MedSurg Chapter 20-24
A patient taking isoniazid (INH) therapy for tuberculosis demonstrates understanding when making which statements?
-"It is alright if I have a grilled cheese sandwich with American cheese."
Patient with an advanced laryngeal tumor is to have radiation therapy. The patient tells the nurse, "If I am going to have radiation, I won't need surgery." What is the best response by the nurse?
-"Radiation is used to shrink the tumor size and is an adjunct to surgery."
A patient with end-stage COPD and heart failure asks the nurse about lung reduction surgery. What is the best response by the nurse?
-"You and your physician should discuss the options that are available for treatment."
A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What should the nurse tell the patient?
-"You should switch to wearing your glasses while taking this medication."
A patient has a Mantoux skin test prior to being placed on an immunosuppressant for the treatment of Crohn's disease. What results would the nurse determine is not significant for holding the medication?
-0 to 3 mm
The sigh mechanism on an assist-control ventilator needs to be adjusted to provide _________ sigh(s) per hour at a rate that is ___________ times the tidal volume.
-1-3 -1.5
For a patient to be safely weaned from a ventilator, the vital capacity should be__________; the minute ventilation should be __________; and the tidal volume should be ___________.
-10-15 mL/kg -6 L/min -7-9 mL/kg
Cuff pressure for an endotracheal tube should be maintained at __________ and should be checked every
-15 and 20 mm Hg -6-8 hours
The five year survival rate for lung cancer is?
-16%
A patient has a dry suction water seal connected to a chest tube. When the water seal rises above _________ level, intrathoracic pressure increase.
-2 cm
The water seal used in a disposable chest drainage system is effective if the water seal chamber is filled to the level of?
-2.0 cm H20
The nurse is administering anticoagulant therapy with heparin. What International Normalized Ratio (INR) would the nurse know is within therapeutic range?
-2.0-2.5
The median survival age for individuals diagnosed with cystic fibrosis is now?
-37 years
Oxygen toxicity may occur when oxygen is?
-50 greater than % -administered for >48 hours
The oxygen flow rate for a nasal cannula should not exceed?
-6 L/min
The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient?
-6 to 12 months
The mortality rate with ARDS is as high as ___________.
-60%
A nurse understands that a safe but low level of oxygen saturation provides adequate tissue saturation while allowing no reserve for the situations that threaten ventilation. What is a safe but low oxygen saturation level for a patient
-95 mm Hg
A patient with emphysema informs the nurse, "The surgeon will be removing about 30% of my lung so that I will not be so short of breath and will have an improved quality of life." What surgery does the nurse understand the surgeon will perform?
-A lung volume reduction
The nurse is instructing a patient who is scheduled for a perfusion lung scan. What should be included in the information about the procedure
-A mask will be placed over the nose and mouth during the test -The patient will be expected to lie under the camera -The imaging time will amount to 20 to 40 minutes
A patient is to receive an oxygen concentration of 70%. What is the best way for the nurse to deliver this concentration?
-A partial rebreather mask
A patient with COPD requires oxygen administration. What method of delivery does the nurse know would be best for this patient?
-A venturi mask
Rhinosinusitis is classified by of symptoms as?
-Acute -Subacute -Chronic
The nurse is assessing a patient who smokes 2 packs of cigarettes per a day and has a strong family history of cancer. What early sign of cancer of the larynx does the nurse look for in this patient?
-Affected voice sounds
Pneumonia tends to occur in patients with one or more of these five underlying disorders?
-Alcoholism -COPD -AIDS -Diabetes -Heart failure
3 ways that bronchodilators relieve bronchospasms
-Alter smooth muscle tone -Reduce airway obstruction -Improve alveolar ventilation
A patient is diagnosed with acute rhinosinusitis caused by a bacterial organism. What antibiotic of choice for the treatment of this disorder does the nurse anticipate educating the patient about?
-Amoxicillin-clavulanate (Augmentin)
A patient has herpes simplex infection that developed after having the common cold. What medication does the nurse anticipate will be administered for this infection?
-An antiviral agent such as acyclovir
A patient is brought into the emergency department with carbon monoxide poisoning after escaping a house fire. What should he nurse monitor this patient for?
-Anemic hypoxia
Results of decreased effective hemoglobin concentration
-Anemic hypoxia
The nurse is interviewing a patient who says he has a dry, irritating cough that is not "bring anything up." What medication should the nurse question the patient about taking?
-Angiotensin converting enzyme (ACE) inhibitors
The most common treatment for rhinitis that is administered for sneezing, pruritus, and rhinorrhea?
-Antihistamines
The nurse is educating the patient diagnosed with acute pharyngitis on methods to alleviate discomfort. What interventions should the nurse include in the information?
-Apply an ice collar -Stay on bed rest during the febrile stage of the illness -Try a liquid or soft diet during the acute stage of disease
A patient playing softball was hit in the nose by the ball and has been determined to have an uncomplicated fractured nose with epistaxis. The nurse should prepare to assist the physician with what tasks?
-Applying nasal packing
The nurse knows that a sputum culture is necessary to identify the causative organism for acute tracheobronchitis. What causative organism would the nurse suspect?
-Aspergillus
6 etiologic factors and nursing assessments for patients with ARDS
-Aspiration (gastric secretions, drowning, hydrocarbons) -Drug ingestion and overdose -Hematologic disorders (disseminated intravascular coagulopathy, massive transfusions, cardiopulmonary bypass) -Prolonged inhalation of high concentrations of oxygen, smoke, or corrosive substances -Localized infection (bacterial, fungal, viral pneumonia) -Metabolic disorders (pancreatitis, uremia) -Shock -Trauma (pulmonary contusion, multiple fractures, head injury) -Major surgery -Fat or air embolism -Sepsis
4 conditions that are influenced by genetic factors that affect respiratory function?
-Asthma -COPD -Cystic fibrosis -Alpha-1 antitrypsin deficiency
The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction and that leads to a collapse of alveoli. What complication should the nurse monitor for?
-Atelectasis
Anticholinergic agent
-Atrovent
A new ICU nurse is observed by her preceptor entering a patient's room to suction the tracheostomy after performing the task 15 minutes before. What should the preceptor educate the new nurse to do to ensure that the patient needs to be suctioned?
-Auscultate the lung for adventitious sounds
The nurse inspects the thorax of a patient with advanced emphysema. What does the nurse expect the chest configuration to be for this patient?
-Barrel chest
The nurse is performing an assessment of a patient who arrived in the emergency department with a barbiturate overdose. The respirations are normal for 3 to 4 breaths followed by a 60-second period of apnea. How does the nurse document the respirations?
-Biot's respirations
The physician orders a beta-2 adrenergic agonist agent (bronchodilator) that is short-acting and administered only by inhaler. What medication does the nurse anticipate will be administered?
-Brethine
When a patients breathing is out of phase with the machine. Occurs when the patient attempts to breath out during the ventilators mechanical inspiratory phase or when there is jerky and increased abdominal muscle effort
-Bucking the ventilator
What is a surgical option for select patients with bullous emphysema?
-Bullectomy
A patient with pulmonary hypertension has a positive vasoreactivity test. What medication does the nurse anticipate administering to this patient?
-Calcium channel blockers
Oxygen transport to the tissues is dependent on four factors?
-Caridac output -Arterial oxygen content -Hemoglobin concentration -Metabolic requirements
The single most cost-effective intervention to reduce the risk of developing COPD or slow progression is?
-Cessation of smoking
3 primary symptoms associated with the progressive stage of COPD
-Chronic cough -Sputum production -Dyspnea on exertion
The stimulus for respirations is a decrease in blood oxygen rather than an elevation in carbon dioxide levels in many patients with?
-Chronic obstructive pulmonary disease
Results from inadequate capillary circulation
-Circulatory hypoxia
The nurse assesses a patient with a heart rate of 42 and a blood pressure of 70/46. What type of hypoxia does the nurse determine this patient is displaying?
-Circulatory hypoxia
No exposure; no infection
-Class 0
Exposure; no evidence of infection
-Class 1
Latent infection; no disease
-Class 2
Disease; not clinically active
-Class 3
Disease; clinically active
-Class 4
Suspected disease; diagnosis pending
-Class 5
What finding by the nurse may indicate that the patient has chronic hypoxia?
-Clubbing of the fingers
The nurse auscultates crackles in a patient with a respiratory disorder. With what disorder would crackles be commonly heard?
-Collapsed aveoli
Combination short-acting beta 2-adrenergic agonist agent
-Combivent
Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern?
-Compromised gas exchange -Decreased airflow -Wheezes
A patient is diagnosed with mild obstructive sleep apnea after having a sleep study performed. What treatment modality will be the most effective for this patient?
-Continuous positive airway pressure
Enlargement of the right ventricle of the heart because of diseases affecting the structure or functions of the lung
-Cor pulmonale
Excision of the vocal cord for lesions in the middle third of the vocal cord
-Cordectomy
The nurse is having an information session with a women's group at the YMCA about lung cancer. What frequent commonly experienced symptoms should the nurse be sure to include in the session?
-Coughing
The three most common symptoms of asthma are?
-Coughing -Wheezing -Dyspnea
The nurse is auscultating the patient's lung sounds to determine the presence of pulmonary edema. What adventitious lung sounds are significant for pulmonary edema?
-Crackles in the lung bases
Mast cell stabilizer
-Cromolyn Sodium
A patient is prescribed a mast cell stabilizer for the treatment of asthma. Which commonly used medication will the nurse educate the patient about?
-Cromolyn sodium
The nurse is transporting a patient with chest tubes to a treatment room. The chest tube becomes disconnected and falls between the bed rail. What is the priority action by the nurse?
-Cut the contaminated tip of the tube and insert a sterile connector and reattach
The nurse is assessing a patient in respiratory failure. What finding is a late indicator of hypoxia?
-Cyanosis
The nurse is caring for a patient with a pulmonary disorder. What observation by the nurse is indicative of a very late symptom of hypoxia
-Cyanosis
For a patient with COPD, the stimulus for respirations is?
-Decreased blood oxygen rather than elevated carbon dioxide levels
When the nurse is assessing the older adult patient, what gerontologic changes in the respiratory system should the nurse be aware of?
-Decreased gag reflex -Increased presence of collagen in aveolar walls -Decreased presence of mucus
The nurse is using an in-line suction kit to suction a patient who is intubated and on a mechanical ventilator. What benefits does inline suction have for the patient?
-Decreases hypoxemia -Decreases patient anxiety -Sustains positive end expiratory pressure (PEEP)
The nurse hears the patient's ventilator alarm sounds and attempts to find the cause. What is the priority action of the nurse when the cause of the alarm is not able to be determined?
-Disconnect the patient from the ventilator and manually ventilate the patient with a manual resuscitation bag until the problem is resolved
Three goals of chest physiotherapy are?
-Dislodged mucus and remove bronchial secretions -Improve ventilation -Increase efficiency of the respiratory muscle
A patient who had a colon resection 3 days ago is complaining of discomfort in the left calf. How should the nurse assess Homan's sign to determine if the patient may have a thrombus formation in the leg?
-Dorisflex the foot while the leg is elevated to check for pain
6 major signs of respiratory disease?
-Dyspnea -Cough -Sputum production -Chest pain -Wheezing -Hemoptysis -Tachypnea -Hypoxia
Name seven possible clinical manifestations of atelectasis
-Dyspnea -Cough -Sputum production -Tachycardia -Tachypnea -Pleura pain -Central cyanosis
The nurse is assessing a patient who has been admitted with possible ARDS. What findings would distinguish ARDS from cardiogenic pulmonary edema?
-Elevated B-type natriuretic peptide (BNP) levels
During a preadmission assessment, for what diagnosis would the nurse expect to find decreased tactile fremitus and hyperresonant percussion sounds?
-Emphysema
A patient is prescribed a medication for hypertension started taking it 3 days ago and arrives in the emergency department with an edematous face and tongue and having a difficult time speaking. What medication is the nurse aware of that may produce this type of side effect?
-Enalapril (Vasotec)
A patient is being educated in the use of incentive spirometry prior to having a surgical procedure. What should the nurse be sure to include in the education?
-Encourage the patient to take approximately 10 breaths per hour, while awake.
The nurse is planning the care for a patient at risk of developing pulmonary embolism. What nursing interventions should be included in the care plan?
-Encouraging a liberal fluid intake -Assisting the patient to do leg elevations above the level of the heart -Using elastic stockings, especially when decreased mobility would promote venous stasis -Applying sequential compression devices
The nurse us educating a patient diagnosed with acute bacterial rhinosinusitis about interventions that may assist with symptom control. What should the nurse include in this information?
-Ensure adequate fluid intake -Increase the humidity in the house -Apply local heat to promote drainage
Three types of alaryngeal communication
-Esophageal speech -Artificial larynx -Tracheoesphageal puncture
A patient arrives in the emergency department after being involved in a motor vehicle accident. The nurse observes paradoxical chest movement when removing the patient's shirt. What does the nurse know that this finding indicates?
-Flail chest
A physician wants a study of diaphragmatic motion because of suspected pathology. What does the nurse anticipate that the physician will most likely order?
-Fluoroscopy
Clinical manifestations that are used to diagnosis obstructive sleep apnea
-Frequent loud snoring and breathing cessation for 10 seconds or longer with 5 or more episodes per an hour. Followed by awakening abruptly with a loud snort when blood oxygen level drops
Identify 8 nursing measures that can be used to prevent atelectasis
-Frequent turning -Early mobilization -Deep breathing maneuvers -Assistance with the use of spirometry -Suctioning -Postural drainage -Aerosol nebulizer treatments -Chest percussion
A patient comes to the clinic with complaints of a sore throat and is diagnosed with acute pharyngitis. What does the nurse understand is the case of acute pharyngitis?
-Group A, beta-hemolytic streptococci
A patient comes to the clinic and is diagnosed with tonsillitis and adenoiditis. What bacterial pathogen does the nurse know is commonly associated with tonsillitis and adenoiditis?
-Group A, beta-hemolytic streptococcus
The most serious complication of tonsillectomy is?
-Hemorrhage
Nine major factors that determine the clinical course and survival of patients with COPD
-History of cigarette smoking -Passive smoking exposure -Age -Rate of decline of FEV -Hypoxemia -Weight loss -Reversibility of airflow obstruction -Pulmonary artery pressure -Resting heart rate
Decreased gas exchange at the cellular level resulting from a toxic substance is classified as?
-Histotoxic
Toxic substance interferes with the ability of tissues to use oxygen
-Histotoxic hypoxia
The nurse is educating the patient in the use of a mini-nebulizer. What should the nurse encourage the patient to do?
-Hold the breath at the end of inspiration for a few seconds -Cough frequently -Frequently evaluate progress
A patient is admitted to the hospital with pulmonary arterial hypertension. What assessment finding by the nurse is a significant finding for this patient?
-Hypertension
Three severe complications of pneumonia are?
-Hypotension -Shock -Respiratory failure
A decrease in the arterial oxygen tension in the blood
-Hypoxemia
Decreased oxygen level in blood
-Hypoxemic hypoxia
Decreas in oxygen supply in the tissue
-Hypoxia
Hypoxemia usually leads to a decrease in oxygen supply to the tissues called?
-Hypoxia
A nurse notes that the FEV1/FVC ratio is less than 70% for a patient with COPD. What stage should the nurse document the patient is in?
-I (1)
Seven post operative risk factors for atelectasis and pneumonia?
-Immobilization -Supine position -Decreased level of consciousness -Inadequate pain management -Prolonged intubation/mechanical ventilation -Presence of nasogastric tube -Inadequate preoperative education
Four respiratory system mechanisms that can lead to acute respiratory failure (ARF) are?
-Impaired CNS function -Neuromuscular -Musculoskeletal -Pulmonary dysfunction
Four nursing diagnoses for a patient receiving mechanical ventilation?
-Impaired gas exchange r/t underlying illness, ventilator setting adjustments, or weaning -Ineffective airway clearance r/t increased mucus production associated with presence of the tube in trachea or continuous positive-pressure mechanical ventilation -Risk for trauma and infection r/t endotracheal intubation or tracheostomy -Impaired physical mobility r/t ventilator dependency -Impaired verbal communication r/t endotracheal tube or tracheostomy tube -Defensive coping and powerlessness r/t ventilator dependency
The diagnosis of hospital-acquired pneumonia is usually associated with the presence of one of three conditions?
-Impaired host defense -An inoculum of organisms that reach the lower respiratory tract -The presence of a highly virulent organsim
The nurse is planning for the care of a patient with acute tracheobronchitis. What nursing interventions should be included in the plan of care?
-Increase fluid intake to remove secretions -Encourage the patient to remain in bed -Using cool-vapor therapy to relieve laryngeal and tracheal irritation
Results of chronic airway inflammation from COPD
-Increased goblet cells and enlarged submucosal glands (proximal airways) -Inflammation and airway narrowing (peripheral airways) -Narrowing of the airway lumen
Four possible nursing diagnoses for a patient with an upper airway infection
-Ineffective airway clearance r/t excessive mucus production secondary to retained secretions and inflammation -Acute pain r/t upper airway irritation secondary to an infection -Impaired verbal communication r/t physiologic changes and upper airway irritation secondary to infection or swelling -Deficient fluid volume r/t decreased fluid intake and increased fluid loss secondary to diaphoresis associated with a fever -Deficient knowledge regarding prevention or URIs, treatment regimen, surgical procedure, or postoperative care
A patient comes to the clinic with a cold and wants something to relieve the symptoms. What should the nurse include in educating the patient about the uncomplicated common cold?
-Inform the patient about the symptoms of secondary infection -Suggest that the patient take adequate fluids and get plenty of rest -Inform the patient that the virus is contagious for 2 days before symptoms appear and during the first part of the symptomatic phase
The nurse is instructing the patient on the collection of sputum specimen. What should be included in the instructions?
-Intially, clear the nose and throat -Take a few deep breaths before coughing -Use diaphragmatic contractions to aid in the expulsion of sputum
The nurse is educating a patient with COPD about the technique for performing pursed lip breathing. What does the nurse inform the patient is the importance of using this technique?
-It prolongs exhalation
Microelectrodes are used for surgical resection of smaller laryngeal tumors
-Laser surgery
A patient diagnosed 2 weeks ago with acute pharyngitis comes to the clinic stating the sore throat got better for a couple of days and is now back along with an earache. What complications should the nurse be aware of related to acute pharyngitis?
-Mastoiditis -Otitis media -Peritonsillar abscess
Four conditions that cause low compliance or distensibility of the lungs are?
-Morbid obesity -Atelectasis -Pneumothorax -Hemothorax -Pulmonary fibrosis -Edema -Pluera effusion -ARDS
When a patient requires a low to medium concentration of oxygen for which precise accuracy is not essential, this is used?
-Nasal cannula
Five examples of low-flow oxygen delivery systems are?
-Nasal cannula -Oropharyngeal catheter -Simple mask -Partial-rebreather -nonrebreather
To prevent the danger of fire, it is important when a patient is on oxygen to post a?
-No smoking sign
The nurse is assessing a patient with chest tubes connected to a drainage system. What should the first action be when the nurse observes excessive bubbling in the water seal chamber?
-Notify the physician
The nurse is performing an assessment for a patient with congestive heart failure. The nurse asks if the patient has difficulty breathing in any position other than upright. What is the nurse referring to?
-Orthopnea
A patient with emphysema is placed on continuous oxygen at 2 L/min at home. Why is it important for the nurse to educate the patient and family that they must have No Smoking signs placed on the doors
-Oxygen supports combustion
A patient has been receiving 100% oxygen therapy by way of nonrebreather mask for several days. Now the patient complains of tingling fingers and shortness of breath, is extremely restless, and describes a pain beneath the breastbone. What should the nurse suspect?
-Oxygen toxicity
The nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurement best reflects the adequacy of aveolar ventilation?
-PaCO2
The nurse is admitting a patient with COPD. The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia?
-PaO2
A patient is diagnosed as being in the early stage of laryngeal cancer of the glottis with only 1 vocal cord involved. For what type of surgical intervention will the nurse plan to provide education?
-Partial laryngectomy
Portion of the larynx is removed, along with one vocal cord, and the tumor
-Partial laryngectomy
What also contributes to respiratory symptoms and COPD?
-Passive smoking
The most common major suppurative complication of sore throat?
-Peritonsillar abscess
A patient comes to the emergency department complaining of a knifelike pain when taking a deep breath. What does this type of pain likely to indicate to the nurse?
-Pleurisy
The term used to describe thoracic surgery in which an entire lung is removed is known as?
-Pneumonectomy
The nurse is conducting a community program about prevention of respiratory illness. What illness does the nurse know is the most common cause of death in the United States?
-Pneumonia
The nurse is educating a patient with asthma about preventative measures to avoid having an asthma attack. What does the nurse inform the patient is a priority intervention to prevent an asthma attack?
-Preparing a written plan of action
The nurse is taking a respiratory history for a patient who has come into the clinic with a chronic cough. What information should the nurse obtain from this patient?
-Previous history of lung disease in the patient or family -Occupational and environmental influences -Previous history of smoking
A child is having an asthma attack and the parent can't remember which inhaler to use for quick relief. The nurse accesses the child's medication information and tell the parent to use which inhalant?
-Proventil
Beta 2-sdrenergic agonist agent
-Proventil
The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment?
-Providing sufficient oxygen to improve oxygenation
A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure?
-Respiratory acidosis
The nurse is caring for a patient with status asthmaticus in the intensive care unit (ICU). What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient?
-Respiratory alkalosis
Patients with COPD are at risk for?
-Respiratory insufficiency -Chronic respiratory failure
Rhinitis can cause nasal passages to become inflamed, congested, and edematous. The swollen conchae block the sinus openings and cause? rhinosinusitis
-Rhinosinusitis
5 potential complications of an upper airway infection
-Sepsis -Peritonsillar abscess -Otitis media -Sinusitis -Meningitis
Four severe complications of untreated rhinosinusitis
-Severe orbital cellulitis -Subperiosteal abscess -Cavernous sinus thrombosis -Meningitis -Encephalitis -Ischemic infarction
When a nonfunctioning nasogastric tube allows the gastric contents to accumulate in the stomach, what condition may result?
-Silent aspiration
Leukotriene modifier
-Singulair
Atelectasis, which refers to closure or collapse of alveoli, may be chronic or acute in nature. What are 10 possible causes of atelectasis in the postoperative patient?
-Smoking -Sleep apnea -Pain -Nasogastric tube -Intubation -Immobility -COPD -ASA (acetylsalicylic acid) -Age -BMI -V/Q ratio
What is used to evaluate airflow obstruction, which is determined by the ratio of FEV1 to forced capacity (FVC)?
-Spirometry
A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing this patient for?
-Sputum and a productive cough
The nurse is caring for a patient with pleurisy. What symptoms does the nurse recognize are significant for this patient's diagnosis?
-Stabbing pain during respiratory movement
Complications of asthma may include?
-Status asthmaticus -Respiratory failure -Pneumonia -Atelectasis
Three common pathogens that cause aspiration pneumonia are?
-Streptococcus pneumonia -Haemophilus influenza -Staphylococcus aureus
Four bacteria organisms that account for more than 60% of all cases of acute rhinosinusitis
-Streptococcus pneumonia -Haemophilus influenza -Staphylococcus aureus -Moraxella catarrhalis
4 common phenomena that can alter bronchial diameter?
-Streptococcus pneumonia -Haemophilus influenzae -Streptococcus aureus -Moraxella catarrahalis
A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse know is the most common organism that causes community-acquired pneumonia?
-Streptococcus pneumoniae
To help prevent infections in patients with COPD, the nurse should recommend vaccination against what 2 bacterial organisms?
-Streptococcus pneumoniae -Haemophilus influenzae
Five signs and symptoms of oxygen toxicity?
-Substernal discomfort -Paresthesias -Dyspnea -Restlessness -Fatigue -Malaise -Progressive respiratory difficulty -Refractory hypoxemia -Alveolar atelectasis -Alveolar infiltrates on x-ray
Suspected when a subsequent infection occurs with another bacterium during antibiotic therapy
-Superinfection
Medication therapy for allergic and nonallergic rhinitis focuses on?
-Symptom relief
A patient in the process of being weaned from the ventilator will have a _____________ connected to the endotracheal tube.
-T-piece
The nurse assess a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on the assessment?
-Tachypnea
The hallmarks of the severity of atelectasis are?
-Tachypnea -Dyspnea -Mild to moderate hypoxemia
A patient comes to the clinic complaining of a possible upper respiratory infection. What should the nurse inspect that would indicate that an upper respiratory infection may be present?
-The nasal mucosa
The nurse suctions a patient through the endotracheal tube for 20 seconds and observes dysrhythmias on the monitor. What does the nurse determine is occurring with the patient?
-The patient is hypoxic from suctioning
The nurse is instructing the patient with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in the education
-The patient should take the medication an hour before meals or 2 hours after meals
A patient in the ICU has been orally intubated and on mechanical ventilation for 2 weeks after having a sever stroke. What action does the nurse anticipate the physician will take now that the patient has been intubated for this length of time?
-The patient will have an insertion of a tracheostomy tube
Methylxanthine
-Theo-dur
In 2011, COPD and associated respiratory disease were estimated to affect 24 million adults and was the ___________ leading cause of death in the United states.
-Third
The nurse is assigned to care for a patient in the ICU who is diagnosed with status asthmaticus. Why does the nurse include fluid intake as being an important aspect of the plan of care?
-To combat dehydration -To loosen secretions -To facilitate expectoration
Complex complete removal of the larynx
-Total laryngectomy
A patient is being mechanically ventilated with an oral endotracheal tube in place. The nurse observes that the cuff pressure is 25 mm Hg. The nurse if aware of what complications that can be cause by this pressure?
-Tracheal ischemia -Tracheal bleeding -Pressure necrosis
Primary causes for an acute exacerbation of COPD are?
-Tracheobronchial infection -Air pollution
The nurse is caring for a patient with suspected ARDS with pO2 of 53. The patient is placed on oxygen via face mask and the PO2 remains the same. What does the nurse recognize as a key characteristic of ARDS?
-Unresponsive arterial hypoxemia
A nurse caring for a patient with pulmonary embolism understands that a high ventilation-perfusion ration may exist. What does this mean for the patient
-Ventilation exceeds perfusion
The most reliable and accurate method of delivery when a precise concentration of oxygen is required for a patient?
-Venturi
Most common causes of laryngitis and the symptoms?
-Viral (cause) -Hoarseness -Aphonia -Severe cough
Antioxidants that may help defend against oxygen free radicals are?
-Vitamin E -Vitamin C -Beta-carotene
Removal of the mucosa of the edge of the vocal cord
-Vocal cord stripping
The nurse is performing chest auscultation for a patient with asthma. How does the nurse describe the high-pitched, sibilant, musical sounds that are heard
-Wheezes
The nurse is caring for a patient who had a total laryngectomy and has drains in place. When does the nurse understand that the drains will most likely be removed?
-When the patient has less than 30 mL for 2 consecutive days
A patient with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the patient has been prescribed?
-With meals
The strongest predisposition factor for asthma is?
-allergy
The two center in the brain that are responsible for the neurologic control of ventilation are?
-apneustic center in lower pons -pneumotaxic center in upper pons
Offers independent control of inspiratory and expiratory pressures while providing pressure support ventilation. It delivers two levels of positive airway pressure provided via a nasal or oral mask, nasal pillow, or mouthpiece with a tight seal and portable ventilator
-bilevel positive airway pressure (bi-PAP) ventilation
Pulmonary circulation is considered a?
-high-pressure -high-resistance system
Characteristics and diagnostic features of ARDS
-hypoxemia that does not respond to supplemental oxygen
The divisions of the lung proceed in the following order, beginning at the mainstream bronchi?
-lobar bronchi -segmented bronchi -subsegmented bronchi -bronchioles
The major cause of death with ARDS is usually?
-nonpulmonary multiple-system organ failure
Inflate the lungs by exerting pressure on the airway, pushing air in, forcing alveoli to expand during during inspiration
-positive-pressure ventilators
Tidal volume, which may significantly change with disease, has a normal value of approximately?
1000 mL
The aveoli begin to lose elasticity, resulting in gas diffusion at what age?
50
Generic risk factor of COPD
A deficiency in alpha-antitrypsin, an enzyme inhibitor that protects the lungs
Alternating episodes of apnea and periods of deep breathing. Usually associated with heart failure and damage to respiratory center
Cheyne-Strokes respirations
Moves the mucus to the back of the larynx
Cilia
The exchange of oxygen and carbon dioxide at the air-blood interface
Diffusion
The exchange of oxygen and carbon dioxide from the aveoli into the blood occurs by?
Diffusion
An abnormal distension of the air spaces, beyond the terminal bronchioles, that results in destruction of the walls of the alveoli
Emphysema
A flap of cartilage that covers the opening of the larynx during swallowing
Epiglottis function
The maximum volume of air that can be inhaled after a normal inhalation is known as?
Expiratory reserve volume
A patient with sinus congestion complains of discomfort when the nurse is palpating the supraorbital ridges. The nurse knows that the patient is referring to which sinus
Frontal
The symbol used to identify the partial pressure of oxygen is?
PaO2
The pressure exerted by each type of gas in a mixture of gases
Partial pressure
The actual flow of blood through the pulmonary circulation
Pulmonary diffusion
Gas exchange between atmospheric air and blood and between blood and the cells of the body
Respiration
Gas exchange between the lungs and blood and between the blood and tissue is called?
Respiration
Alveolar cells that secrete surfactant
Type II cells
The movement of air in and out of the airways
Ventilation
The left lung in contrast to the right lung, has?
one less lobe
The lungs are enclosed in a serous membrane called?
pluera
