H&I 2-Oxygenation

Hospital acquired pneumonia (HAP), occurs ______hours or longer after hospitalization and is Not present at time of admission.

48 hours

What is bronchiolitis usually caused by?

RSV

X-ray shows a whiteout in which problem?

ARDS

Dyspnea, coughing, tachypnea, restlessness, normal to light crackles, hypoxemia and respiratory alkalosis are signs of _____________.

ARDS -as it progresses: fluid accum. Decreased lung compliance, tachycardia, diaphoresis, changes in mental status, cyanosis, pallor

__________sudden progressive form of respiratory failure where alveolar membranes are damaged and become permeable to intravascular fluid.

ARDS -from consolidation and infiltrates -recover in several months to 2 years

What are usually administered prior to posterior drainage (2 things)?

Aerosolized bronchodilators and hydration therapy

A client with ARDS is showing signs of increased dyspnea. the nurse reviews a report of blood gas values that recently arrived. Which finding is abnormal? pH 7.35, PaO2 95mm Hg, PaCO2 22mmHg, HCO3 22 mEq/L. What are they experiencing?

PaCO2 (35-45) Respiratory Alkalosis due to hyperventilation

Explain why we see dyspnea in patients

during inspiration, the airways are wider trapping the air on expiration due to hyperinflation -CO2 is not able to leave

The nurse is caring for a patient with DKA and documents that the client is experiencing Kussmaul's respiration's. Which did the nurse observe? a. Respiration's that are increased in rate and abnormally deep b. Respiration's that cease for several seconds c. Respiration's that are abnormally slow and deep d. Respiration's that are shallow

A. Respiration's that are increased in rate and abnormally deep -occur because of compensatory actions by the lungs

Which of the following is a nursing intervention for RSV/bronchiolitis: Select all that apply a. Facilitation of gas exchange b. Preventing transmission c. Maintaining fluid balance d. Reducing fever e. Decreasing anxiety

All are correct

_______is a chronic inflammatory disease of the airways.

Asthma

What are some things the nurse will do on an assessment of a patient with COPD?

-History/Physical -Spirometry reading -Chest x-ray -serum a-antitrypsin levels: protein in blood that protects the lung from damage -ABGs -6 min walk test -COPD assessment

Treatment with antibiotics in pneumonia should show improvement of decreased temperature, improved breathing, and decreased chest discomfort within _________hours.

48-72

What is peak expiratory flow (PEF) used for? What do these values mean? >70 40-69 26-39 <25

Asthma >70: mild 40-69: moderate 26-39: severe <25: life threatening

Which positioning allows fo recruitment of collapsed alveolar units, improvement in ventilation, reduction in shunting, mobilization of secretions, and improvement in functional reserve capacity?

Prone -specifically helps patients with ARDS

__________ prolonged exhalation and prevents air trapping in the alveoli.

Pursed-lip breathing -helps the client control rate and depth of respiration. -prevents bronchiole collapse and air trapping

Methylxanthines, beta adrenergic agonists, corticosteroids, anticholinergics, and antibiotics are medications used for which type of illness?

Respiratory illness -Methylxanthines: not 1st line therapy, interacts with many drugs -B eta adrenergic agonists: inhaled, oral -Corticosteroids: IV, Oral, MDI/DPI -Anticholinergics: nebulizer, MDI -Antibiotics: IV, oral

_________ helps with deep breathing and allows for prolonged exhalation and helps prevent alveolar colllapse.

Spirometer

Chest physiotherapy consists of: (select all that apply) a. Oxygen therapy b. Postural drainage c. Percussion d. Vibration

B,c,d

What is the age of highest risk for SIDS? a. 0-3 months b. 3-6 months c. 2-5 months d. 1-4 months

D. 1-4 months

__________ is difficulty breathing or shortness of breath.

Dyspnea

If you are using a Short-acting beta adrinergic inhaler/oral med and a metered-dose inhaler, which do you use first?

Short-acting beta adrinergic inhaler/ oral med

What are the 4 stages of COPD and their FEV1 percentage?

Stage I: Mild FEV1 > 80% Stage II: Moderate FEV1 50-80% Stage III: Severe FEV1 30-50% Stage IV: Very Severe FEV1 < 30% -these are used to determine severity of COPD based on symptoms, class and exacerbation history

Community Acquired Pneumonia (CAP), occurs in patients who have Not been hospitalized or resided in a long-term care facility within _______days of the onset symptoms.

14 days

When a client is supine, side-to-side repositioning should be done every _______ hours with the head of the bed elevated at least ________degrees.

2 hours 30 degrees

The nurse is instructing a client with COPD how to do pursed-lip breathing. In which order from first to last should the nurse explain the steps to the client? 1. Breathe in normally through your nose for 2 counts (while counting to yourself) 2. Relax your neck and shoulder muscles 3. Pucker your lips as if you were going too whistle 4. Breathe out slowly through pursed lips for 4 counts

2,1,3,4

The nurse is caring for a client who has been placed on droplet precautions. Which protective gear is required? Select all that apply a. Glasses b. Gloves c. Gown d. Surgical masak e. Respirator

A,b,c,d -droplets are too heavy to be airborne, so the respirator is not required

During posterior drainage, side positions should NOT be performed on patients with: (select all that apply) a. Asthma b. Chest trauma c. Hemoptysis d. Renal failure e. Heart disease f. Pulmonary embolus g. Head injury

B,c,e,f,g

The nurse is preparing to suction a client via a tracheostomy tube. The nurse should plan to limit the suctioning time to a max of which time period? a. 30 secs. B. 10secs. c. 1 minute d. 5 secs.

B. 10 secs.

A 79-year-old client is admitted to the hospital with a diagnosis of bacterial pneumonia. While obtaining the clients health history, the nurse learns that the client has osteoarthritis, follows a vegetarian diet, and is very concerned with cleanliness. Which client information would most likely be a predisposing factor for the diagnosis of pneumonia? a. Osteoarthritis b. Age c. Vegetarian diet d. Daily bathing

B. Age -pneumonia is more common in elderly or debilitated clients

The nurse is caring for an infant with bronchiolitis and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding which is the most appropriate nursing action? a. Initiate strict enteric precautions b. Move the infant to a room with another child with RSV c. Leave the infant in the present room because RSV is not contagious d. Inform the staff that they must wear a mask, gloves, and a gown when caring for the child

B. Move the infant to a room with another child with RSV

To improve the oxygenation of a client with ARDS who is receiving mechanical ventilation, the nurse should place the client in which position? a. Lateral side b. Prone c. Supine d. Semi-Fowler's

B. Prone

An oxygen delivery system is prescribed for a client with chronic obstructive pulmonary disease (COPD) to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed: a) Face tent b) Venturi Mask c) Aerosol Mask d) Tracheostomy collar

B. Venturi mask -delivers the most accurate oxygen concentration -best for a client with chronic airflow limitation

Teach the client that bronchodilators alleviate ________ and enhance _______ clearance of secretions

Bronchospasm mucociliary clearance

For postural drainage, how long should they maintain in the position during percussion/vibration to maximize the therapy? a. 3 minutes b. 4 minutes c. 5 minutes d. 10 minutes

C. 5 minutes; 2-4 times a day -position will be determined by the area of lung affected (chest x-ray, assessment, and chest auscultations

The nurse is caring for a client with bacterial pneumonia. The effectiveness of the client's oxygen therapy can be best determined by the: a. Absence of cyanosis b. Clients respiratory rate c. Arterial blood gas values d. Clients level of consciousness

C. Arterial blood gas values

A new parent expresses concern to the nurse regarding sudden infant death syndrome (SIDS). She asks the nurse how to position her new infant for sleep. In which position should the nurse tell the parent to place the infant? a. Side or prone b. Stomach with the face turned c. Back rather than the stomach d. Back or prone

C. Back rather than the stomach -supine

The mother of an 8 year old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child complains of discomfort on the right side and that ibuprofen is not effective. Which instruction should the nurse provide to the mother? a. Increase the frequency of ibuprofen b. Encourage the child to lie on the left side c. Encourage the child to lie on the right side d. Increase the dose of ibuprofen

C. Encourage the child to lie on the right side

RSV/Bronchiolitis is usually transferred by: a. People who cough or sneeze and don't cover their mouth b. Toilet seats c. Inadequate hand washing d. Kissing

C. Inadequate hand washing -not airborne -usually Nov. - March -peaks at the age of 6 months

The nurse instructs a 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 the primary purpose of pursed-lip breathing is to promote which outcome? a. Promote oxygen intake b. Strengthen the intercostal muscled c. Promotes CO2 elimination d. Strengthens the diaphragm

C. Promotes CO2 elimination

The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the client to assume? a.side-lying in bed B. Sitting in a recliner chair c. Sitting up and leaning on an over bed table d. Sitting up in bed

C. Sitting up and leaning on an over bed table

Chronic cough, sputum production, dyspnea, the of exposure to risk factors, chest tightness wheezing, fatigue, weight loss, anorexia (when advanced) barrel chest are signs of which respiratory problem?

COPD

_____________ : clinical manifestations- hypoxemia, hypercapnea, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration.

COPD

Smoking impairs ______ action and _______ function.

Ciliary Macrophage

What lung sounds will be heard in a pneumonia patient?

Crackles

________ is a late sign of decreased oxygenation and is not a reliable indicator of the effectiveness of oxygen therapy.

Cyanosis

A 10- year old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, that indicated a worsening of the condition? a. Respiration's of 18 breaths/min b. Warm, dry skin c. Pulse rate of 90 beats/minute d. Decreased wheezing

D. Decreased wheezing -decreased wheezing in a child with asthma may be interpreted as a positive but it is actually a signal of the inability to move air. -a 'silent chest' is an ominous sign during an asthma episode -increased wheezing=improvement

The nurse administers theophylline to a client. When evaluating the effectiveness of this medication, the nurse should assess for: a. Thinning of tenacious, purple to sputum b. Suppression of the clients respiratory infection c. Decrease in bronchial secretions d. Less difficulty breathing

D. Less difficulty breathing -bronchodilator

The nurse is caring for a patient with pneumonia. if a pleural effusion is developing, the nurse would expect which finding? a. Barrel-shaped chest b. Paradoxical respirations c. Hyper resonance percussion d. Localized decreased breath sounds

D. Localized decreased breath sounds -decreased movement of chest on effected side, dullness to percussion, sharp pain, dyspnea, cough

Which is an expected outcome of pursed-lip breathing for clients with emphysema? a. To strengthen the intercostal muscles b. The provost oxygen intake c. To strengthen diaphragm d. To promote CO2 elimination

D. To promote CO2 elimination

In a COPD patient will the pulmonary function test (PFTs) demonstrate increased or decreased vital capacity?

Decreased

_______ is the destruction of the alveoli which creates trouble with oxygen delivery and removal of CO2, which reduces the amount of air lungs can hold too which there is not cure.

Emphysema

What are some ways to enhance breathing during dyspnea with emphysema?

Exercise, smart breathing, smoking cessation, avoid pollutants, medications, oxygen therapy

The face tent, aerosol mask, and tracheostomy collar are high-flow oxygen deviled systems but are most often used to administer _________________________.

High humidity

What position should a patient with RSV be in? What should the nurse encourage?

High-fowlers Pursed-lip breathing and diaphragmatic breathing

Turn an ARDS client _________ do not give then IV fluids or diuretics. Diagnosis of ARDS would show an O2 stat of ___________

Hourly 60-88%

___________is greater than normal amounts of CO2 in the blood (PaCO2 is over 45mmHg).

Hypercapnia

_________ is low oxygen tension in the blood characterized by a variety of no specific signs and symptoms (PaO2 less than 60mmHg or O2 saturation less than 88%).

Hypoxemia

_________ can be caused by prolonged suctioning which stimulated the pacemakers cells in the heart.

Hypoxemia -a vasovagal response may occur causing bradycardia. -nurse MUST pre oxygenate the client -remember during suctioning the clients airway is blocked

__________ are small, handheld, pressurized devices that deliver a measured does of drug with each activation. Must be primed before use.

Metered Dose Inhaler -Take off cap and shake -breathe out all the way -breathe in slowly and press inhaler down once -hold breath for 10 sec.

Smoking, upper respiratory tract infections, malnutrition, immunosuppression, and the prescience of chronic illness are predisposing factors of _________________.

Pneumonia

Impaired gas exchange, ineffective airway clearance, ineffective breathing pattern, Acute chest pain, activity intolerance are all due to what illness?

Pneumonia -at risk for deficient fluid volume and imbalanced body temperature

Altered level of consciousnesses, brain injury, depressed or absent gag and cough reflex, susceptible to aspiration, drug overdose, stroke victims, immunocompromised are clients at high risk for ______________.

Pneumonia -can be caused by Aspiration, Inhalation, or Hematogenous

What should you do to prevent a person from dying from possible respiratory failure?

Prepare for intubation and mechanical ventilation

Is warm, dry skin a good thing or a bad thing during an asthma attack?

Warm, dry skin indicated improvement in the child's condition because the child is normally diaphoretic (increased perspiration) during exacerbation.

What lung sounds will you her in a patient with RSV?

Wheezing, crackles -may need to intimate if they are in respiratory failure

The nurse is caring for a client hospitalized with an acute exacerbation of COPD. Which finding would the nurse expect to note on an assessment of this client? a. Oxygen saturation with exercise b. A hyper inflated chest noted on the x-ray c. Pulmonary function tests that demonstrate increased vital capacity d. Hypocapnia

b. A hyper inflated chest noted on the x-ray