula? a. Congeals mucous secretions and relieves dyspnea b. Decreases the effort required for breathing and permits rest c. Triggers the cough reflex and facilitates expectoration of mucus d. Liquefies mucous secretions and makes them easier to expectorate

b. Decreases the effort required for breathing and permits rest Administering oxygen by way of nasal cannula limits the energy required for breathing; this allows the child to conserve energy that can be used for fluid and nutrient intake. Congealed mucus will obstruct air passageways and increase respiratory distress. Oxygen administration does not trigger the cough reflex. Oxygen administration through a nasal cannula will have a drying effect.

A primary health care provider prescribes airborne precautions for a client with tuberculosis. After being taught about the details of airborne precautions, the client is seen walking down the hall to get a glass of juice from the kitchen. What is the most effective nursing intervention? a. Ensure regular visits by staff members. b. Explore what the precautions mean to the client. c. Report the situation to the infection control nurse. d. Reteach the concepts of airborne precautions to the client.

b. Explore what the precautions mean to the client. Communication facilitates joint solution of the problem; the nurse must first determine the client's understanding and perceptions before solutions to the problem can be attempted. Ensuring regular visits by staff members will not collect data about why the client is leaving the room. Reporting the situation to the infection control nurse abdicates the responsibility of the primary nurse. Reteaching the concepts of airborne precautions to the client may be done, but not until further assessment is performed to determine the reason why the client is leaving the room