Respiratory

The nurse is teaching a client who has been diagnosed with TB how to avoid spreading the disease to family members. Which statement(s) by the client indicate(s) that he has understood the nurses instructions? Select all that apply. "I will need to dispose of my old clothing when I return home." "I should always cover my mouth and nose when sneezing." "It is important that I isolate myself from family when possible." "I should use paper tissues to cough in and dispose of them properly." "I can use regular plate and utensils whenever I eat."

"I will need to dispose of my old clothing when I return home." "I should use paper tissues to cough in and dispose of them properly." "I can use regular plate and utensils whenever I eat."

Theophyllines

(amniophylline and elixophyllin) Very narrow therapeutic range (10-20), teach to avoid caffeine, may drop BP

A nurse evaluates the blood theophylline level of a client receiving aminophylline (theophylline) by intravenous infusion. The nurse would determine that a therapeutic blood level exists if which of the following were noted in the laboratory report? 5 mcg/mL 15 mcg/mL 25 mcg/mL 30 mcg/mL

15 mcg/mL The therapeutic theophylline blood level range from 10-20 mcg/mL.

Which of the following family members exposed to TB would be at highest risk for contracting the disease? 45-year-old mother 17-year-old daughter 8-year-old son 76-year-old grandmother

76-year-old grandmother Elderly persons are believed to be at higher risk for contracting TB because of decreased immunocompetence. Other high-risk populations in the US include the urban poor, AIDS, and minority groups.

A client with a positive skin test for TB isn't showing signs of active disease. To help prevent the development of active TB, the client should be treated with isoniazid, 300 mg daily, for how long? 10 to 14 days 2 to 4 weeks 3 to 6 months 9 to 12 months

9 to 12 months Because of the increased incidence of resistant strains of TB, the disease must be treated for up to 24 months in some cases, but treatment typically lasts for 9-12 months. Isoniazid is the most common medication used for the treatment of TB, but other antibiotics are added to the regimen to obtain the best results.

s/s of TB

COUGH WITH SPUTUM BLOOD STREAKED, WEIGHT LOSS, ANOREXIA, NIGHT SWEATS, FEVER, CHILLS, SOB, CRACKLES OR WHEEZES, FATIGUE, ACHING CHEST

the thyroid cartilage of the larynx is split in the midline of the neck, and the portion of the vocal cord is removed with the tumor. Voice quality may change - may be rough, raspy, hoarse, limited projection. Airway and swallowing remain intact.

Hemilaryngectomy

Isoniazid (INH) and rifampin (Rifadin) have been prescribed for a client with TB. A nurse reviews the medical record of the client. Which of the following, if noted in the client's history, would require physician notification? Heart disease Allergy to penicillin Hepatitis B Rheumatic fever

Hepatitis B Isoniazid and rafampin are contraindicated in clients with acute liver disease or a history of hepatic injury.

The nurse is ware that the most relevant knowledge about oxygen administration to a male client with COPD is Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing. Hypoxia stimulates the central chemoreceptors in the medulla that makes the client breath. Oxygen is administered best using a non-rebreathing mask Blood gases are monitored using a pulse oximeter.

Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing. COPD causes a chronic CO2 retention that renders the medulla insensitive to the CO2 stimulation for breathing. The hypoxic state of the client then becomes the stimulus for breathing. Giving the client oxygen in low concentrations will maintain the client's hypoxic drive.

hypoexmia

PO2 consistently below 50

A client who is HIV+ has had a PPD skin test. The nurse notes a 7-mm area of induration at the site of the skin test. The nurse interprets the results as: Positive Negative Inconclusive The need for repeat testing

Positive The client with HIV+ status is considered to have positive results on PPD skin test with an area greater than 5-mm of induration. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client.

A client's ABG analysis reveals a pH of 7.18, PaCO2 of 72 mm Hg, PaO2 of 77 mm Hg, and HCO3- of 24 mEq/L. What do these values indicate? Metabolic acidosis Respiratory alkalosis Metabolic alkalosis Respiratory acidosis

Respiratory acidosis

_____ may be used prophylactically before the pt participates in a dyspnea producing activity like eating or walking

SABAs

rIFAMPIN

TAKEN WITH inh, IT WILL TURN URINE ORANGE

Lung scan

assess normal lung function, vascular supply, and gas exchange

_____ often come before dyspnea by several years

chronic cough and sputum

Cancers of the larynx develop ___

slowly

copd diet

soft, high-calorie, low-carbohydrate, high-fat, small frequent feedings

When a patient with TB is being prepared for discharge, which statement by the patient indicates the need for further teaching? "Everyone in my family needs to go and see the doctor for TB testing." "I will continue to take my isoniazid until I am feeling completely well." "I will cover my mouth and nose when I sneeze or cough and put my used tissues in a plastic bag." "I will change my diet to include more foods rich in iron, protein, and vitamin C."

"I will continue to take my isoniazid until I am feeling completely well." Patients taking isoniazid must continue the drug for 6 months. The other 3 statements are accurate and indicate understanding of TB. Family members should be tested because of their repeated exposure to the patient. Covering the nose and mouth when sneezing or coughing, and placing the tissues in plastic bags help prevent transmission of the causative organism. The dietary changes are recommended for patients with TB.

You are acting as preceptor for a newly graduated RN during her second week of orientation. You would assign the new RN under your supervision to provide care to which patients? Select all that apply. A 38-year old with moderate persistent asthma awaiting discharge A 63-year old with a tracheostomy needing tracheostomy care every shift. A 56-year old with lung cancer who has just undergone left lower lobectomy A 49-year old just admitted with a new diagnosis of esophageal cancer.

A 38-year old with moderate persistent asthma awaiting discharge A 63-year old with a tracheostomy needing tracheostomy care every shift. The new RN is at an early point in her orientation. The most appropriate patients to assign to her are those in stable condition who require routine care. The patient with the lobectomy will require the care of a more experienced nurse, who will perform frequent assessments and monitoring for postoperative complications. The patient admitted with newly diagnosed esophageal cancer will also benefit from care by an experienced nurse. This patient may have questions and needs a comprehensive admission assessment. As the new nurse advances through her orientation, you will want to work with her in providing care for these patients with more complex needs.

A nurse is assigned to care for four clients. When planning client rounds, which client would the nurse check first? A client on a ventilator A client in skeletal traction A postoperative client preparing for discharge A client admitted on the previous shift who has a diagnosis of gastroenteritis

A client on a ventilator The airway is always a high priority, and the nurse first checks the client on a ventilator. The clients described in options 2, 3, and 4 have needs that would be identified as intermediate priorities.

Blessy, a community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is: Dyspnea Chest pain A bloody, productive cough A cough with the expectoration of mucoid sputum

A cough with the expectoration of mucoid sputum One of the first pulmonary symptoms is a slight cough with the expectoration of mucoid sputum. Options A, B, and C are late symptoms and signify cavitation and extensive lung involvement.

A client has been hospitalized with a diagnosis of laryngeal cancer. Which factor is most significant in the development of laryngeal cancer? A family history of laryngeal cancer Chronic inhalation of noxious fumes Frequent straining of the vocal cords A history of alcohol and tobacco use

A history of alcohol and tobacco use A history of frequent alcohol and tobacco use is the most significant factor in the development of cancer of the larynx. Answers A, B, and C are also factors in the development of laryngeal cancer, but they are not the most significant; therefore, they are incorrect.

A client was infected with TB 10 years ago but never developed the disease. He's now being treated for cancer. The client begins to develop signs of TB. This is known as which of the following types of infection? Active infection Primary infection Superinfection Tertiary infection

Active infection

A client with a productive cough, chills, and night sweats is suspected of having active TB. The physician should take which of the following actions? Admit him to the hospital in respiratory isolation Prescribe isoniazid and tell him to go home and rest Give a tuberculin test and tell him to come back in 48 hours and have it read Give a prescription for isoniazid, 300 mg daily for 2 weeks, and send him home

Admit him to the hospital in respiratory isolation The client is showing s/s of active TB and, because of the productive cough, is highly contagious. He should be admitted to the hospital, placed in respiratory isolation, and three sputum cultures should be obtained to confirm the diagnosis. He would most likely be given isoniazid and two or three other antitubercular antibiotics until the diagnosis is confirmed, then isolation and treatment would continue if the cultures were positive for TB. After 7 to 10 days, three more consecutive sputum cultures will be obtained. If they're negative, he would be considered non-contagious and may be sent home, although he'll continue to take the antitubercular drugs for 9 to 12 months.

The public health nurse is providing follow-up care to a client with TB who does not regularly take his medication. Which nursing action would be most appropriate for this client? Ask the client's spouse to supervise the daily administration of the medications. Visit the clinic weekly to ask him whether he is taking his medications regularly. Notify the physician of the client's non-compliance and request a different prescription. Remind the client that TB can be fatal if not taken properly.

Ask the client's spouse to supervise the daily administration of the medications. Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. In DOT, a responsible person, who may be a family member or a health care provider, observes the client taking the medication. Visiting the client, changing the prescription, or threatening the client will not ensure compliance if the client will not or cannot follow the prescribed treatment.

A patient with chronic obstructive pulmonary disease (COPD). Which intervention for airway management should you delegate to a nursing assistant (PCT)? Assisting the patient to sit up on the side of the bed Instructing the patient to cough effectively Teaching the patient to use incentive spirometry Auscultation of breath sounds every 4 hours

Assisting patients with positioning and activities of daily living is within the educational preparation and scope of practice of a nursing assistant. Teaching, instructing, and assessing patients all require additional education and skills and are more appropriate for a licensed nurse.

A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: Pleural effusion Pulmonary edema Atelectasis Oxygen toxicity

Atelectasis In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn't cause pleural effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn't one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.

Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in the client, should be reported immediately to the physician? Dry cough Hermaturia Bronchospasm Blood-streaked sputum

Bronchospasm If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. Hematuria is unrelated to this procedure.

A client has active TB. Which of the following symptoms will he exhibit? Chest and lower back pain Chills, fever, night sweats, and hemoptysis Fever of more than 104*F and nausea Headache and photophobia

Chills, fever, night sweats, and hemoptysis Typical signs and symptoms are chills, fever, night sweats, and hemoptysis. Chest pain may be present from coughing, but isn't usual. Clients with TB typically have low-grade fevers, not higher than 102*F. Nausea, headache, and photophobia aren't usual TB symptoms.

Which of the following diagnostic tests is definitive for TB? Chest x-ray Mantoux test Sputum culture Tuberculin test

Sputum culture The sputum culture for Mycobacterium tuberculosis is the only method of confirming the diagnosis. Lesions in the lung may not be big enough to be seen on x-ray. Skin tests may be falsely positive or falsely negative.

Kristine is scheduled for a bronchoscopy. When teaching Kristine what to expect afterward, the nurse's highest priority of information would be: Food and fluids will be withheld for at least 2 hours. Warm saline gargles will be done q 2h. Coughing and deep-breathing exercises will be done q2h. Only ice chips and cold liquids will be allowed initially.

Food and fluids will be withheld for at least 2 hours. Prior to bronchoscopy, the doctors sprays the back of the throat with anesthetic to minimize the gag reflex and thus facilitate the insertion of the bronchoscope. Giving the client food and drink after the procedure without checking on the return of the gag reflex can cause the client to aspirate. The gag reflex usually returns after two hours.

A nurse is caring for a client diagnosed with TB. Which assessment, if made by the nurse, would not be consistent with the usual clinical presentation of TB and may indicate the development of a concurrent problem? Nonproductive or productive cough Anorexia and weight loss Chills and night sweats High-grade fever

High-grade fever The client with TB usually experiences cough (non-productive or productive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweats (which may occur at night), and a low-grade fever.

bag of COPD

INCREASED co2 and DECREASED o2

The nurse should include which of the following instructions when developing a teaching plan for clients receiving INH and rifampin for treatment for TB? Take the medication with antacids Double the dosage if a drug dose is forgotten Increase intake of dairy products Limit alcohol intake

Limit alcohol intake INH and rifampin are hepatotoxic drugs. Clients should be warned to limit intake of alcohol during drug therapy. Both drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours after these drugs are administered. Clients should not double the dosage of these drugs because of their potential toxicity. Clients taking INH should avoid foods that are rich in tyramine, such as cheese and dairy products, or they may develop hypertension.

Postural Drainage—positioning

Lung segment to be drained should be in the uppermost position to allow gravity to work.

The most appropriate nursing order for a patient who develops dyspnea and shortness of breath would be... Maintain the patient on strict bed rest at all times Maintain the patient in an orthopneic position as needed Administer oxygen by Venturi mask at 24%, as needed Allow a 1 hour rest period between activities

Maintain the patient in an orthopneic position as needed When a patient develops dyspnea and shortness of breath, the orthopneic position encourages maximum chest expansion and keeps the abdominal organs from pressing against the diaphragm, thus improving ventilation. Bed rest and oxygen by Venturi mask at 24% would improve oxygenation of the tissues and cells but must be ordered by a physician. Allowing for rest periods decreases the possibility of hypoxia.

Cancer of the Larynx

Malignant tumore in or around the larynx (windpipe) or voice box

A nurse is teaching a client with TB about dietary elements that should be increased in the diet. The nurse suggests that the client increase intake of: Meats and citrus fruits Grains and broccoli Eggs and spinach Potatoes and fish

Meats and citrus fruits The nurse teaches the client with TB to increase intake of protein, iron, and vitamin C.

After bronchoscopy

Monitor for gag reflex to return, listen to breath sounds (pneumothorax), observe sputum

The Causative agent of Tuberculosis is said to be: Mycobacterium Tuberculosis Hansen's Bacilli Bacillus Anthracis Group A Beta Hemolytic Streptococcus

Mycobacterium Tuberculosis

Prep for bronchoscopy

NPO 8-12H, may receive meds during procedure but will be awake

The nurse should observe for side effects associated with the use of bronchodilators. A common side effect of bronchodilators is: Tinnitus Nausea Ataxia Hypotension

Nausea A side effect of bronchodilators is nausea. Answers A and C are not associated with bronchodilators; therefore, they are incorrect. Answer D is incorrect because hypotension is a sign of toxicity, not a side effect.

The right forearm of a client who had a purified protein derivative (PPD) test for tuberculosis is reddened and raised about 3mm where the test was given. This PPD would be read as having which of the following results? Indeterminate Needs to be redone Negative Positive

Negative This test would be classed as negative. A 5 mm raised area would be a positive result if a client was HIV+ or had recent close contact with someone diagnosed with TB. Indeterminate isn't a term used to describe results of a PPD test. If the PPD is reddened and raised 10mm or more, it's considered positive according to the CDC.

The patient with COPD has a nursing diagnosis of Ineffective Breathing Pattern. Which is an appropriate action to delegate to the experienced LPN under your supervision? Observe how well the patient performs pursed-lip breathing Plan a nursing care regimen that gradually increases activity intolerance Assist the patient with basic activities of daily living Consult with the physical therapy department about reconditioning exercises

Observe how well the patient performs pursed-lip breathing Experienced LPNs/LVNs can use observation of patients to gather data regarding how well patients perform interventions that have already been taught. Assisting patients with ADLs is more appropriately delegated to a nursing assistant. Planning and consulting require additional education and skills, appropriate to an RN.

The patient with COPD tells the nursing assistant that he did not get his annual flu shot this year and has not had a pneumonia vaccination. You would be sure to instruct the nursing assistant to report which of these? Blood pressure of 152/84 mm Hg Respiratory rate of 27 breaths/min Heart rate of 92 beats/min Oral temperature of 101.2 F (38.4C)

Oral temperature of 101.2 F (38.4C) A patient who did not have the pneumonia vaccination or flu shot is at increased risk for developing pneumonia or influenza. An elevated temperature indicates some form of infection, which may be respiratory in origin. All of the other vital sign values are slightly elevated but are not a cause for immediate concern.

The nurse observes that Mr. Adams begins to have increased difficulty breathing. She elevates the head of the bed to the high Fowler position, which decreases his respiratory distress. The nurse documents this breathing as: Tachypnea Eupnea Orthopnea Hyperventilation

Orthopnea Orthopnea is difficulty of breathing except in the upright position. Tachypnea is rapid respiration characterized by quick, shallow breaths. Eupnea is normal respiration - quiet, rhythmic, and without effort.

A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophyllin) (400 mg in 500 ml) at 50 ml/hour. The theophylline level is reported as 6 mcg/ml. The nurse calls the physician who instructs the nurse to change the dosage to 0.45 mg/kg/hour. The nurse should: Question the order because it's too low Question the order because it's too high Set the pump at 45 ml/hour Stop the infusion and have the laboratory repeat the theophylline measurement

Question the order because it's too low A therapeutic theophylline level is 10 to 20 mcg/ml. The client is currently receiving 0.5 mg/kg/hour of aminophylline. Because the client's theophylline level is sub-therapeutic, reducing the dose (which is what the physician's order would do) would be inappropriate. Therefore, the nurse should question the order.

Timothy's arterial blood gas (ABG) results are as follows; pH 7.16; Paco2 80 mm Hg; Pao2 46 mm Hg; HCO3- 24 mEq/L; Sao2 81%. This ABG result represents which of the following conditions? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis

used as needed for dyspnea

SABAs

Orthopnea

SOB when lying down and relieved by sitting up

A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the result of which diagnosis test that will confirm this diagnosis? Bronchoscopy Sputum culture Chest x-ray Tuberculin skin test

Sputum culture Tuberculosis is definitively diagnosed through culture and isolation of Mycobacterium tuberculosis. A presumptive diagnosis is made based on a tuberculin skin test, a sputum smear that is positive for acid-fast bacteria, a chest x-ray, and histological evidence of granulomatous disease on biopsy.

The nursing assistant tells you that a patient who is receiving oxygen at a flow rate of 6 L/min by nasal cannula is complaining of nasal passage discomfort. What intervention should you suggest to improve the patient's comfort for this problem? Suggest that the patient's oxygen be humidified Suggest that a simple face mask be used instead of a nasal cannula Suggest that the patient be provided with an extra pillow Suggest that the patient sit up in a chair at the bedside

Suggest that the patient's oxygen be humidified When the oxygen flow rate is higher than 4 L/min, the mucous membranes can be dried out. The best treatment is to add humidification to the oxygen delivery system. Application of a water-soluble jelly to the nares can also help decrease mucosal irritation. None of the other options will treat the problem.

a voice sparing option; the hyoid bone, glottis, and false cords are removed. The true cords, cricoids cartilage and trachea remain intact. A tracheostomy is left in place until the glottis airway is established. Post-op radiation may be needed. Voice quality may change.

Supraglottic Laryngectomy

In staging and grading neoplasm TNM system is used. TNM stands for: Time, neoplasm, mode of growth Tumor, node, metastasis Tumor, neoplasm, mode of growth Time, node, metastasis

TNM stands for tumor, node, and metastasis.

For a female patient with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway? Restricting fluid intake to 1,000 ml per day Enforcing absolute bed rest Teaching the patient how to perform controlled coughing Administering prescribe sedatives regularly and in large amounts

Teaching the patient how to perform controlled coughing Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the patient's ability to maintain a patent airway, causing a high risk for infection from pooled secretions.

A client diagnosed with active TB would be hospitalized primarily for which of the following reasons? To evaluate his condition To determine his compliance To prevent spread of the disease To determine the need for antibiotic therapy

To prevent spread of the disease

A client is admitted to the hospital with a temperature of 99.8°F, complaints of blood-tinged hemoptysis, fatigue, and night sweats. The client's symptoms are consistent with a diagnosis of: Pneumonia Reaction to antiviral medication Tuberculosis Superinfection due to low CD4 count

Tuberculosis A low-grade temperature, blood-tinged sputum, fatigue, and night sweats are symptoms consistent with tuberculosis. If the answer in A had said pneumocystis pneumonia, answer A would have been consistent with the symptoms given in the stem, but just saying pneumonia isn't specific enough to diagnose the problem. Answers B and D are not directly related to the stem.

Skin reactions are common in radiation therapy. Nursing responsibilities on promoting skin integrity should be promoted apart from: Avoiding the use of ointments, powders and lotion to the area Using soft cotton fabrics for clothing Washing the area with a mild soap and water and patting it dry not rubbing it. Avoiding direct sunshine or cold.

Washing the area with a mild soap and water and patting it dry not rubbing it. No soap should be used on the skin of the client undergoing radiation. Soap and irritants and may cause dryness of the patient's skin. Only water should be used in washing the area.

Which of the following symptoms is common in clients with TB? Weight loss Increased appetite Dyspnea on exertion Mental status changes

Weight loss TB typically produces anorexia and weight loss. Other signs and symptoms may include fatigue, low-grade fever, and night sweats.

Indirect laryngoscopy

a flexible fiber optic tube with a camera can be used to visualize and obtain biopsy of the site

The nurse is teaching the client how to use a metered dose inhaler (MDI) to administer a Corticosteroid drug. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply. a)The inhaler is held upright. b)Head is tilted down while inhaling the medication c)Client waits 5 minutes between puffs. d)Mouth is rinsed with water following administration e)Client lies supine for 15 minutes following administration.

a,d

A nurse is reinforcing instructions to a client following a total laryngectomy about caring for the stoma. Choose the instructions that the nurse provides to the client. Select all that apply. a)Protect the stoma from water. b)Soaps should be avoided near the stoma. c)Wash the stoma daily using a washcloth. d)Use diluted alcohol on the stoma to clean it. e)Apply a thin layer of petroleum jelly to the skin surrounding the stoma. f)Use soft tissues to clean any secretions that accumulate around the stoma.

a,b,c,e The client with a stoma should be instructed to wash the stoma daily with a washcloth. Soaps, cotton swabs, or tissues should be avoided because their particles may enter and obstruct the airway. The client should be instructed to avoid applying alcohol to a stoma because it is both drying and irritating. A thin layer of petroleum jelly applied to the skin around the stoma helps prevent cracking. The client is instructed to protect the stoma from water.

emphysema

abnormal enlargement of the air spaces beyond the terminal bronchioles, with destruction of the alveoli

You are a team leader RN working with a student nurse. The student nurse is to teach a patient how to use and MDI without a spacer. Put in correct order the steps that the student nurse should teach the patient. A. Remove the inhaler cap and shake the inhaler B. Open your mouth and place the mouthpiece 1 to 2 inches away C. Tilt your head back and breathe out fully D. Hold your breath for at least 10 seconds E. Press down firmly on the canister and breathe deeply through your mouth F. Wait at least 1 minute between puffs. A, C, B, D, E, F. A, C, B, E, D, F. C, A, B, E, D, F. C, A, B, D, E, F.

acbedf

Crackles

lower pitched, coarse, rattling sounds; caused by excess fluid in lungs

Breath sounds in COPD

may be diminished. Dry crackles may be heard at the bases and wheezes may be heard with forced expiration. Ranchi may be heard if pt has excess secretions

Late Resp distress s/s

nasal flaring, clubbing of fingers, cyanosis, hypoxia, hypoxemia, hypercapnea, used of accessory muscles

COPD dyspnea

often very severe and interferes with ADLS

COPD patho

chronic airflow limitation that is not fully reversible. Includes an increase in mucus-producing cells, chronic inflammation, and structural changes

pursed-lip breathing

close mouth, breath in through the nose and out through pursed lips slowly taking twice the amount of time it took to breathe in

Ronchi

continuous snoring sounds, arise from large airways, caused by thick secretions

Isoniazid (INH)

don't take with antacids, may cause hepatitis and neuropathy. Take with vitb6 to avoid neuropathy

Ambulation after lung surgery

done the first day

Three primary symptoms of COPD

dyspnea, cough, and sputum production

side effects of bronchodilators

dysrhytmias, tachycardia, tachypnea, restlessness, nervousness, tremores, anorexia, n/v, dizziness

Many pts with COPD have a combo of

emphysema, chronic bronchitis, or heightened airway responsiveness

PLEURAL Effusion

fluid in the pleural space

s/s of hypercapnia

headache, confusion, bounding pulse, sweating (common in COPD pts.)

pT. POSITION WITH COPD

high or semi fowlers

COPD-hyper or hypo inflation?

hyper

Thoracentesis position

in the sitting position with arms and head resting supported on a bedside table. If unable to sit, the pt. should lie at the edge of the bed on the unaffected side with HOB 30-45 degrees

Early Resp distress s/s

increased rate of breathing, anxiety, breath sounds

COPD: resp rate and characteristics

increased rate, rapid and shallow, use of accessory muscles, limited diaphragmatic excursions

Pleuravac the first chamber

is a collection chamber. The volume needs to be measured and recorded each shift. drainage more than 100ml/hr is too much, call the doctor

Pleuravac the second chamber

is the water seal chamber- this chamber prevents air from entering the pleural cavity. Its normal to have a rise of 2-4 in durance inhalation and a fall during exhalation.No fluctuation may indicate an obstruction

Early s/s of larynx cancer

persistent cough, hoarseness lasting longer than two weeks, burning, pain, lump in throat

chronic bronchitis

presence of cough and sputum production for at least 3 months in each of two consecutive years. Hyper mucus secretions

Parts of the lung affected with COPD

proximal and peripheral airways, parenchyma, and vasculature

Bronchography

radio-opaque dye covers the bronchial tree; used to id bronchiectesis

Bronchodilators

relieve spasm, reduce airway obstruction, and aid in secretion clearance.

Ethambutol

report vision changes!!!!

Sputum Smear

sputum is stained with red dye, after dried an acid alcohol is added to remove the stain. The TB bacteria will not allow destaining. Not definite but used as a quick guess

about 95% of larynx cancer develops from ______ cells, which line the larynx

squamos epithelial

Wheezing

squeaky, musical sounds associated with air trying to squeeze through small airways due to inflammation

Pleuravac the third chamber

suction control bottle. suction is used to increase the pressure

TB patho

transmitted by airborne route via laughing, coughing, sneezing, singing, etc.

Spirometry

used to evaluate airway obstruction

bronchoscopy

visualization of a pts lungs, airways, voice box, vocal cord, trachea, and many branches

Late s/s of Lar. cancer

weight loss, could breath, nasal obstruction/discharge, dyspnea, dysphagia

A police officer brings in a homeless client to the ER. A chest x-ray suggests he has TB. The physician orders an intradermal injection of 5 tuberculin units/0.1 ml of tuberculin purified derivative. Which needle is appropriate for this injection? 5/8" to ½" 25G to 27G needle. 1" to 3" 20G to 25G needle. ½" to 3/8" 26 or 27G needle. 1" 20G needle.

½" to 3/8" 26 or 27G needle.

Inhaled and systemic corticosteroids

(mometasone, asmanex, fluticansone, flovent, pulmicort) reserved for acute exacerbations and for those with severe symptoms that don't respond to bronchodilators

Indications for spacers

-you have a hard time using your inhaler, -the taste of the propellent, -using steroids and have yeast infections

Direct laryngoscopy

with local/general anesthesia to directly visulize the vocal cords/larynx using a lighted laryngoscope blade

Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client? Hypocapnia A hyperinflated chest noted on the chest x-ray Increased oxygen saturation with exercise A widened diaphragm noted on the chest x-ray

A hyperinflated chest noted on the chest x-ray Clinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.

COPD and Right-sided heart failure

AS ALVEOLI continue to break down, resistance to blood flow is increased, forcing the right ventricle to maintain a higher pressure in the pulmonary artery. Right sided heart atrophy and failure may occur.

Pyrazinamide

added for first 2 months of therapy bc it will help shorten the needed time for therapy se: photosensitivity

Nurse Maureen has assisted a physician 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 would be appropriate? Inform the physician Continue to monitor the client Reinforce the occlusive dressing Encourage the client to deep-breathe

Continue to monitor the client The presence of fluctuation of the fluid level in the water seal chamber indicates a patent drainage system. With normal breathing, the water level rises with inspiration and falls with expiration. Fluctuation stops if the tube is obstructed, if a dependent loop exists, if the suction is not working properly, or if the lung has reexpanded. Options A, C, and D are incorrect.

Barrel chest/hyperinflation

advanced copd; hyperinflation, bilateral intercostal retractions, horizontal fixation of the ribs, prolonged exhalation, hyper-resonance with percussion

When caring for a male patient who has just had a total laryngectomy, the nurse should plan to: Encourage oral feeding as soon as possible Develop an alternative communication method Keep the tracheostomy cuff fully inflated Keep the patient flat in bed

Develop an alternative communication method A patient with a laryngectomy cannot speak, yet still needs to communicate. Therefore, the nurse should plan to develop an alternative communication method. After a laryngectomy, edema interferes with the ability to swallow and necessitates tube (enteral) feedings. To prevent injury to the tracheal mucosa, the nurse should deflate the tracheostomy cuff or use the minimal leak technique. To decrease edema, the nurse should place the patient in semi-fowler's position.

Nurse Lei caring for a client with a pneumothorax and who has had a chest tube inserted notes continues gentle bubbling in the suction control chamber. What action is appropriate? Do nothing, because this is an expected finding Immediately clamp the chest tube and notify the physician Check for an air leak because the bubbling should be intermittent Increase the suction pressure so that the bubbling becomes vigorous

Do nothing, because this is an expected finding Continuous gentle bubbling should be noted in the suction control chamber. Option b is incorrect. Chest tubes should only be clamped to check for an air leak or when changing drainage devices (according to agency policy). Option c is incorrect. Bubbling should be continuous and not intermittent. Option d is incorrect because bubbling should be gentle. Increasing the suction pressure only increases the rate of evaporation of water in the drainage system.

A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client? Encouraging additional fluids for the next 24 hours Ensuring the return of the gag reflex before offering foods or fluids Administering atropine intravenously Administering small doses of midazolam (Versed).

Ensuring the return of the gag reflex before offering foods or fluids After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex returns because the preoperative sedation and the local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours. Additional fluids is unnecessary because no contrast dye is used that would need to be flushed from the system. Atropine and Versed would be administered before the procedure, not after.

A male patient is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient? Activity intolerance related to fatigue Anxiety related to actual threat to health status Risk for infection related to retained secretions Impaired gas exchange related to airflow obstruction

Impaired gas exchange related to airflow obstruction A patient airway and an adequate breathing pattern are the top priority for any patient, making "impaired gas exchange related to airflow obstruction" the most important nursing diagnosis. The other options also may apply to this patient but less important.

Which of the following physical assessment findings would the nurse expect to find in a client with advanced COPD? Increased anteroposterior chest diameter Underdeveloped neck muscles Collapsed neck veins Increased chest excursions with respiration

Increased anteroposterior chest diameter Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrel-chested appearance. Overly developed, not underdeveloped, neck muscles are associated with COPD because of their increased use in the work of breathing. Distended, not collapsed, neck veins are associated with COPD as a symptom of the heart failure that the client may experience secondary to the increased workload on the heart to pump into pulmonary vasculature. Diminished, not increased, chest excursion is associated with COPD.

The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? It helps prevent early airway collapse It increases inspiratory muscle strength It decreases use of accessory breathing muscles It prolongs the inspiratory phase of respiration

It helps prevent early airway collapse Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)

A female client with chronic obstructive pulmonary disease (COPD) takes anhydrous theophylline, 200 mg P.O. every 8 hours. During a routine clinic visit, the client asks the nurse how the drug works. What is the mechanism of action of anhydrous theophylline in treating a nonreversible obstructive airway disease such as COPD? It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive It inhibits the enzyme phosphodiesterase, decreasing degradation of cyclic adenosine monophosphate, a bronchodilator It stimulates adenosine receptors, causing bronchodilation It alters diaphragm movement, increasing chest expansion and enhancing the lung's capacity for gas exchange

It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive Anhydrous theophylline and other methylxanthine agents make the central respiratory center more sensitive to CO2 and stimulate the respiratory drive. Inhibition of phosphodiesterase is the drug's mechanism of action in treating asthma and other reversible obstructive airway diseases — not COPD. Methylxanthine agents inhibit rather than stimulate adenosine receptors. Although these agents reduce diaphragmatic fatigue in clients with chronic bronchitis or emphysema, they don't alter diaphragm movement to increase chest expansion and enhance gas exchange.

maintenance meds copd

LABAs and anticholinergic

Which of the following is a priority goal for the client with COPD? Maintaining functional ability Minimizing chest pain Increasing carbon dioxide levels in the blood Treating infectious agents

Maintaining functional ability A priority goal for the client with COPD is to manage the s/s of the disease process so as to maintain the client's functional ability. Chest pain is not a typical sign of COPD. The carbon dioxide concentration in the blood is increased to an abnormal level in clients with COPD; it would not be a goal to increase the level further. Preventing infection would be a goal of care for the client with COPD.

Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with newly diagnosed asthma. When teaching the patient about this drug, the nurse should explain that it may cause: Nasal congestion Nervousness Lethargy Hyperkalemia

Nervousness Albuterol may cause nervousness. The inhaled form of the drug may cause dryness and irritation of the nose and throat, not nasal congestion; insomnia, not lethargy; and hypokalemia (with high doses), not hyperkalemia. Otther adverse effects of albuterol include tremor, dizziness, headache, tachycardia, palpitations, hypertension, heartburn, nausea, vomiting and muscle cramps.

a portion of the larynx is removed, along with one vocal cord and the tumor; all other structures remain. The airway remains intact, and the patient is expected to have no difficulty swallowing; voice quality may change - hoarseness. High cure rate!

Partial Laryngectomy

A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to: Promote oxygen intake Strengthen the diaphragm Strengthen the intercostal muscles Promote carbon dioxide elimination

Promote carbon dioxide elimination Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation. Options A, B, and C are not the purposes of this type of breathing.

A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The nurse should base her response on the fact that the: Area of redness is measured in 3 days and determines whether tuberculosis is present. Skin test doesn't differentiate between active and dormant tuberculosis infection. Presence of a wheal at the injection site in 2 days indicates active tuberculosis. Test stimulates a reddened response in some clients and requires a second test in 3 months.

Skin test doesn't differentiate between active and dormant tuberculosis infection. The Mantoux test doesn't differentiate between active and dormant infections. If a positive reaction occurs, a sputum smear and culture as well as a chest X-ray are necessary to provide more information. Although the area of redness is measured in 3 days, a second test may be needed; neither test indicates that tuberculosis is active. In the Mantoux test, an induration 5 to 9 mm in diameter indicates a borderline reaction; a larger induration indicates a positive reaction. The presence of a wheal within 2 days doesn't indicate active tuberculosis.

Methylprednisolone

Solumedrol IV, Prednisone, Fluticasone (flovent, vanceril), Azmacort

major complication after lung surgery

atelectasis

After change of shift, you are assigned to care for the following patients. Which patient should you assess first? A 60-year old patient on a ventilator for whom a sterile sputum specimen must be sent to the lab A 55-year old with COPD and a pulse oximetry reading from the previous shift of 90% saturation A 70-year old with pneumonia who needs to be started on intravenous (IV) antibiotics A 50-year old with asthma who complains of shortness of breath after using a bronchodilator

The patient with asthma did not achieve relief from shortness of breath after using the bronchodilator and is at risk for respiratory complications. This patient's needs are urgent. The other patients need to be assessed as soon as possible, but none of their situations are urgent. in COPD patients pulse oximetry oxygen saturations of more than 90% are acceptable.

Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude? The system is functioning normally The client has a pneumothorax The system has an air leak The chest tube is obstructed

The system has an air leak Constant bubbling in the chamber indicates an air leak and requires immediate intervention. The client with a pneumothorax will have intermittent bubbling in the water-seal chamber. Clients without a pneumothorax should have no evidence of bubbling in the chamber. If the tube is obstructed, the nurse should notice that the fluid has stopped fluctuating in the water-seal chamber.

Which phrase is used to describe the volume of air inspired and expired with a normal breath? Total lung capacity Forced vital capacity Tidal volume Residual volume

Tidal volume Tidal volume refers to the volume of air inspired and expired with a normal breath. Total lung capacity is the maximal amount of air the lungs and respiratory passages can hold after a forced inspiration. Forced vital capacity is the vital capacity performed with a maximally forced expiration. Residual volume is the maximal amount of air left in the lung after a maximal expiration.

complete removal of the larynx, including the hyoid bone, epiglottis, cricoid cartilage, and two or three rings of the trachea. The tongue, pharyngeal walls and trachea are preserved. Performed for advanced laryngeal cancer. Results in permanent loss of voice and a change in the airway. Can provide the desired cure but leaves the patient with significant loss of the natural voice and the need to breathe through a stoma created in the lower neck. The tracheal stoma prevents the aspiration of food and fluid into the lower respiratory tract. Patients will require an alternative to normal speech.

Total Laryngectomy:

After the respiratory therapist performs suctioning on a patient who is intubated, the nursing assistant measures vital signs for the patient. Which vital sign value should the nursing assistant report to the RN immediately? Heart rate of 98 beats/min Respiratory rate of 24 breaths/min Blood pressure of 168/90 mm Hg Tympanic temperature of 101.4 F (38.6 C)

Tympanic temperature of 101.4 F (38.6 C) Infections are always a threat for the patient receiving mechanical ventilation. The endotracheal tube bypasses the body's normal air-filtering mechanisms and provides a direct access route for bacteria or viruses to the lower part of the respiratory system.

The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching? Make inhalation longer than exhalation Exhale through an open mouth Use diaphragmatic breathing Use chest breathing

Use diaphragmatic breathing In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.

An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed? Face tent Venturi mask Aerosol mask Tracheostomy collar

Venturi mask The Venturi mask delivers the most accurate oxygen concentration. It is the best oxygen delivery system for the client with chronic airflow limitation because it delivers a precise oxygen concentration. The face tent, aerosol mask, and tracheostomy collar are also high-flow oxygen delivery systems but most often are used to administer high humidity.

Pleural Friction Rub

loud, rough, grating, and scratching associated with pain on deep inspiration, caused by inflamed lung tissue rubbing the chest wall

hypercapnea

not enough CO2 being excreted from lungs

COPD pt is at risk for

respiratory infections, resp. insufficiency, and failure

Corticosteroids precautions

rinse out mouth to prevent thrush