hesi exit eaq respiratory questions

No bubbling in suction control chamber

verify tubing is attached, verify water is filled to prescribed level, assess wall suction regulator

fremitus

vibration of the chest wall produced by vocalization.

mediastinoscopy

visual examination of the mediastinal structures, including the heart, trachea, esophagus, bronchus, thymus, and lymph nodes

In which order would the nurse take these actions when suctioning a client who is receiving mechanical ventilation? auscultate lungs vitals hyperoxygenate for 30 minutes Rotate the catheter during its withdrawal. suction for 10 seconds

vitals auscultate hyperoxygenate suction for 30 suction 10 slow withdrawal of catheter

smokers require more of which vitamin

vitamin c 35

how do you palpate fremitus

with the palm of the hand

asthma nursing plans and interventions

• Administer bronchodilators. • Administer fluids and humidification. • Education (causes, medication regimen) • ABGs • Ventilatory patterns • C-PAP and Bi-PAP

Penicillin adverse effects

• Allergic reactions • Anaphylaxis • Phlebitis at IV site • Diarrhea • GI distress • Superinfection

Tracheostomy care

• Aseptic technique (remove inner cannula only from stoma) • Clean nondisposable inner cannula with H2O2; rinse with sterile saline in accordance with hospital policy • 4 × 4 gauze dressing is butterfly folded after inner cannula is inserted.

characteristics of chronic bronchitis

• Generalized cyanosis • Right-sided HF • Distended neck veins • Crackles • Expiratory wheezes

proper steps inhaler with spacer

• Have client exhale completely. • Grip mouthpiece (in mouth) only if client has a spacer; otherwise, keep the mouth open to bring in volume of air with misted medication. While inhaling slowly, push down firmly on the inhaler to release the medication.

Nursing plans and interventions for chronic bronchitis and emphysema

• Monitor for signs and symptoms of fluid overload • Maintain PO 2 between 55 and 60 • Baseline ABGs • Teach pursed-lip breathing and diaphragmatic breathing. • Teach tripod position. • Administer bronchodilators and antiinflammatory agents.

when to tracheal suction

• Suction when adventitious breath sounds are heard, when secretions are present at endotracheal tube, and when gurgling sounds are noted.

inhaler with spacers considerations

• Use bronchodilator inhaler before steroid inhaler. • Wait at least 1 minute between puffs (inhaled doses). • After steroid inhaler use, client must perform oral care to prevent fungal infections.

characteristics of emphysema

-Barrel chest • Pursed-lip breathers • Distant, quiet breath sounds • Wheezes • Pulmonary blebs on radiograph

tracheal suctioning

-Use aseptic/sterile technique throughout procedure. -• Wear mask and goggles. • Advance catheter until resistance is felt. • Apply suction only when withdrawing catheter (gently rotate catheter when withdrawing).

diseases characterized as chronic airflow limitations

-asthma -emphysema -chronic bronchitis

if the chest tube becomes disconnected...

-do NOT clamp! -immediately place the end of the tube in a container of sterile saline or water until a new drainage system can be connected

findings associated with increased c02 retention

-drowsiness -confusion -irregular pulse

Comatose and immobile pneumonia prevention

-elevation of head of bed at least 30 degrees for feeding and for 1 hour after feeding; turn frequently.

electrolytes chronic airway diseases

-supplemental magnesium and calcium because of their role in muscle contraction and relaxation, may be important for people with COPD -Routine monitoring of magnesium and phosphorus levels is important because of their role related to bone mineral density

symptoms of pneumonia

-tachypnea -productive cough -rapid bounding pulse

HIV and tuberculosis

-tuberculosis is a clinically active disease, which is contagious. -Tuberculosis is the leading cause of mortality in clients infected with HIV. -Persons with active tuberculosis are usually treated on an outpatient basis

causative agents pneumonia

-viral, -bacterial, - -fungal -chemical

Normal tidal volume

0.5 L

preoperative teaching laryngeal cancer

1. Allow client and family to observe and handle tracheostomy tubes and suctioning equipment. 2. Explain how and why suctioning will take place after surgery. 3. Plan for acceptable communication methods after surgery. 4. Consider literacy level. 5. Refer client to speech pathologist. 6. Discuss the planned rehabilitation program.

Promoting respiratory function after laryngectomy

1. Assess respiratory rate and characteristics every 1 to 2 hours. 2. Keep bed in semi-Fowler position at all times. 3. Keep laryngeal airway humidified at all times. 4. Auscultate lung sounds every 2 to 4 hours. a. Clients retain secretions b. Suction excess secretions from mouth and tracheostomy as needed immediately after surgery. 5. Provide tracheostomy care every 2 to 4 hours and as needed (PRN).

Older adult pneumonia s/s

1. Confusion 2. Lethargy/malaise 3. Anorexia 4. Rapid respiratory rate 5. Tachycardia

pneumonia breathing nurse interventions for coughing

1. Deep breathing every 2 hours (may use incentive spirometer) 2. Using humidity to loosen secretions (may be oxygenated) 3. Suctioning the airway, if necessary 4. Chest physiotherapy

TB full list of symptoms

1. Fever with night sweats 2. Anorexia, weight loss 3. Malaise, fatigue 4. Cough, hemoptysis 5. Dyspnea, pleuritic chest pain with inspiration 6. Cavitation or calcification as evidenced on chest radiograph 7. Positive sputum culture is positive for M. tuberculosis 8. Recurring upper respiratory infections (URIs)

radiation therapy considerations

1. Provide skin care according to health care provider's request. 2. Instruct the client not to wash off the lines drawn by the radiologist. 3. Instruct client to wear soft cotton garments only. 4. Avoid use of powders and creams on radiation site unless specified by the radiologist.

postop care laryngectomy

1. Simplify communications. 2. Use planned alternative communication methods. 3. Keep call bell/light within reach at all times. 4. Ask client yes/no questions whenever possible. 5. Allow client to grieve as related to alteration in body image.

the normal value of expiratory reserve volume is

1.0L

normal residual volume

1.5L

3 chamber drainage system

1st chamber: collects drainage 2nd chamber: underwater seal 3rd chamber: control suction

early detection of laryngeal cancer

2 weeks of hoarseness in voice

Duodenal ulcer pain

2-3 hrs pc; food intake relieves pain

Normal PetCO2 range

20-40 if elevated hypoventilation and sub 20 is hyper

Normal HC03 or bicarb

21-28

Venturi mask FiO2

24-60. provides accurate fi02

Fi02/Nasal cannula

25-45%

fi02 simple face mask

35-60%

normal inspiratory volume

3L

Annual flu vaccine

65 and older as well as those who are high risk

normal p02 range

80-100

non rebreather fi02

80-100%

age gender laryngeal cancer

8x more likely in men usually 55-70 years old

TB drug length

9-12 months TAKE FULL COURSE

Pulse ox pneumonia

90-95% usually

subcutaneous emphysema

A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissues.

Polycythemia

A disorder characterized by an abnormal increase in the number of red blood cells in the blood occurs in COPD

tuberculin skin test (mantoux test)

A positive tuberculosis (TB) skin test in a healthy client is exhibited by an induration 10 mm or greater in diameter 48 to 72 hours after the skin test. Anyone who has received a bacillus Calmette-Guérin (BCG) vaccine will have a positive skin test and must be evaluated with an initial chest radiograph.

Nursing plans and interventions Lung cancer

A. Nursing interventions are similar to those implemented for the client with COPD. B. Place client in semi-Fowler position. C. Teach pursed-lip breathing to improve gas exchange. D. Teach relaxation techniques; client often becomes anxious about breathing difficulty. E. Administer O2 as indicated by pulse oximetry or ABGs. F. Take measures to allay anxiety.

TB disease description

A. Transmission is by airborne droplets. B. After initial exposure, the bacteria encapsulate (form a Ghon lesion). C. Bacteria remain dormant until a later time, when clinical symptoms appear

adventitious breath sounds

Abnormal breath sounds such as wheezing, stridor, rhonchi, and crackles.

Oseltamivir (Tamiflu)

Antiviral

common complication of abdominal surgery

Atelectasis

Sputum cultures TB

Collect sputum cultures as needed; client may return to work after three negative cultures.

tissues TB

Cough into tissues and dispose of immediately into biohazardous waste bags.

Kussmaul respirations

Deep, rapid breathing; usually the result of an accumulation of acid DKA

pink puffer

Dyspnea, hyperventilation (emphysema)

fluid timing chronic airway diseases

Fluids should be taken between meals (rather than with them) to prevent excess stomach distention and to decrease pressure on the diaphragm.

tracheostomy cuff Guillian-barre syndrome

Inflate the cuff before the feeding and for 30 minutes after each feeding.

pain when deep breathing or coughing after thoracic surgery can be relieved by.

Instruct the client to splint the wound with a pillow when coughing.

Diaphragmatic breathing (aka abdominal breathing)

Involves the contraction & relaxation of the diaphragm observed by the movement of the abdomen as a result of the diaphragms contraction & downward movement.

acid fast rods in a clients sputum indicate

Mycobacterium tuberculosis

suctioning do nots

Never suction for more than 10 to 15 seconds, and pass the catheter only three or fewer times. ensure hyperoxygenation with 100% oxygen for 1-2 minutes

vesicular breath sounds

Normal breath sounds made by air moving in and out of the alveoli. Soft swishing sounds of breathing

Antiemetic drugs

Ondansetron (Zofran)

Hands only CPR

Only chest compressions

Lung percussion pneumonia

Pain and dullness to percussion over the affected lung area tactile fremitus

postoperative breathing exercises

Place a hand on the abdomen while feeling it rise. Correct5 Hold the breath for several seconds at the height of inspiration. pursed lip breathing

sharp stabbing pain when breathing is indicative of

Pleural effusion.

intrinsic asthma

Reaction to exercise, heat or cold exposure, and emotional upset no identifiable allergen

when chest tubes collection container is full

Replace unit when full.

Laryngeal cancer risk factors

SMOKING 1. Vocal straining 2. Chronic laryngitis 3. Family predisposition 4. Industrial exposure to carcinogens 5. Nutritional deficiencies: riboflavin

The nurse is providing immediate postoperative care to a client who underwent a right pneumonectomy. In which position would the nurse place the client?

Supine or right side-lying

Hemoptysis can be caused by

TB

Breathing for chronic airflow limitations

Teach diaphragmatic and pursed-lip breathing. Teach prolonged expiratory phase to prevent bronchiolar collapse and prevent air trapping.

tidaling

These fluctuating movements are a good indicator that the system is intact; they should move upward with each inspiration and downward with each expiration

thoracotomy

Thoracotomy for clients who have a resectable tumor. (Unfortunately, detection commonly occurs so late that the tumor is no longer localized and is not amenable to resection.)

COPD Humidification

Used because O2 has a drying effect on the mucosa Supplied by nebulizers, vapotherm, and bubble-through humidifiers. reduces risk of infection

chest tube considerations

a. Keep all tubing coiled loosely below chest level, ensure connections are tight and taped. g. Encourage the client to breathe deeply periodically. k. Maintain dry occlusive dressing.

Lobectomy and segmental resection

a. Position client on back. b. Chest tubes are usually inserted (Fig. 4.3). c. Check to ensure chest tubing is not kinked or obstructed.

orthopnea

ability to breathe easily only in an upright position

pleural effusion

abnormal accumulation of fluid in the pleural space

mediastinal shift

abnormal movement of the structures within the mediastinum to one side of the chest cavity. can occur with right-sided paradoxical motion of the chest and multiple rib fractures, resulting in a flail chest

fluids chronic airway diseases

aim for 3L minimum unless contraindicated example cor pulmonale would be contra

extrinsic asthma

allergic asthma pet dander, dust mites, mold, dust, and others.

pleurisy

an inflammation of the pleura that produces sharp chest pain with each breath -pleural friction rub

Cheyne-Stokes respiration

an irregular pattern of breathing characterized by alternating rapid or shallow respiration followed by slower respiration or apnea

before chest tube removal what is performed?

an x-ray to determine lung expansion

before chemo administer

antiemetics

occlusive dressing

any dressing that forms an airtight seal helps maintain negative pressure in pleural space

pneumonia caused by

aspiration inhalation hematogenous spread

TB is often what

asymptomatic

Raccoon Eyes (Bilateral Periorbital Ecchymosis) indicates

basilar skull fracture required immediate treatment

Lung sounds of pneumonia

bronchial breath sounds

peptic ulcer food

can aggravate pain

Tuberculosis radiographic appearance

cavities caused by caseation

If tidaling stops

check for kinked tubing, accumulation of fluid in the tubing, occlusions, or change in the client's position

HESI Hint Tracheostomy care involves what three things

cleaning the inner cannula, suctioning, and applying clean dressings.

COPD lung sounds

coarse crackles, wheezes, prolonged expiration, hyperresonance

atelactasis

collapse of alveoli or lung

atelectasis

collapsed lung

check for dehydration before

contrast is used

contrast causes

contrast medium is hypertonic and causes diuresis

Tuberculosis symptoms

cough with blood in mucus night sweats weight loss increased temp

hempotysis

coughing up blood

Inadequate arterial oxygenation is manifested by

cyanosis and slow capillary refill (<3 seconds). A chronic sign is clubbing of the fingernails, and a late sign is clubbing of the fingers.

Blue Bloater (Chronic Bronchitis)

cyanosis, fluid retention

if condensation is present in the humidified oxygen tubing then what?

drain the condensation into a water trap

findings in polycythemia

elevated hemoglobin and hematocrit

cor pulmonale, right ventricular failure

enlargement of the right ventricle, resulting from chronic disease within the lungs, that causes congestion within the pulmonary circulation and resistance of blood flow to the lungs

How often should you verify function of the ventilator?

every 4 hours

Which client's activity might have led to insertion of an epistaxis catheter to treat the posterior nasal bleeding and developing pneumonia?

excessive application of petroleum jelly

hypercapnia

excessive carbon dioxide in the blood

water seal chamber

expect intermittent bubbling if CONTINUOUS bubbling-problem

pain when deep breathing or coughing after thoracic surgery is

expected

Hypercapnia S/S

extreme drowsiness, tachycardia, and tachypnea

sore throat is a common side effect after

general anesthesia surgery

if a chest tube is dislodged from a client

he nurse should cover with a dry sterile dressing taped on three sides. If an air leak is noted, tape the dressing on three sides only; this allows air to escape and prevents the formation of a tension pneumothorax. Notify the health care provider.

Management of Laryngeal Cancer

includes radiation therapy, often with adjuvant chemotherapy or surgical removal of the larynx (laryngectomy).

diuresis

increased formation and secretion of urine

Continuous bubbling in water seal chamber

indicates an air leak in the system

chest radiograph pneumonia

infiltrates with consolidation or pleural effusion

thrombophlebitis

inflammation of a vein with clot formation inc risk after knee surgery

flail chest

instability of the chest wall resulting from multiple rib fractures.

prolonged vocal hoarseness could indicate

laryngeal cancer

coarse crackles sound

long, discontinuous low-pitched sounds similar to blowing through a straw under water while auscultating the lungs of a client with chronic obstructive pulmonary disease

broken nose dipstick test

looks for glucose if detected indicates leaking CSF

Nasal cannula flow rate

low O2 flow for low O2 concentrations (good for COPD)

fi02 setting chronic bronchitis and emphysema

lowest setting to prevent c02 retention

leading causes of cancer related death

lung cancer

stoma cleaned with

mild soap and water

Hesi Hint Always have suction equipment available at the bedside for?

new and chronic tracheostomy clients.

When a chest tube is connected to suction, continuous bubbling is an indication

of an air leak between the drain and the client.

The nurse is caring for a client whose mechanical ventilator settings include the use of positive end-expiratory pressure (PEEP). This treatment improves oxygenation primarily through which mechanism of action?

opening collapsed alveoli and keeping them open

GI side effects of steroids

peptic ulcers and gastric bleeding. assess for tarry stools

Cor Pulmonale Treatment successful indicator

peripheral edema resolves

Fluids and pneumonia

provide up to 3L to help liquefy lung secretions

Helical CT is the most commonly used test to detect what?

pulmonary embolism

pneumonectomy

removal of entire lung a. Position client on operative side or back. b. Chest tubes are not usually used.

Hypercapnia causes

respiratory acidosis spontaneous pneumothorax

red tag

respiratory distress bleeding neurological deficits

Early signs of cerebral hypoxia

restlessness and irritability

nasal polyps

rounded tissue growths on the nasal or sinal mucosa. should notify provider if detected

drugs ending in sodium

semi synthetics Synthetic version of penicillin

tuberculin skin test detects

sensitized T cells

cor pulmonale

serious cardiac disease associated with chronic lung disorders, such as emphysema

Causes of Cheyne-Stokes

severe heart failure, renal failure, meningitis, drug overdose, and increased intracranial pressure occurs normally in infants and aging persons during sleep

Bleb

small blister; fluid filled. present with emphysema if bursting can cause pneumothorax

diet chronic chronic airflow diseases

small frequent meals increased protein and calories

Hematogenous spread

spread through the blood

pulmonary embolism symptoms

sudden chest pain, dyspnea, hemoptysis increased respiratory rate, also may have cough, tachycardia, fever, diaphoresis, anxiety,

after a laryngectomy a tube feeder is needed until

the incision completely heals

cancer of larynx coloration

the tongue and mouth often appear white, gray, dark brown or black and may appear patchy.

Exudative phase

the wound is filled with fibrin and coagulated blood

Glottal stop technique

to remove secretions (take a deep breath, occlude the tracheostomy tube momentarily, cough, and simultaneously remove the finger from the tube).

When evaluating for response to treatment for a client with pharyngitis, which action will the nurse take?

use a tongue blade to inspect tonsils for swelling

pulmonary function tests diagnoses which respiratory condition

used to diagnose