28 Lower Respiratory

Pleural effusion:

Lung expansion restricted by fluid in pleural space

Empyema:

Lung expansion restricted by pus in intrapleural space

Airway stenting:

Palliative treatment for airway collapse or compression therapy.

The nurse identifies a flail chest in a trauma patient when:

Paradoxic chest movement occurs during respiration

Following a motor vehicle accident, the nurse assesses the driver for which distinctive sign of flail chest?

Paradoxical chest movement

Muscular dystrophy:

Paralysis of respiratory muscles

The resurgence in TB resulting from the emergence of multidrug-resistant strains of Mycobacterium tuberculosis was primarily the result of

Poor compliance with drug therapy in patients with TB

The resurgence in tuberculosis (TB) resulting from the emergence of multidrug-resistan strains of Mycobacterium tuberculosis was primarily the result of:

Poor compliance with drug therapy in patients with TB

During an acute exacerbation of COPD, the patient is severely short of breath and the nurse identifies a nursing diagnosis of ineffective breathing pattern related to obstruction of airflow and anxiety. The best action by the nurse is to

Position the patient upright with the elbows resting on the over the bed table.

Atelectasis:

Presence of collapsed, airless alveoli

Chronic obstructive pulmonary disease (COPD):

Pulmonary capillary/alveolar damage

A common complication of many types of environmental lung diseases is:

Pulmonary fibrosis

Two days after undergoing pelvic surgery, a patient develops marked dyspnea and anxiety. The first action the nurse should take is to:

Raise the head of the bed

A nursing measure that should be instituted after a pneumonectomy is:

Range-of-motion exercises on the affected upper extremity

Pneumonectomy

Removal of a lung

Wedge Resection

Removal of a small lesion

Segmental Resection

Removal of lung segment

Lung Volume Reduction Surgery

Removal of lung tissue by multiple wedge excisions

Lobectomy

Removal of one lung lobe

A patient receiving chemotherapy for breast cancer develops a Cryptococcus infection of the lungs and is treated with IV amphotericin B. The nurse monitors the patient carefully during the drug's administration with the knowledge that this drug increases the patient's risk for (select all that apply)

Renal impairment Nausea and vomiting Malignant hyperthermia reaction

While caring for a patient with primary pulmonary hypertension, the nurse observes that the patient has exertional dyspnea and chest pain, in addition to fatigue. The nurse knows that these symptoms are related to:

Right ventricular hypertrophy and dilation

To determine whether a tension pneumothorax is developing in a patient with chest trauma, the nurse assesses the patient for:

Severe respiratory distress and tracheal deviation

Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of impaired gas exchange based on the findings of:

SpO2, of 86%

Kyphoscoliosis:

Spinal angulation restricting ventilation

A pulmonary embolus is suspected in a patient with a deep-vein thrombosis who develops hemoptysis, tachycardia, and pleuritic chest pain, and diagnostic testing is scheduled. The nurse plans to teach the patient about:

Spiral (helical) CT scan

After the health care provider sees a patient hospitalized with a stroke who developed a fever and adventitious lung sounds, the following orders are written, Which will the nurse implement first?

Sputum specimen for Gram stain and culture and sensitivity

After the health care provider sees a patient hospitalized with a stroke who developed a fever and adventitious lung sounds, the following orders are written. Which will the nurse implement first?

Sputum specimen for Gram stain and culture and sensitivity

To decrease the patient's sense of panic during an acute asthma attack, the best action of the nurse is to

Stay with the patient and encourage slow, pursed-lip breathing

Pulmonary fibrosis:

Stiffening of pulmonary vasculature

Decortication

Stripping of a fibrous membrane

When caring for the patient with a chest tube, the nurse should intervene when the nursing assistant is

Stripping or milking the chest tube to promote drainage

A patient with a 40-pack-year history of smoking has recently stopped because of the fear of developing lung cancer. The patient asks the nurse what he can do to learn about whether he develops lung cancer. The best response for the nurse is,

"Screening measures for lung cancer are controversial, but we can discuss the advantages and disadvantages of various measures."

1. List the three methods by which microorganisms that cause pneumonia reach the lungs.

- Aspiration from the nasopharynx or oropharynx; - Inhalation of microbes in the air; - Hematogenous spread from infections elsewhere in the body

Opportunistic pneumonia

- Cytomegalovirus - Pneumocystis jiroveci

Hospital-acquired pneumonia

- Enterobacter sp. - Klebsiella sp. - Escherichia coli - Staphylococcus aureus - Pseudomonas aeruginosa - Streptococcus pneumoniae

Community-acquired pneumonia

- Haemophilus influenzae - Mycoplasma pneumoniae - Legionella pneumophila - Staphylococcus aureus - Streptococcus pneumoniae

A patient is on a continuous epoprostenol infusion pump. The alarm goes off indicating an obstruction in the intravaneous line downstream. The nurse should:

Assess the central line immediately for any obstruction or accidental clamping of tubing

A dietary modification that helps meet the nutritional needs of patients with COPD is

Avoiding foods that require a lot of chewing

Patient Profile T.S. is a 46-year-old patient who was diagnosed with primary pulmonary hypertension at the age of 42. At that time she presented to her primary care health care provider with a history of increasing fatigue and recent onset of swelling in her feet and ankles. A chest x-ray revealed severe cardiomegaly with pulmonary congestion. She underwent a right- sided cardiac catheterization, which showed very high pulmonary artery pressures. Since then, she has been treated with several drugs, but her pulmonary hypertension has never been controlled and her peripheral edema has progressively worsened. Subjective Data • Short of breath at rest and exercise intolerant to the extent that she had to quit her job • Recently divorced from her husband • Has two children: a girl, 10 years old, and a boy, 4 years old Objective Data • 3+ pitting edema from her feet to her knees • Respirations: 28 at rest • Heart rate: 92 and bounding

1. What drugs might T.S. have been given to treat her pulmonary hypertension? 2. Is T.S. a candidate for heart-lung or lung transplantation? Why or why not? 3. What transplantation procedure would be considered for T.S.? What is the rationale? 4. Priority Decision: What priority preoperative counseling would be necessary for T.S. to prepare for a transplantation procedure? 5. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?

1. Low-flow oxygen; calcium-channel blocking agents (nifedipine [Adalat], diltiazem [Cardizem]), prostacyclins (epoprostenol [Flolan], bosentan [Tracleer]), diuretics 2. Yes, because her medical treatment has failed, and she can be potentially treated with either a lung or heart-lung transplant. She meets additional criteria of being less than 60 years old and a nonsmoker. 3. A heart-lung transplant is indicated for the patient because she has heart damage from the pulmonary hypertension, although there is evidence that even a single-lung transplant can markedly correct pulmonary hypertension and the resultant cor pulmonale.

4. Ability to cope with the postoperative regimen that includes the following: • Strict adherence to immunosuppressive drugs • Continuous monitoring and reporting of manifestations of infection • Financial resources for the procedure, drugs, and follow-up care • Social and emotional support system because she is a single mother 5. Nursing diagnoses: • Activity intolerance related to fatigue as a result of hypoxemia • Excess fluid volume related to pump failure • Impaired gas exchange related to mechanical failure • Ineffective role performance related to inability to perform role responsibilities • Anxiety related to breathlessness • Risk for impaired skin integrity related to edema Collaborative problems: Potential complications: dysrhythmias; hypoxemia

4. Identify the pathophysiologic stages of pneumococcal pneumonia

= Massive dilation of capillaries with alveolar filling with organisms, neutrophils, and fibrin = Exudate becomes lysed and processed by macrophages, and normal lung tissue is restored = Outpouring of fluid into alveoli that supports microorganism growth and spread = Blood flow decreases and leukocytes and fibrin consolidate in affected lung tissue

Identify four clinical situations in which hospitalized patients are at risk for aspiration pneumonia and one nursing intervention for each situation that is indicated to prevent pneumonia.

= Patient with altered consciousness: Position to side, protect airway. = Patient with a feeding tube: Check placement of the tube before feeding, residual feeding; keep head of bed up after feedings or continuously with continuous feedings. = Patient with local anesthetic to throat: Check gag reflex before feeding or offering fluids. = Patient with difficulty swallowing: Cut food in small bites, encourage thorough chewing, and provide soft foods that are easier to swallow than liquids.

The usual treatment for large pneumothorax or hemothorax of any cause is:

A chest tube connected to water-seal drainage.

Chylothorax:

Accumulation of lymphatic fluid in the pleural space from a leak in the thoracic duct.

Six days after a heart-lung transplant, the patient develops a low-grade fever and a decreased SpO2 with exercise. The nurse recognizes that this may indicate:

Acute rejection that can be treated with corticosteroids

The patient with lung cancer needs to receive influenza vaccine and pneumococcal vaccines. The nurse will

Administer both vaccines at the same time in different arms

A patient diagnosed with active TB 1 week ago is admitted to the hospital with symptoms of chest pain. Initially, the nurse gives the highest priority to

Admitting the patient to an airborne-infection isolation room

A patient diagnosed with class 3 TB 1 week ago is admitted to the hospital with symptoms of chest pain. Initially, the nurse gives the highest priority to:

Admitting the patient to an airborne-infection isolation room

When a patient with asthma is admitted to the emergency department in severe respiratory distress, the nurse anticipates that initial drug treatment will most likely include administration of

Aerosolized albuterol

In assessing a patient with pneumococcal pneumonia, the nurse recognizes that clinical manifestations of this condition include (select all that apply):

An abrupt onset of fever Productive cough with rust-colored sputum

When obtaining a health history from a patient at the clinic with suspected CAP, the nurse expects the patient to report:

An abrupt onset of fever and chills

Which statement best describes the treatment of lung abscess?

Antibiotics given for a prolonged period are the usual treatment of choice

A patient with active TB continues to have positive sputum cultures ater 6 months of treatment because she says she cannot remember to take the medication all the time. The best action by the nurse is to:

Arrange for directly observed therapy by a responsible family member of a public health nurse

A patient with active TB continues to have positive sputum cultures after 6 months of treatment because she says she cannot remember to take the medication all the time. The best action by the nurse is to

Arrange for directly observed therapy by a responsible family member or a public health nurse.

Surgical therapy:

Best procedure for cure of lung cancer.

A patient with a lung mass found on chest x-ray is undergoing further testing. The nurse explains that a diagnosis of lung cancer can be confirmed by:

Biopsy positive for malignant cells

A patient with advanced lung cancer refuses pain medication saying, "I deserve everything this cancer can give me." The nurse's best response to the patient is:

Can you tell me what the pain means to you?

A patient has been receiving high-dose corticosteroids and broad-spectrum antibiotics for treatment secondary to a traumatic injury and infection. The nurse plans care for the patient knowing that the patient is most susceptible to:

Candidiasis

The classification of pneumonia as community-acquired pneumonia (CAP) or hospital- acquired pneumonia (HAP) is clinically useful because

Causative agents can be predicted, and empiric treatment is often effective

Opioid and sedative overdose:

Central depression of respiratory rate and depth

Open pneumothorax:

Collapse of the lung from accumulation of air in the intrapleural space caused by a sucking chest wound.

Closed pneumothorax:

Collapse of the lung from accumulation of air in the intrapleural space caused by an injury to the lungs from closed rib fractures.

Hemothorax:

Collapse of the lung from accumulation of blood in the intrapleural space is a(n)

Chemotherapy:

Considered primary treatment for small cell lung cancer (SCLC)

The nurse notes tidaling of the water level in the tube submerged in the water-seal chamber in a patient with closed chest tube drainage. The nurse should

Continue to monitor this normal finding

Photodynamic therapy:

Dye activated by laser light that destroys cancer cells

A patient with pneumonia has a nursing diagnosis of ineffective airway clearance related to pain, fatigue and thick secretions. An appropriate nursing intervention for the patient is to

Encourage a fluid intake of at least 3L/day

A patient with pneumonia has a nursing diagnosis of ineffective airway clearance related to pain, fatigue, and thick secretions. An appropriate nursing intervention for the patient is to:

Encourage a fluid intake of at least 3L/day

Pickwickian syndrome

Excess fat restricts chest wall and diaphragmatic excursion

Idiopathic pulmonary fibrosis:

Excessive connective tissue in lungs

When obtaining a health history from a patient suspected of having early TB, the nurse asks the patient about experiencing

Fatigue, low grade fever and night sweats

When obtaining a health history from a patient suspected of having early TB, the nurse asks the patient about experiencing

Fatigue, low-grade fever, and night sweats

List the components of the four-drug therapy that is recommended for the initial 2-month treatment of clinically active TB.

For the first 2 months, a four-drug regimen consists of isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), and ethambutol (Myambuto)

Cryotherapy:

Freezes bronchial tumors with use of bronchoscope

Initial antibiotic treatment for pneumonia is usually based on

History and physical examination and characteristics chest radiographic findings

A patient is admitted to the hospital with fever, chills, a productive cough with rusty sputum, and pleuritic chest pain. Pneumococcal pneumonia is suspected. An appropriate nursing diagnosis for the patient based on the patient's manifestations is:

Hyperthermia related to acute infections process

Radiation therapy and surgery:

Improves survival when combined with chemotherapy

Thoracotomy

Incision into the thorax.

Pleurisy:

Inflammation of the pleura restricting lung movement

Guillain-Barre syndrome causes respiratory problems primarily by:

Interrupting nerve transmission to respiratory muscles

Following a thoracotomy, the patient has a nursing diagnosis of ineffective airway clearance related to inability to cough as a result of pain and positioning. The best nursing interventionfor this patient is to

Medicate the patient with analgesics 20-30 min before assisting to cough and deep-breathe

Biologic and targeted therapy:

Medications that block growth of cancer cells

Pulmonary embolism:

Obstruction of pulmonary blood flow

During an annual health assessment of a 65 y/o clinic patient, the patient tells the nurse he had the pneumonia vaccine when he was 58. The nurse advises the patient that the best way from him to prevent pneumonia now is to:

Obtain the pneumococcal vaccine this year with an annual influenza vaccine

During an annual health assessment of a 65 year old clinic patient, the patient tells the nurse he had the pneumonia vaccine when he was age 59. The nurse advises the patient that the best way for him to prevent pneumonia now is to

Obtain the pneumococcal vaccine this year with an annual influenza vaccine

Bronchoscopic laser:

Palliative treatment by bronchoscope to remove obstructing bronchial tumors

A patient with TB has been admitted to the hospital and is placed in an airborne infection isolation room. Which of the following should the patient be taught (select all that apply)?

Take all medications for full length of time to prevent multidrug-resistant TB Wear a standard isolation mask if leaving the airborne infection isolation room Maintain precautions in airborne infection isolation room by coughing into a paper tissue

An appropriate nursing intervention for a patient with pneumonia with the nursing diagnosis of ineffective airway clearance related to thick secretions and fatigue would be to:

Teach the patient how to cough effectively to bring secretions to the mouth

29. Describe the function of each chamber: Water-seal, Suction control, Collection chamber

The collection chamber receives the fluid and air from the pleural or mediastinal space. Nursing keeps track of the amount of drainage and can mark the container for easy measuring. The water-seal chamber contains 2 cm of water, which will act as a one-way valve. Incoming air will enter from the collection chamber and bubble up through the water. The water will prevent backflow of the air into the patient from the system. The suction control chamber applies suction to the chest drainage. The water suction type system contains a column of water with the top end vented to the atmosphere to control the amount of suction. The amount of suction applied is controlled by the amount of water in the chamber (usually −20 cm), not the wall suction applied to it. The dry suction device contains no water and uses a regulator to dial the desired negative pressure.

Which of the following statements describe the management of a patient following lung transplantation (select all that apply)?

The lung is biopsied using a transtracheal method The use of a home spirometer will help to monitor lung function Immunosuppressant therapy usually involves a three-drug regimen

The nurse should check for leaks in the chest tube and pleural drainage system when:

There is continuous bubbling in the water-seal chamber

The primary treatment for cor pulmonale is directed toward:

Treating the underlying pulmonary condition

Prophylactic cranial radiation:

Used to prevent metastasis to the brain

To reduce the risk for most occupation lung diseases, the most important measure promoted by the occupational nurse is:

Using masks and effective ventilation systems to reduce exposure to irritants

The primary treatment for cystic fibrosis is

Vigorous and consistent chest physiotherapy.

Tension pneumothorax:

When air in the intrapleural space progressively increases intrathoracic pressure because it cannot escape during expiration.

During a health-promotion program, the nurse plans to target women in a discussion of lung cancer prevention because (select all that apply)

Women develop lung cancer at a younger age than men More women die of lung cancer than die from breast cancer Women who smoke are at greater risk to develop lung cancer than men who smoke Women are more likely to develop small cell carcinoma than men