Ch. 27

A client with a history of asthma reports shortness of breath. The nurse observes that the peak flowmeter indicates a peak expiratory flow (PEF) reading that is in the red zone. What is the priority nursing action? A. Obtain vital signs. B. Administer rescue drugs. C. Notify the health care provider. D. Repeat the PEF reading to verify results.

B A PEF reading in the red zone indicates a range that is 50% below the client's personal best PEF reading and indicates serious respiratory obstruction. The client needs to receive rescue drugs immediately, and then the health care provider should be notified. Repeating the PEF reading and taking vital signs are also important, but doing so delays the administration of the rescue drugs. These can be done after rescue drugs are given.

Drugs used for Asthma Prevention and Treatment

Bronchodilators: SABAs, LABAs, Cholinergic Antagonists Anti-Inflammatories: Corticosteroids, Cromone, Leukotrine Modifiers, Monoclonal Antibodies

A client with COPD has all of the following ABG changes from earlier today. Which change alerts the nurse to take immediate action to prevent harm? A. pH from 7.21 to 7.20 B. HCO3- remains the same at 31 mEq/L C. Paco2 from 45 mm Hg to 68 mm Hg D. Pao2 from 88 mm Hg to 86 mm Hg

C

Rescue drugs for asthma

Ipratroprium and Albuterol

Which complication will the nurse assess for first in any client with cystic fibrosis (CF)? Respiratory infection Pneumothorax Osteoporosis Weight loss

Respiratory infection

Asthma Symptoms and Control Level

Symptoms • Daytime symptoms of wheezing, dyspnea, coughing present more than twice weekly • Waking from night sleep with symptoms of wheezing, dyspnea, coughing • Reliever (rescue) drug needed more than twice weekly • Activity limited or stopped by symptoms more than twice weekly Control Level Controlled: None of the above symptoms Partly Controlled: 1 or 2 of the above symptoms Uncontrolled: 3 to 4 of the above symptoms

Patients who have excessive secretions are at increased risk for respiratory tract infections. Teach patients to

avoid crowds, and stress the importance of receiving a pneumonia vaccination and a yearly influenza vaccine.

Anti-inflammatory drug therapy for asthma is for ________________ They are not effective in ___________________________ Teach patients to take anti-inflammatory asthma drugs __________________

prevention or control of asthma. reversing symptoms during an asthma attack and should not be used alone as reliever drugs. on a scheduled basis, even when no symptoms are present.

Control therapy drugs are used to

reduce airway sensitivity (responsiveness) to prevent asthma attacks from occurring and maintain gas exchange. They are used every day, regardless of symptoms.

Drugs for COPD tx

same as asthma control drugs also mucolytics are used to dec. thick secretions step up and step down tx

The Patient With Chronic Obstructive Pulmonary Disease: Assess nutrition status

• Check weight maintenance, loss, or gain. • Determine food and fluid intake. • Determine use of nutritional supplements. • Observe general condition of the skin.

The Patient With Chronic Obstructive Pulmonary Disease: Assess cardiac status for adequate perfusion

• Measure rate, quality, and rhythm of pulse. • Check dependent areas for edema. • Check neck veins for distention with the patient in a sitting position. • Measure capillary refill.

Cholinergic Antagonist

Causes bronchodilation by inhibiting the parasympathetic nervous system, allowing the sympathetic system to dominate, releasing norepinephrine that activates beta2 receptors. Purpose is to prevent asthma attacks or COPD bronchospasms and improve gas exchange, although some are considered reliever drugs. ex: Ipratropium

What is the priority action for the nurse to take when a client comes to the emergency department with extremely labored breathing and a history of asthma that is unresponsive to prescribed inhalers? Preparing the client for intubation Establishing IV access to give emergency medications. Placing the client in a high-Fowler position, and starting oxygen Asking the client how long he or she has had asthma and what triggered this attack

Placing the client in a high-Fowler position, and starting oxygen

Diaphragmatic or Abdominal Breathing

• If you can do so comfortably, lie on your back with your knees bent. If you cannot lie comfortably, perform this exercise while sitting in a chair. • Place your hands or a book on your abdomen to create resistance. • Begin breathing from your abdomen while keeping your chest still. You can tell if you are breathing correctly if your hands or the book rises and falls accordingly.

Which complication does the nurse suspect when a client with severe chronic obstructive pulmonary disease COPD has new-onset increased fatigue, dependent edema, neck vein distension, and oral cyanosis? Asthma Pneumonia Cor pulmonale Lung cancer

Cor pulmonale

A client with primary pulmonary arterial hypertension (PAH) receiving treprostinil by continuous IV infusion now has a fever of 101.6°F (38.7°C). Which actions will the nurse perform to prevent harm? Select all that apply. A. Administer the prescribed antipyretic B. Ask the client whether a productive cough is present C. Apply oxygen by nasal cannula D. Culture the IV site E. Determine whether a durable power of attorney has been signed F. Increase the treprostinil flow rate G. Initiate a second IV access and administer prescribed antibiotic H. Place the client in protective isolation

D, G, F

Which changes in arterial blood gas (ABG) values will the nurse expect in a client with long-term chronic obstructive pulmonary disease (COPD)? Increased pH; increased PaO2; increased PaCO2; Increased bicarbonate level Increased pH; increased PaO2; increased PaCO2; decreased bicarbonate level Decreased pH; decreased PaO2; decreased PaCO2; decreased bicarbonate level Decreased pH; Decreased PaO2; Increased PaCO2; Increased bicarbonate level

Decreased pH; Decreased PaO2; Increased PaCO2; Increased bicarbonate level

Short-Acting Beta2 Agonist (SABA)

Fast acting reliever/rescue drug used during an asthma attack or used just before engaging in activity that could usually triggers an attack Ex: albuterol

For which side effects of radiation therapy will the nurse prepare the client who has stage II lung cancer? (Select all that apply.) Scalp alopecia Increased risk for infection Fatigue Difficulty swallowing Dry, peeling skin on the chest Increased bruising

Fatigue Difficulty swallowing Dry, peeling skin on the chest

positioning interventions for COPD pts

Having the patient remain in an upright position with the head of the bed elevated, increasing chest expansion and keeping the diaphragm in the proper position to contract. This position conserves energy by supporting the patient's arms and upper body. Help the patient who can tolerate sitting in a chair get out of bed for 1-hour periods two to three times a day.

CF complications

Pulmonary atrophy and organ dysfunction. Pancreatic insufficiency Malnutrition Intestinal obstruction Poor growth Male sterility Cirrhosis of the liver Osteoporosis - risk for bone fractures DM Respiratory failure - the main cause of death Chronic respiratory tract infections Lung abscesses Pneumothorax Hemorrhage GERD Hearing loss Dec. gas exchange due to narrowed airway vitamin deficiencies of the fat-soluble vitamins (e.g., vitamins A, D, E, K)

Which point is most important to prevent harm for the nurse to teach a client with chronic obstructive pulmonary disease (COPD) who is being discharged on home oxygen therapy? Removing combustion hazards present in the home Understanding the signs and symptoms of hypoxemia Correct performance when setting up the oxygen delivery system Demonstrating how to use a pulse oximetry device

Removing combustion hazards present in the home

Which action is most important for the nurse to take when a client with chronic obstructive pulmonary disease who is taking a cholinergic antagonist now reports nausea, blurred vision, headache, and inability to sleep? Asking the client to explain the exact techniques he or she uses when taking the drug Reporting the symptoms to the primary health care provider immediately Reminding the client that these side effects are normal and not to worry Requesting an order to draw blood to determine the drug level

Reporting the symptoms to the primary health care provider immediately

Which outcome indicates to the nurse that oxygen therapy for the client with chronic obstructive pulmonary disease (COPD) who has hypoxemia and hypercarbia is effective? PCO2 is within normal range. Finger clubbing has resolved. Client reports decreased distress. SpO2 is between 88% and 90%.

SpO2 is between 88% and 90%.

curschmann spirals

Spiral shaped mucus plugs seen in asthmatics

Which action will the nurse take to prevent harm when prescribed to administer an IV antibiotic to a client with pulmonary artery hypertension (PAH) who is being managed with a continuous prostacyclin agonist infusion? Requesting a prescription for an oral antibiotic Starting a peripheral IV access to use for administering the antibiotic Administering the IV antibiotic through the continuous infusion's side port Stopping the prostacyclin agonist infusion for 15 minutes to administer the IV antibiotic

Starting a peripheral IV access to use for administering the antibiotic

Why will the nurse administer vitamin supplements to a client who has cystic fibrosis (CF)? Increased blood levels of vitamins enhance chloride transport activity. Clients are too fatigued to ingest sufficient vitamins and nutrients. High doses of vitamins can slow the progression of the disease. Steatorrhea causes a deficiency of fat-soluble vitamins.

Steatorrhea causes a deficiency of fat-soluble vitamins.

Which action is most important for the nurse to take when preparing a client with cystic fibrosis (CF) for a lung transplantation procedure? Reminding the client to continue taking prescribed vitamin supplementation Teaching the client how to perform pulmonary muscle strengthening exercises Using aseptic technique when assisting the client to perform pulmonary hygiene Collaborating with the registered dietitian nutritionist to provide high-calorie, high-protein meals

Teaching the client how to perform pulmonary muscle strengthening exercises

emphysema (alveolar problem)

elastic lung tissue cannot recoil after stretching leading to hyperinflation some alveoli are destroyed, and others become large and flabby, with less area for gas exchange. s/s: dyspnea/air hunger, tachypnea, use of accessory muscles pt inc. resp rate to compensate for dec. gas exchange, abgs may be normal until disease becomes more advanced need chest xray

Which statement made by a client prescribed a reliever drug inhaler for asthma indicates to the nurse correct understanding of this therapy? "I will keep this inhaler with me at all times." "Reliever drugs are needed to prevent asthma attacks." "At night, I will be sure to store the inhaler in a cool, dry place." "If I forget a dose, I will use the inhaler as soon as I remember it."

"I will keep this inhaler with me at all times."

Which client statements about using an aerosol inhaler for asthma management indicate to the nurse that he has correct understanding of this drug delivery system? (Select all that apply.) "If I use a spacer, I don't have to wait a minute between the two puffs." "If the spacer makes a whistling sound, I am breathing in too rapidly." "Rinsing my mouth after using the inhaler and then swallowing the rinse ensures I will get all of the drug." "When I suspect the canister is close to empty, I will shake it to check how much is left." "I will hold my breath for at least 10 seconds after inhaling the drug."

"If the spacer makes a whistling sound, I am breathing in too rapidly." "I will hold my breath for at least 10 seconds after inhaling the drug."

The nurse is assessing a client with a chest tube following a pneumonectomy. Which assessment finding requires nursing intervention? A. Bandage around the posterior tube is loose. B. 2 cm of water is in the second chest tube chamber. C. The water in the water seal chamber rises and falls with inhalation/exhalation. D. Bubbling present in the water seal chamber when the client coughs.

A After lung surgery, two tubes, anterior and posterior, are used. Dressings around the wound should not be loose. Other findings are normal.

A client with COPD has just been reclassified for disease severity from a GOLD 2 to a GOLD 3. Which client statement about changes in management or lifestyle indicate to the nurse that more teaching is needed to prevent harm? A. "This year I will get the pneumonia vaccination in addition to a flu shot." B. "Now I will try to rest as much as possible and avoid any unnecessary exercise." C. "Maybe drinking a supplement will help me retain weight and have more energy." D. "Perhaps using a spacer with my metered dose inhaler will make the drug work better."

B

The client, who is 24 hours postoperative after a right lower lobectomy for stage II lung cancer and has two chest tubes in place, reports intense burning pain in his lower chest. On assessment, the nurse notes there is no bubbling on exhalation in the water seal chamber. What action will the nurse perform first? A. Immediately notify either the Rapid Response Team or the thoracic surgical resident. B. Assist the client to a side-lying position and reassess the water seal chamber for bubbling. C. Administer the prescribed opioid analgesic immediately, and then assess the chest tube system. D. No action is needed because these responses are normal for the first postoperative day after lobectomy.

B

Which specific information will the nurse teach to the client with eosinophilic asthma newly prescribed benralizumab therapy? A. Avoid breathing into the inhaler or getting it wet. B. The drug can only be given by a health care professional. C. Do not chew, crush, or split the tablet containing this drug. D. The drug must be taken at bedtime because of the extreme drowsiness it causes.

B

A 60-year-old woman with COPD who smoked cigarettes for 40 years is admitted to the hospital. The ED nurse reports the following to the medical-surgical nurse: Has a saline lock in the R forearm and is on oxygen at 2 L per nasal cannula Had a bronchodilator respiratory treatment in the ED. Has bilateral expiratory wheezes and crackles, anteriorly and posteriorly. Which assessment finding does the nurse expect to see when the client arrives? (Select all that apply.) A. Bradycardia B. Shortness of breath C. Use of accessory muscles D. Sitting in a forward posture E. Barrel chest appearance

B, C, D, E The client with COPD often has a barrel chest appearance, is short of breath, and may use accessory muscles when breathing. These clients tend to move slowly and are slightly stooped. Usually they sit with a forward-bending posture. With severe dyspnea, they exhibit activity intolerance and activities such as bathing and grooming are avoided. Bradycardia is not anticipated.

When performing a medication reconciliation for a newly admitted client before planned abdominal surgery, the nurse notes that the client is prescribed salmeterol and fluticasone daily for asthma control. What is the priority action for the nurse to take regarding this information to prevent harm? A. Record and display the information in a prominent place within the client's medical record. B. Ask the client how long the drugs have been prescribed and how well the asthma is controlled. C. Collaborate with the surgeon to arrange for continuation of this therapy in the perioperative period. D. Ensure that parenteral forms of these drugs are prescribed for use while the client remains NPO after surgery.

C

Which problem experienced by a man with late-stage lung cancer is the priority for immediate action by the nurse? Anorexia and weight loss Extreme fatigue Constipation for 2 days Pain rating of 9 on a 0-10 scale

Pain rating of 9 on a 0-10 scale

How will the nurse categorize the level of asthma control for a client who reports usually waking at night with wheezing once weekly and needing to use the prescribed reliever inhaler to stop the episode? Controlled Partly controlled Minimally controlled Uncontrolled

Partly controlled

Effective Coughing for COPD pts

Teach the patient to cough on arising in the morning to eliminate mucus that collected during the night. Coughing to clear mucus before mealtimes may make meals more pleasant. Coughing before bedtime may help clear lungs for a less interrupted night's sleep. teach the patient to sit in a chair or on the side of a bed with feet placed firmly on the floor. Instruct him or her to turn the shoulders inward and to bend the head slightly downward, hugging a pillow against the stomach. The patient then takes a few breaths, attempting to exhale more fully. After the third to fifth breath (in through the nose, out through pursed lips), instruct him or her to take a deeper breath and bend forward slowly while coughing two or three times ("mini" coughs) from the same breath. On return to a sitting position, the patient takes a comfortably deep breath. The entire coughing procedure is repeated at least twice.

Nursing implications for Ipratropium

inhaled drug, if patient is to use any of these as a reliever drug, teach him or her to carry it at all times because it can stop or reduce life-threatening bronchoconstriction. Also can be used for prevention. Teach patient to increase daily fluid intake because the drugs cause mouth dryness. Teach patient to observe for and report blurred vision, eye pain, headache, nausea, palpitations, tremors, and inability to sleep as these are systemic symptoms of overdose and require intervention.

Nursing implications for Albuterol

inhaled drug, teach patients to carry drug with them at all times because it can stop or reduce life-threatening bronchoconstriction.

Nursing implications for Montelukast

oral drug Blocks the leukotriene receptor, preventing the inflammatory mediator from stimulating inflammation. Purpose is to prevent asthma attack triggered by inflammation or allergens. Teach patient to use the drug daily, even when no symptoms are present, because maximum effectiveness requires continued use for 48-72 hours and depends on regular use. Teach patient not to decrease the dose of or stop taking any other asthma drugs unless instructed by the health care professional because this drug is for long-term asthma control and does not replace other drugs, especially corticosteroids and reliever (rescue) drugs.

Nursing implications for Prednisone

oral drug Disrupt production pathways of inflammatory mediators. The main purpose is to prevent an asthma attack caused by inflammation or allergies (controller drug). Teach patient about expected side effects because knowing which side effects to expect may reduce anxiety when they appear. Teach patient to avoid anyone who has an upper respiratory infection because the drug reduces all protective inflammatory responses, increasing the risk for infection. Teach patient to avoid activities that lead to injury because blood vessels become more fragile, leading to bruising and petechiae. Teach patient to take drug with food to help reduce the side effect of GI ulceration. Teach patient not to suddenly stop taking the drug for any reason because the drug suppresses adrenal production of corticosteroids, which are essential for life.

The Patient With Chronic Obstructive Pulmonary Disease: Assess the patient's and caregiver's understanding of disease and adherence to management, including

• Correct use of supplemental oxygen • Correct technique and dosing schedule for use of inhalers • Symptoms to report to the primary health care provider indicating the need for acute care • Increasing severity of resting dyspnea • Increasing severity of usual symptoms • Development of new symptoms associated with poor gas exchange • Respiratory infection • Failure to obtain the usual degree of relief with prescribed therapies • Use of pursed-lip and diaphragmatic breathing techniques • Scheduling of rest periods and priority activities • Participation in rehabilitation activities

Asthma PTs should seek immediate emergency care if you experience any of these:

• Gray or blue fingertips or lips • Difficulty breathing, walking, or talking • Retractions of the neck, chest, or ribs • Nasal flaring • Failure of drugs to control worsening symptoms

Warning Signals Associated With Lung Cancer

• Hoarseness • Change in respiratory pattern • Persistent cough or change in cough • Blood-streaked sputum • Rust-colored or purulent sputum • Frank hemoptysis • Chest pain or chest tightness • Shoulder, arm, or chest wall pain • Recurring episodes of pleural effusion, pneumonia, or bronchitis • Dyspnea • Fever associated with one or two other signs • Wheezing • Weight loss • Clubbing of the fingers

Asthma Management/Precautions

• If you have exercise-induced asthma, use your reliever bronchodilator inhaler 30 minutes before exercise to prevent or reduce bronchospasm. • Be sure that you know the proper technique and correct sequence when you use metered dose inhalers. • Get adequate rest and sleep. • Reduce stress and anxiety; learn relaxation techniques; adopt coping mechanisms that have worked for you in the past. • Wash all bedding with hot water to destroy dust mites.

The Patient With Chronic Obstructive Pulmonary Disease: Assess respiratory status and adequacy of gas exchange

• Measure rate, depth, and rhythm of respirations. • Examine mucous membranes and nail beds for evidence of hypoxia. • Determine use of accessory muscles. • Examine chest and abdomen for paradoxical breathing. • Count number of words patient can speak between breaths. • Determine need and use of supplemental oxygen. (How many liters per minute is the patient using?) • Determine level of consciousness and presence/absence of confusion. • Auscultate lungs for abnormal breath sounds. • Measure oxygen saturation by pulse oximetry. • Determine sputum production, color, and amount. • Ask about activity level. • Observe general hygiene. • Measure body temperature.

Nursing Accommodations for an Older Adult With a Respiratory Problem

• Provide rest periods between activities such as bathing, meals, and ambulation. • Have the patient sit in an upright position for meals to prevent aspiration. • Encourage nutritional fluid intake after the meal to prevent an early sensation of fullness and promote increased calorie intake. • Schedule drugs around routine activities to increase adherence to drug therapy. • Arrange chairs in strategic locations to allow the patient with dyspnea to stop and rest while walking. • Urge the patient to notify the primary health care provider promptly for any symptoms of infection. • Encourage the patient to receive the pneumococcal vaccines and to have an annual influenza vaccination. • For patients who are prescribed home oxygen, instruct them to keep tubing coiled when walking to reduce the risk for tripping.

Priority nursing interventions for CF focus on

teaching about drug therapy, infection prevention, pulmonary hygiene, nutrition, and vitamin supplementation.

forward-bending posture with the arms held forward

tripod position/orthopneic

What is the nurse's best response when a client with emphysema asks how removing part of the lungs through lung volume reduction surgery will improve breathing? "This surgery makes room for the new lungs when a lung transplant is available." "Breathing will be improved because diseased lung parts are removed and replaced with healthy parts." "By removing only the over-inflated parts of the lungs, the air you breathe in will be going only to the lung areas that work best." "This surgery is preventive, because the parts of the lungs being removed are those that having the highest probability for developing cancer."

"By removing only the over-inflated parts of the lungs, the air you breathe in will be going only to the lung areas that work best."

The patient with COPD may need an oxygen flow of _________________ L/min via nasal cannula or up to ________ via Venturi mask.

2 to 4 40%

Which statements are correct regarding the drug management of asthma? Select all that apply. 1. Long-acting beta agonists are indicated to relieve acute attack symptoms. 2. Control therapy medications are used to prevent asthma attacks from occurring. 3. Control therapy medications are used to reduce airway responsiveness. 4. Reliever medications are used to stop an asthma attack once it has started. 5. Anti-inflammatory medications are used to cause bronchodilation.

2,3,4 Control (formerly called preventive) therapy is used to reduce airway responsiveness to prevent the occurrence of asthma attacks. This therapy is used every day, regardless of symptoms. Reliever drugs are indicated when symptoms of an attack occur to decrease the duration and severity of the attack. Long-acting beta agonists do not act quickly enough to relieve acute symptoms; they are indicated for their long-term impact on symptoms. Anti-inflammatory drugs decrease inflammation and can be beneficial in the treatment of asthma; however, they do not cause bronchodilation.

Which assessment finding in a client who has had a lobectomy and placement of a chest tube 8 hours ago requires immediate follow-up by the nurse? 200 mL red drainage from chest tube over 2 hours Client sleepy but able to be aroused 3-cm area of red drainage on the incisional dressing Report of pain at the chest tube insertion site

200 mL red drainage from chest tube over 2 hours

weight/nutrition plans for COPD pts

4-6 small meals a day Use bronchodilator 30 min. before meal Easy to chew foods & not gas forming Avoid dry foods (stimulate coughing) Avoid caffeine (increases urine output, dehydration) Eat high-calorie, high-protein Supplements, avoid drinking with meals

The Step System

5 steps: step 1 is relief inhaler only & no daily drugs, then drugs are added with each step up

All hypoxic patients, even those with COPD and hypercarbia, should receive oxygen therapy at rates appropriate to reduce hypoxia and bring Sp O 2 levels up between

88% and 92%.

Which precaution is a priority for the nurse to teach a client prescribed the gene therapy combination of ivacaftor/tezacaftor in order to prevent harm from this therapy? A. Examine your skin and the whites of your eyes daily for a yellow appearance. B. Apply ice to the injection site for 30 minutes after each dose to keep bleeding to a minimum. C. Wait at least 15 minutes after using other inhaled drugs before inhaling this drug combination. D. Go to your primary health care provider immediately if you develop a fever or other signs of infection.

A

Which statement about the genetics of cystic fibrosis is true? A. Recessive disorder affecting chloride transport B. Recessive disorder affecting alpha1-antitrypsin levels C. Dominant disorder inhibiting alveoli formation D. Dominant disorder increasing production of interleukin-5

A

Anti-Inflammatories

All of these drugs help improve bronchiolar airflow and increase gas exchange by decreasing the inflammatory response of the mucous membranes in the airways. They do not cause bronchodilation. ex: corticosteroids- prednisone, fluticasone cromone leukotrine modifiers- montelukast monoclonal antibodies

Nursing implications for Fluticasone

MDI inhaled drug, fine liquid spray, sometimes used with a spacer Disrupt production pathways of inflammatory mediators. The main purpose is to prevent an asthma attack caused by inflammation or allergies (controller drug). Teach patient to use the drug daily, even when no symptoms are present, because maximum effectiveness requires continued use for 48-72 hours and depends on regular use.

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A 62 year old with chronic obstructive pulmonary disease (COPD) being discharged with an oxygen saturation of 90% A 52 year old with end-stage pulmonary fibrosis and an oxygen saturation of 89% A 42 year old with lung cancer who needs an IV antibiotic administered before going to surgery A 22 year old with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate of 38 breaths/min

A 22 year old with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate of 38 breaths/min

lower respiratory disorders

Asthma---Emphysema---Chronic Bronchitis--TB--COPD--Lung Cancer--CF--PAH

Which assessment findings in a client with asthma indicate to the nurse that the client's asthma condition is deteriorating and progressing toward respiratory failure? Respiratory alkalosis; slow, shallow respiratory rate Tachypnea, thick and tenacious sputum, and hemoptysis Crackles, rhonchi, and productive cough with yellow sputum Audible wheezing with use of accessory muscles on inhalation

Audible wheezing with use of accessory muscles on inhalation

A client newly diagnosed with stage I nonsmall cell lung cancer (NSCLC) who is getting ready for curative surgery asks the nurse whether the oncologist might consider this new drug he has seen on television, pembrolizumab, instead of surgery. What is the nurse's best response? A. "This drug will only work on those lung cancers that have the right target and your tumor does not have it." B. "This drug is approved for use in clients whose lung cancer has metastasized not for early-stage cancers." C. "Why would you want to take a drug for months when you may be cured by surgery alone?" D. "You need to talk about this with your oncologist and your surgeon."

B

Long-Acting Beta2 Agonist (LABA)

Causes bronchodilation through relaxing bronchiolar smooth muscle by binding to and activating pulmonary beta2 receptors. Onset of action is slow with a long duration. Primary use is prevention of an asthma attack. Should never be prescribed as the only drug therapy for asthma and are not to be used during an acute asthma attack or bronchospasm. Teach the patient to use these control drugs daily as prescribed, even when no symptoms are present, and to use a SABA to relieve acute symptoms. Any patient using these drugs must be monitored closely. Ex. Salmeterol

Which action is most appropriate for the nurse to take first when the water seal chamber of the chest drainage device in a client who had a lobectomy has small bubbles when the client coughs the appropriate action by the nurse? Checking the tubing for blood clots Briefly increasing the amount of suction Documenting the finding in the medical record Add additional sterile water to the water seal chamber

Documenting the finding in the medical record

Which action will the nurse teach a client with chronic bronchitis to use to mobilize secretions? Avoiding triggers that cause coughing Elevating the head of the bed 45 degrees Drinking at least 2 L of fluid daily Assuming the tripod position as often as possible

Drinking at least 2 L of fluid daily

Which laboratory finding does the nurse expect in a client who has metastatic lung cancer and new-onset back pain? Hyperkalemia Hyperglycemia Hypercalcemia Hypernatremia

Hypercalcemia

For which side effect will the nurse monitor a client with pulmonary arterial hypertension (PAH) who is receiving endothelin receptor antagonist therapy? Increased clot formation Decreased urine output Hypotension Sepsis

Hypotension

Which action is most important for a nurse to take to prevent complications for a client with a history of chronic obstructive pulmonary disease (COPD) is admitted for a surgical procedure that is unrelated to the respiratory system? Assessing the client's respiratory system every 8 hours Monitoring for signs and symptoms of pneumonia Instructing the client to use a tissue when coughing or sneezing Ensuring the client remains in bed for a full 24 hours after surgery

Monitoring for signs and symptoms of pneumonia

Bronchospasm

Narrowing of bronchial tubes, constriction of the smooth muscle When pollutants or respiratory viruses stimulate & cause constriction Inflammatory response can occur at the same time, this can trigger more constriction

Which action will the nurse teach an older client with a respiratory problem to make as an accommodation to promote adequate gas exchange? Avoid any nonessential physical activity or exercise. If you must walk any distance in cool weather move quickly to keep warm. Replace at least one meal each day with a high-calorie liquid food supplement. Notify your primary health care provider at the first sign of respiratory infection.

Notify your primary health care provider at the first sign of respiratory infection.

Which features will the nurse expect to be present in a client who has long-term chronic obstructive pulmonary disease? (Select all that apply.) Poor gas exchange from decreased alveolar surface area Increased anteroposterior chest diameter from air-trapping Arterial blood gas value with increased PaO2 level Hypercapnia from retained PaCO2 Respiratory acidosis with a low pH Increased eosinophil count

Poor gas exchange from decreased alveolar surface area Increased anteroposterior chest diameter from air-trapping Hypercapnia from retained PaCO2 Respiratory acidosis with a low pH

_________________ prevents muscle deconditioning

Pulmonary rehabilitation and energy conservation

What is the primary indication for the nurse to apply supplemental oxygen to the client with pulmonary artery hypertension (PAH)? The client determines when oxygen supplementation is needed. The nurse applies oxygen when the client's respiratory rate is increased. The nurse applies oxygen when the client's respiratory rate is decreased. Oxygen therapy is part of the client's ongoing clinical management and is applied continuously.

The client determines when oxygen supplementation is needed.

Which action is most important to teach a client living with progressing idiopathic pulmonary fibrosis? Taking oral temperature daily Using energy conservation measures Maintaining an oral fluid intake of at least 2 L daily Using oxygen by nasal cannula whenever dyspnea is present

Using energy conservation measures

status asthmaticus

a severe, life-threatening asthma attack that is refractory to usual treatment and places the patient at risk for developing respiratory failure. severe, life-threatening, acute, airway obstruction extreme labored breathing wheezing accessory muscles distended neck veins may develop pneumothorax, cardiac or respiratory arrest tx: IV fluids Potent bronchodilators Steroids Epinephrine Oxygen Intubation Possible tracheotomy

What can increase incidence and severity of chronic respiratory disorders such as asthma, COPD, pulmonary fibrosis, and lung cancer?

air pollution, extreme temperatures, insects/microorganisms, heavy flooding/climate change

Inflammation in asthma

airway lumens become obstructed occurs due to cold/dry air, aspirin/NSAIDS, microorganisms, air particles eosinophils and neutrophils leads to airway damage and altered cellular regulation with enlargement of the bronchial epithelial cells, including mucus-secreting cells, and changes in the bronchial smooth muscle. coughing may inc.

Asthma

airway obstruction caused by both inflammation and airway tissue sensitivity (hyperresponsiveness) with bronchoconstriction Most common lower respiratory disorder Decreases gas exchange airway changes are reversible IF controlled

The underlying problem of CF is

blocked chloride transport in the cell membranes that causes the formation of mucus that has little water content and is thick.

beta-adrenergic receptors

can cause an increase in bronchial dilation.

airway tissue sensitivity (hyperresponsiveness) in asthma

constriction of bronchial smooth muscle narrow the tubular structure of the airways can occur with exercise or upper respiratory illness and for unknown reasons, GERD

late-stage CF s/s

cough w/ sputum and hemoptysis, chest congestion, crackles, cough, fatigue, dec. tolerance

Labs and diagnostics during asthma

dec. PaO2 (<80) dec. PaCO2 early in the attack (<35) inc. PaCO2 late in the attack (>45) inc. eosinophils (especially in sputum) and IgE dec. FEV1

Asthma pt history assessment: The patient with asthma usually has a pattern of intermittent episodes of

dyspnea (perceived shortness of breath), chest tightness, coughing, wheezing loud on exhalation w/ tachypnea (especially in nonsmokers), curschmann spirals, and increased mucus production. Also assess smoking hx and when/where you get your asthma symptoms

COPD should be suspected in any patient who has

dyspnea, chronic cough or sputum production, recurrent lower respiratory infections, and/or a history of particulate matter exposures

FEV1

forced expiratory volume in one second

Laboratory Assessment for COPD pts

hypoxemia hypercarbia (worsens with damaged alveoli) resp acidosis metabolic alkalosis (increased arterial bicarbonate) occurs as compensation

A decrease in either the FEV1 or the PEF (PERF) of 15% to 20% below the expected value for age, gender, and size is common for the patient with asthma. Asthma is diagnosed when these values

increase by 12% or more after treatment with bronchodilators. Airway responsiveness is tested by measuring the PEF and FEV1 before and after the patient inhales the drug methacholine, which induces bronchospasm in susceptible adults.

Chronic Bronchitis (airway problem)

inflammation of the bronchi and bronchioles caused by exposure to irritants (cigarette smoke) large amounts of thick mucus is produced which dec. airways Complications Hypoxemia Acidosis Respiratory infection Cardiac failure, Cor Pulmonale/Right-sided HF Dysrhythmias Respiratory failure

Nursing implications for Salmeterol

inhaled drug, teach patient to not use these drugs as reliever drugs because they have a slow onset of action and do not relieve acute symptoms.

Perform suctioning on COPD pts

only when needed—not routinely.

Preventative maintenance therapy for CF involves

positive expiratory pressure, active cycle of breathing technique, and an individualized exercise program.

Asthma Management: pts should avoid

potential environmental asthma triggers, such as smoke, fireplaces, dust, mold, and weather changes of warm to cold. drugs that trigger your asthma (e.g., aspirin, NSAIDs, beta blockers). food that has been prepared with monosodium glutamate (MSG) or metabisulfite.

Pursed-Lip Breathing

• Close your mouth and breathe in through your nose. • Purse your lips as you would to whistle. Breathe out slowly through your mouth, without puffing your cheeks. Spend at least twice the amount of time it took you to breathe in. • Use your abdominal muscles to squeeze out every bit of air you can. • Remember to use pursed-lip breathing during any physical activity. Always inhale before beginning the activity and exhale while performing it. Never hold your breath.