NUR 275 Exam 3: gas exchange and cellular regulation
What is an abnormal accumulation of fluid in the pleural space?
pleural effusion
What occurs secondary to a breach in the pleural space which is then exposed to positive atmospheric pressure allowing air to enter into the pleural space or air to escape from the lung itself?
pneumothorax • Normally, the pressure in the pleural space is negative or subatmospheric; this negative pressure is required to maintain lung inflation.
What ventilator setting is the amount of force it takes to deliver air to the lungs? What happens if the patient has poor lung compliance?
pressure poor lung compliance needs increased pressure
What is the pathophysiology of cystic fibrosis?
- A mutation in the CF gene causes dysfunction of CFTR, which affects mucus production - Secretions are too sticky and thick, plugging the lungs and pancreas instead of acting as lubricant - Prevents release of enzymes, resulting in poor digestion and malnutrition
What are indications for mechanical ventilation to be used?
- Acute Respiratory Failure - Respiratory Center Depression (DKA, OD, MI, etc) - Neuromuscular Disturbances (spinal injury, ALS, etc) - regulate rate of breathing to reduce risk of hypoxic brain injury - concern for loss of airway
What are the characteristics of a malignant cell?
- Anaplasia - loss of specific appearance of the parent cell; becomes smaller and rounded - Large Nuclear-cytoplasmic ratio - cell nucleus is larger than normal cell while cell body is smaller - Specific function is lost - cell serves NO USEFUL PURPOSE! - Loose adherence - easily break off from main tumor - Migration - cells do not bind tightly together and have many enzymes on cell surface; leads to metastasis - Contact inhibition does not occur - Rapid and continuous cell division - do not respond to signals for apoptosis - Abnormal chromosomes - chromosomes are lost, gained, broken, or rearranged
What are side effects of chemo?
- Anemia - Thrombocytopenia (↓ platelets) - Neutropenia (↓ WBCs) - N/V - Alopecia (hair loss) - Mucositis (inflammation of mucous membranes) - Myelosuppression - Extravasation - "chemo brain" - peripheral neuropathy
What assessments should the nurse perform for a patient with a chest tube?
- Auscultate lung sounds - Rate, depth, pattern of RR - evaluate for signs of cyanosis, CO2 retention (prolonged expiration) or hypoxemia
How is chemotherapy used in the treatment of cancer?
- Used to cure, augment the treatment, and attempt to increase survival rate and time - Some selectivity in killing cancer cells - can be given oral, parental, intravenous, intracavity, or intrathecal
What are intrinsic and extrinsic factors of cancer
- Environmental carcinogens include chemicals, physical, or viral agents - sun exposure - pollutants - exposure to infectious agents - Immune function - Age - Genetic risk - Nutrition - Physical activity - Previous medical treatments - Tobacco
How is cystic fibrosis diagnosed?
- Genetic testing: Confirms positive screening and sweat tests - Prenatal mutation testing using amniotic fluid sample - Test sweat for elevated chloride levels
What special needs may oncology patients have for services and other concerns?
- Hospice - Home Care - Pain/Complication Management - Cultural and Spiritual Concerns - Ethical and Moral Considerations - Role of Caregiver/Family Support
How does having cystic fibrosis affect the ability for gas exchange?
- Lungs absorb excessive levels of Na and water, thickening secretions and making them hard to move - Inability to clear secretions increases incidence of infection, leading to progressive tissue damage and cell death - Lungs can no longer mix and exchange gases properly - Lungs may become hyperinflated and trap gas; hypoxemia
What nursing interventions should be implemented for a patient that has a chest tube?
- Monitor respiratory and CV status - Prevent complications - Deep breathing/ISB - Elevate HOB? - Monitor CT system - leaks/patency drainage (color, amount, bubbling, changes
What is the main mechanism of carcinogenesis?
- Oncogenes are turned on (expressed) under controlled conditions when cells need to divide for normal growth - Oncogenes are turned off (suppressed) by products of "suppressor genes"
What is the priority of nursing care during chemotherapy?
- Prevent life-threatening side effects - Manage symptoms that occur with chemotherapy - Support psychosocial needs
What precautions should be taken when taking care of a radioactive patient?
- Private room/private bath - Sign at Door - Radioactive material - Door closed to patient room - Dosimeter film badge at all times (shows how much radiation nurse has been exposed to) - lead apron while providing care (protect vital organs) - limit caregivers - no pregnant nurses or visitors - All linens and soiled trash stay in room until source is removed
What are examples of oncologic emergencies?
- Sepsis - DIC (Disseminated Intravascular Coagulation) - SIADH (Syndrome of Inappropriate Anti -diuretic Hormone) - Spinal Cord Compression - Superior Vena Cava Syndrome - Tumor Lysis Syndrome - Hypercalcemia (neuro complications)
What is a Peripheral Blood Stem Harvest? When is it used?
- Stem cell production is accelerated using medication so increased amounts of stem cells are pushed out into circulation where they are harvested, processed, and stored - Reinfused after lethal doses of chemo Used when client unable to withstand general anesthesia for autologous transplant
What are tumor markers? Where can they be found?
- Substances that are produced by cancer or by other cells of the body in response to cancer or certain benign (noncancerous) conditions - Most are made by normal cells, but are produced at much higher rates in cancerous conditions - Most are proteins, but gene expression patterns and changes to DNA are also being used now - Found in blood, urine, stool, tumor tissue, or other bodily fluids of some patients with cancer
What is the role of carcinogens in the cellular process?
- Substances that change the activity of cellular genetic material (DNA) - Normal cell DNA is damaged or mutated when exposed to any carcinogen (initiator). The mutation often damages the suppressor genes - This leads to overexpression of oncogenes and leads to normal cells mutating into cancer cells by uncontrolled cell division
What are treatment options for patients with cancer?
- Surgery - Radiation therapy - Chemotherapy - Hormonal therapy - Targeted therapy (modulation of the immune response) - Biologic therapy (molecular and genetic therapies) - Bone marrow and hematopoietic stem cell transplantation - Symptom management
What education should be provided to patients and parents about epiglottitis?
- Teach parents of pediatric clients the signs and symptoms of epiglottitis - importance of vaccinations (HiB) What to do if you suspect your child has epiglottitis? - Epiglottitis is a medical emergency; seek emergent care immediately. - Do not try to examine your child's throat. - Do not give your child water, food, or cough medicine. - Do not allow your child to lie down; keep the child upright.
How is bronchiolitis diagnosed?
- Test Nasopharyngeal Secretions with swab - Chest X-ray: To see the hyper expansion of the lungs due to the blocked alveoli; also rule out other complications - Pulse Oximetry: To measure the amount of oxygen in the blood. - Look at assessment data and family history. - Monitor fluid and electrolytes.
Why are children with cystic fibrosis at increased risk for malnutrition?
- The thick, sticky mucus that plugs the GI system causes poor absorption of essential nutrients. - the pancreas is unable to secrete adequate amounts of pancreatic enzymes necessary for absorbing essential nutrients. - frequent resp infections increase metabolic demands (need more energy)
How is breast cancer managed?
- accurate diagnosis - grading of disease - determines plan of care (treatment options, breast conservation and overall survival rate) - careful margin evaluation
What are risk factors for colorectal cancer?
- age (risk increases after 40) - smoking - obesity - african americans - Positive Family History of polyposis - Crohn's Disease and ulcerative colitis
How is leukemia diagnosed?
- bone marrow biopsy - cytogenetic testing (examines chromosomes) - flow cytometry with immunophenotyping (sorting and counting cells by surface markers) - molecular testing (look for specific mutations in the DNA - peripheral smear (examines blood specimen under microscope)
How can chest physiotherapy be performed for patients with CF?
- chest percusion or vibration to help loosen mucus secretions - high frequency chest wall oscillation like the Vest device - posetive expiratory pressure (PEP) devices like flutter mucus clearance device
What are potential side effects of radiation?
- diarrhea - fatigue - hair loss - mouth changes - nausea and vomiting - sexual and fertility changes - skin changes - throat changes - urinary and bladder changes
What are potential cardiac complications patients with cystic fibrosis may develop?
- heart works to hard and gets too big (cardiomegaly) - pulmonary HTN - malnutrition causing alterations in electrolytes
Why do colonizations of bacteria collect on mucosal surfaces of the lungs for patients with cystic fibrosis?
- mucosal surface alterations reduce the size of airways and the function of airways - Thick mucus production impairs mucociliary clearance, diminishing the immune response - alterations lead to the colonization of aerobic, anaerobic, and opportunistic microorganisms
What are oncogenes? When do they become a problem?
- part of every cell's normal makeup - become a problem only if they are overexpressed as a result of exposure to carcinogenic agents or events. - Both external and personal factors can activate oncogenes - if not exposed to carcinogen/activated: carrier
What are characteristics of benign tumor cells?
- specific morphology: retain morphology of parent cells - small nuclear to cytoplasmic ratio: similar to normal cells - specific differentiated functions: Still acts like a normal cell (ie: responds to hormone fluctuations) - normal chromosomes: Some exceptions, but most have 23 pairs of chromosomes
What are examples of carcinogens?
- tobacco - smoking (1st/2nd hand) - air pollution - environmental hazards - asbestos
What is the pathophysiology of bronchiolitis?
- virus causes infection and inflammation of bronchioles - mucus plug forms causing narrowed airway and wheezing and air trapping - hyperexpansion of the lungs - decrease gas exchange - increase in heart rate and respiration rate to compensate
What systems have been developed to help standardize tumors/cancer?
1. Grading classifies cellular aspects of the cancer 2. Ploidy classifies tumor chromosomes as normal or abnormal 3. Staging classifies clinical aspects of cancer
What are the two major categories of tumors?
3. Solid (develop from specific tissue) 2. Hematologic (arise from blood cell-forming tissue) Ex: leukemia
What FIO2 (percent of O2 delivered) does the patient receive when on a vent?
35-100% on ventilator room air is 21% O2
When should you discuss the need for colon cancer screening with a patient?
40 yrs old - discuss the need for colon cancer screening. Options: - colonoscopy - sending stool sample
What is the normal mean corpuscular volume (MCV) value? What does it tell you?
82-98 • measures the size of the red blood cell
What childhood disorder is caused by a bacterial infection of the epiglottis and is a medical emergency?
epiglottitis
What ventilator mode is a volume cycle mode of ventilation that has no set rate and is triggered by inspiration to deliver a set volume of air to the lungs?
AC (assist control) vent controls volume and pressure
How do you calculate an absolute neutrophil count (ANC)?
ANC = WBC × (% Neutrophils + % Bands) • Remember to convert the % to a decimal value! • ANC + WBC x (x/100 Neutrophils + x/100 Bands)
How is absolute neutrophil count (ANC) calculated?
ANC = WBC × (% Neutrophils + % Bands) • Remember to convert the % to a decimal value! • ANC + WBC x (x/100 Neutrophils + x/100 Bands)
What type of croup is a result of allergens?
Acute spasmodic laryngitis
What are the classifications of leukemia?
Acute: rapid growth of immature hematopoietic cells - Acute lymphocytic leukemia (ALL) - Acute myelogenous leukemia (AML) - Serious infection or abnormal bleeding @onset Chronic: mature-appearing cells; onset gradual - Chronic myelogenous leukemia (CML) - Chronic stable phase - acute aggressive phase (blastic) - Moves into peripheral blood; infiltrate liver and spleen Chronic lymphocytic leukemia (CLL) - Long-lived but functionally inactive lymphocytes
What type of polyps have the potential to become canerous?
Adenomatous polyps
What nursing care and teaching should be provided if a patient has had a polyp removed?
After care includes monitoring for: • Abdominal distention or pain • Rectal bleeding, mucopurulent drainage from the rectum, and fever. Teaching • Nature of the polyp • Clinical manifestations to watch for • Emphasis on need for regular, routine monitoring and/or screening • Follow-up sigmoidoscopic or colonoscopic examinations
What type of chemotherapeutic drug kills fast-growing cancer cells by altering DNA structure and preventing cell reproduction and inhibiting cell division?
Alkylating agents
What type of bone marrow transplant is often given by a family member or someone who is a match to the recipients marrow?
Allogenic
What type of chemotherapeutic drug kills cancer cells by interrupting a specific phase of cell reproduction?
Antimetabolites
What type of chemotherapeutic drug kills cancer cells by stopping the synthesis of RNA, DNA, or proteins?
Antitumor Antibiotics
What type of chemo administration is used primarily for the administration of chemotherapy agents directly into a tumor site? Where is the most common site for this purpose?
Arterial therapy the liver is the most common site for this purpose
When is a thoracotomy usually performed for a pneumothorax?
As a rule of thumb, the chest wall is opened surgically (thoracotomy) if more than 1,500 mL of blood is aspirated initially by thoracentesis (or is the initial chest tube output) or if chest tube output continues at greater than 200 mL per hour
What clinical sign assists in determining the effective dosage of pancreatic enzymes?
Assess the stool - allows you to look what is being absorbed vs excreted - Stools that sink in water have less fat (it has been absorbed) - stools that float have more fat (has not been absorbed) - Stool should not float if dosage is correct
What type of bone marrow transplant occurs when the recipient's own marrow is put back into their body?
Autologous
A student nurse is observing a nurse in the intensive care unit. The nurse responds to a low pressure ventilator alarm. The nurse responds immediately and while silencing the alarm, the nurse assesses the tubing and all connections. Why does the student nurse know this is an appropriate course of action? Select all that apply A. Low pressure alarms are indicative of increased resistance in the ventilator system. B. All pressure alarms require immediate attention. C. Low pressure alarms can be caused by a kink in the tubing. D. Low pressure alarms are indicative of a leak in the ventilator system.
B. All pressure alarms require immediate attention. D. Low pressure alarms are indicative of a leak in the ventilator system. B&D, Low pressure alarms require immediate attention and are indicative of a leak in the ventilator system. A&C are incorrect because they are indicative of high pressure alarms.
What type of cancer treatment uses substances that are extracted or produced from biologic material and modify a patient's biologic response to tumor cells?
Biologic (Immuno) Therapies
How does cystic fibrosis affect fertility in men and women?
Both - 95% chance of sterility, 5% chance of being able to reproduce - delayed puberty Women - too little body fat delays periods/makes them irregular - if pregnant, pts body needs to provide nutrients to fetus and patient (very difficult to sustain)
What type of radiation therapy occurs when radiation source comes in direct, continuous contact with the tumor tissue for a specific time period? What are examples of delivery methods?
Brachytherapy Oral or IV routes • Unsealed or suspended in a fluid •Example - thyroid gland (radionuclide iodine - 131) Implanted •Solid or sealed radiation source •Implanted within or near the tumor • May be temporary or permanent
What pediatric respiratory disorder is most often caused by RSV, but can be caused by other viruses?
Bronchiolitis
What are early signs and symptoms of cancer that can be remembered with the CAUTION mnemonic?
C - changes in bowel or bladder habits A - A sore throat that does not heal U - unusual bleeding or discharge T - thickening or lump in the breast or elsewhere I - ingestion or difficulty swallowing O - obvious changes in wart or mole N - nagging cough or horseness (lung CA)
What childhood disorder is an inherited autosomal disorder that leads to severe lung, digestive, and organ damage that affects the cells that produce mucus?
Cystic fibrosis
What is a preventable, treatable, and slowly progressive disease of airflow obstruction which involves the airways, pulmonary parenchyma, or both? What disorders does this include?
COPD COPD includes emphysema and chronic bronchitis - both cause airflow obstruction which leads to ineffective ventilation and alterations in gas exchange
What are common causes of blood loss anemia? How is it treated?
Causes: Blood loss through GI tract, GU tract, trauma or epistaxis Treatment: consists of identifying source of blood loss, reversing blood loss, and administration of PRBCs if bleeding and/or symptoms are severe
What is all functions carried out within a cell to maintain homeostasis, including its responses to extracellular signals (e.g. hormones, cytokines, and neurotransmitters) and the way each cell produces an intracellular response?
Cellular regulation
A nurse is observing the closed chest drainage system of a client who is 24 hr post thoracotomy. The nurse notes rapid, steady bubbling in the water seal chamber. Which of the following actions should the nurse take? A. Check the tubing and connections for leaks B. Check the suction control outlet on the wall C. Clamp the chest tube with hemostats D. Continue to monitor the client's respiratory status
Check the tubing and connections for leaks Rapid, steady bubbling in the water seal chamber is indicative of an air leak. Tidaling in the graduated water seal chamber is normal with inspiration and expiration and requires no intervention.
What component of COPD is characterized by air (CO2) trapping secondary to mucus plugs and narrowed airways causing hyperinflation of the alveoli?
Chronic bronchitis
What classification of leukemia involves more mature forms of white blood cells and onset is more gradual?
Chronic leukemia
How is pressure support delivered for a patient on a ventilator?
Delivered with vent or patient-initiated breaths
How are polyps diagnosed and treated?
Diagnosis • Maybe found on digital rectal exam • Occult Blood testing may detect blood • Barium Enema • Sigmoidoscopy • Colonoscopy Treatment • Polypectomy • Regular Monitoring
A nurse is working with a client who smokes and has recently been diagnosed with emphysema. Which of the following is the appropriate intervention by the nurse to assist the client with smoking cessation? A. Discourage the use of nicotine gum B. Discuss the ways the client can reduce the number of cigarettes smoked per day. C. Inform the client the treatment will be ineffective if he continues to smoke. D. Suggest the client switch form smoking cigarettes to smoking a pipe.
Discuss the ways the client can reduce the number of cigarettes smoked per day. This intervention can set a realistic goal for the client.
What are complications of bone marrow transplant or Hematopoietic Stem Cell transplantation during and after the infusion?
During - Micropulmonary emboli and hypersensitivity to WBC in marrow (monitor RR and coagulation time) After • Infection • Bleeding • Renal insufficiency • GI effects • Thrombosis • Graft vs Host rejection (graft rejection)
What component of COPD involves air trapping secondary to destruction of alveolar walls causing collapsed alveolar sacs?
Emphysema
What is the goal of treating a pneumothorax?
Evacuation of air and or blood from pleural space
What is the amount of radiation delivered to the tissue called?
Exposure
What is an uncommon genetic disorder characterized by hundreds of adenomatous polyps throughout the colon with a 100% malignancy rate by age 40?
Familial Polyposis
What are the types of rays used in radiation therapy? What are they used for?
Gamma • Able to deeply penetrate tissues • Most commonly used Beta • Must be placed very close to cancer cells • Used for selective therapy
What experimental cancer treatment attacks cancer at the molecular level, eliminating the need for drugs, radiation, and/or surgery?
Gene therapy
What are symptoms of lung cancer?
Generally, not symptomatic until late in course • s/s depend on location of tumor • Most frequent sign is chronic cough • may also present with dyspnea, hemoptysis and recurrent fever
What are the different grades/severities of COPD based on pulmonary function?
Grade 1: mild Grade 2: moderate Grade 3: severe Grade 4: very severe
What are complications of anemia and what should you monitor the patient for?
Heart failure: - With chronic low blood volume, the heart compensates to increase cardiac output, resulting in heart failure - look for fluid volume overload, crackles, JVD, edema Neurologic Manifestations: - In Vitamin B12 deficiency anemia, neurological complications often arise - patients complain of gradually progressing LE paresthesia - may cause issues with proprioception
What type of traumatic pneumothorax is characterized by a collection of blood in the pleural space?
Hemothorax • may include torn intercostal vessels, lacerations of the great vessels, or lacerations of the lungs • Occurs with major trauma • Hemopneumothorax can co-exist
What type of cancer treatment controls some types of cancers by slowing tumor growth but does not cure the disease? What are examples of this treatment?
Hormonal Manipulation Hormone agonists • Compete with natural hormones at the receptors • slow tumor growth Hormone Antagonists •Bind to the specific hormone receptor on or in the tumor cell •Slow tumor growth Hormone Inhibitors •Inhibit the production of specific hormones
What is growth that causes tissue to increase in size by increasing the number of cells? Are the cells benign or malignant?
Hyperplasia cells are malignant
What type of polyp is usually small, located in end portion of the colon, with no potential to become malignant?
Hyperplastic polyps
What is growth that causes tissue to increase in size by enlarging each cell? Are the cells benign or malignant?
Hypertrophy cells are benign
What term is defined as reduced oxygenation of arterial blood?
Hypoxemia
What stage of therapy when treating leukemia involves an aggressive attempt to bring on remission?
Induction • Goal is to destroy leukemic cells in the tissues, peripheral blood, and bone marrow to eventually restore normal hematopoiesis on bone marrow recovery • Achieved after one course of induction therapy in 70% of patients but high probability of relapse without further treatment
A client who presents with shortness of breath and fatigue is diagnosed with iron deficiency anemia. What is impacting the alteration in gas exchange? a.Ineffective ventilation b.Ineffective coping c.Ineffective transport d.Ineffective perfusion
Ineffective transport In the case of anemia, gas exchange is impacted by the inability of hgb to transport oxygen to the body's cells.
What step of malignant transformation is a change in gene expression that leads to excessive cell division by the loss of intracellular regulation (due to DNA damage)?
Initiation
What type of cancer treatment works by slowing tumor growth, stimulating growth and activation of NK cells, changing appearance and function of cancer cells, and inhibiting expression of oncogene? When is this most commonly used?
Interferons Interferons interfere used in melanoma, renal cell carcinoma, ovarian cancer, and t-cell lymphoma
What type of cancer treatment helps different immune system cells recognize and destroy abnormal body cells?
Interleukins
What type of chemotherapy agent administration goes directly into the peritoneal cavity? What cancers is this most often used to treat?
Intraperitoneal therapy used especially for ovarian and gastrointestinal tumors that have metastasized into the peritoneum
What method of chemo delivery is used for cancers that cross the blood-brain barrier into the central nervous system?
Intrathecal
What term is defined as insufficient flow of oxygenated blood to tissues, may cause cellular injury or death?
Ischemia
What lab tests can be done to diagnose colorectal cancer? What other screenings can be done?
Labs: - CBC/Chemistry - stool occult blood - Carcinoembryonic Antigen (CEA) (not specific diagnosis but can predict prognosis) Other: • Colonoscopy with tissue examination in pathology • CT scan & MRI to evaluate extent of the disease
What does a low MCV indicate? What does a high MCV indicate?
Low - small RBCs - microcytic anemia - carries less O2 High - large RBCs - megaloblastic anemia - carries too much O2
What is the process of changing a normal cell into a cancer cell?
Malignant transformation
What is a positive or negative pressure breathing device used for long term ventilation and oxygen delivery?
Mechanical ventilation
What step of malignant transformation occurs when the tumor sets up "satellite locations" elsewhere in the body?
Metastasis
What occurs when cancer cells move from primary site and establish remote colonies?
Metastasis = additional tumors • Remember, metastasis locations are still an original site type of cancer Ex. Breast cancer that spreads to the brain it is still breast cancer
What cancer treatment requires a specific drug for a specific cancer that requires that agents are specific to protein, receptor, or cellular substance needed by cancer cell?
Monoclonal Antibody Therapy
What are the common microorganisms that cause respiratory infections in children with CF?
Most colonize multiple organisms: - Haemophilus influenzae - Staphylococcus aureus - Pseudomonas aeruginosa - Burkholderia cepacia (also known as Pseudomonas cepacia) Escherichia coli - Klebsiella pneumoniae - MRSA
What type of breathing support provides positive pressure ventilation via facemask, nasal mask, or nasal pillows? What are examples of this type of breathing suppor?
Noninvasive ventilation 1. Continuous Positive Airway Pressure (CPAP): - Provides positive pressure to the airways throughout the respiratory cycle. - gives continuous pressure and uses pt's own respiratory drive 2. Bi-level Positive Airway Pressure (BiPAP): - Machine provides control of inspiratory and expiratory pressures. - Ensures a set rate
Why are geriatric patients more affected by anemia? What complications does it result in?
Older adults are generally significantly affected by anemia because their HR and CO do not increase as quickly as younger patients results in: • Decreased mobility • Activity intolerance • Fatigue • Dyspnea • Confusion • Increased risk of falling and delirium
What is defined as the amount of pressure we want the vent to leave in the lungs after expiration in order to keep the alveoli called?
PEEP: Positive End Expiratory Pressure
What type of ventilator pushes air into the lungs for inspiration with passive expiration?
Positive-Pressure Ventilators
What stage of therapy when treating leukemia is given immediately after induction and lasts for several months?
Postinduction/Post-remission - High dose "Intensification" therapy • Uses drugs that target the leukemic cells in a different way to reach remission. • Consolidation is usually one or two additional courses of the induction or intensification drugs "for good measure"
What nursing care should be provided pre and post op for colorectal cancer surgery?
Pre-op • Reinforcement of surgeon's plan • ET nurse measures for ostomy • Bowel prep if no obstruction • Prophylactic antibiotics • Routine pre-op teaching Post-op • Pain management • NGT • Monitoring abdomen • Early ambulation • TPN considered after 3-5 days • GI medications • diet • infection risk
When are negative pressure ventilators used? What are examples of negative pressure ventilators?
Primarily used to treat patients with slowly progressing neuromuscular disorders. Examples: ◦ Iron lung ◦ Cuirass (chest shell) ◦ Body wrap
How can a primary tumor be identified?
Primary Tumor = original tumor - Identified by the tissue from which it arose - Depending on location, tumor can lethally damage organ or lead to inability to perform vital functions
What skin care should be provided to patients that have received radiation?
Radiation damage - dry skin may lead to breakdown • Wash with water or mild soap • No washcloth • Dry by patting, not rubbing • Avoid exposure to sun • Avoid heat • DO NOT REMOVE SKIN MARKINGS!!
What are the clinical manifestations of cystic fibrosis?
Respiratory: Wheezing, cough, clubbing, sinus infections GI: Intestinal blockage, abdominal pain, diarrhea, constipation, greasy stool Derm: Jaundice, salty skin Musculoskeletal: Muscle/joint pain, delayed growth/puberty Other: Fever, low BMI
Why is thrombocytopenia a side effect of chemo? What platelet value requires caution and can cause spontaneous bleeding?
Result of bone marrow suppression from chemotherapy • <50,000 = caution • <20,000=spontaneous bleeding
What are secondary prevention methods for cancer?
Routine screening does not reduce incidence but can greatly reduce some deaths • Mammography & Clinical Breast Exam • Prostate-Specific antigen (PSA) and digital rectal exam (DRE) (50+) • Colonoscopy (50+) • Fecal Occult Blood (Guiac)
What ventilator mode provides breaths at a set volume, pressure, and rate, but also allows for the patient to breathe above the vent?
SIMV Vent controls rate, pressure and volume
What type of pneumothorax occurs after air enters the pleural space through a breach of either the parietal or visceral pleura? What are potential causes of this type of pneumothorax?
Simple pneumothorax Causes: • Ruptured bleb (bubble) • Bronchopleural fistula (abnormal connection) • Interstitial lung disease • Emphysema • Spontaneous
What are assessment findings of Acute laryngotracheobronchitis croup?
Starts with cold like symptoms • Low-grade fever • Restlessness • Hoarseness • Barky cough • Dyspnea • Inspiratory stridor • Retractions • Nasal flaring • Tachypnea • Continuous stridor
A nurse is caring for a client immediately after extubation. Which of the following symptoms requires the nurse's attention? A. Coughing B. Hoarseness C. Crackles D. Stridor
Stridor Stridor is heard during inspiration and is a sign of laryngeal edema, which may compromise the airway
What chemotherapy treatment involves a slow infusion for a short time into the thighs, hips, and abdomen?
Subcutaneous therapy (hypodermoclysis)
What type of bone marrow transplant comes from the recipient's identical twin?
Syngeneic
What type of cancer treatment is designed to interfere with process of tumor growth, progression, and metastases by stimulating the immune system to destroy cancer cells or by delivering toxic drugs directly to cancer cells?
Targeted therapy EX: Antibodies, antibody-drug conjugates, or small molecule inhibitors
What type of chemotherapeutic drug disrupts enzyme needed for DNA synthesis and cell division and prevents proper DNA maintenance eventually leading to cell death?
Topoisomerase Inhibitors cell will not divide and eventually will die
What type of pneumothorax is caused by air escaping from a laceration in the lung itself or wound in chest wall? What are causes of this pneumothorax and what are examples?
Traumatic pneumothorax Causes: Blunt trauma, Penetrating trauma, Invasive procedures Types: Hemothorax and open pneumothorax
What are types of airways and breathing support that may be used to assist a patient with impaired gas exchange?
Types of airways: - Nasopharyngeal/ Oropharyngeal airways - Endotracheal tube - Tracheostomy tube Breathing support: - noninvasive ventilation - mechanical ventilation
What type of chest tube system is used to prevent air from reentering the chest on inspiration? How is the amount of suction controlled?
Wet suction control (water seal) Ocean system Amount of suction: amount of water instilled into the suction chamber
A nurse is caring for a client who is immobile. Which of the following actions is the priority for the nurse to include in the client's plan of care? a) Auscultate breath sounds at least every 2 hr. b) Perform range-of-motion (ROM) exercises at least two to three times daily. c) Make sure the client has an intake of 2,000 to 3,000 mL of fluid per day. d) Apply antiembolic stockings.
a) Auscultate breath sounds at least every 2 hr. The priority action the nurse should contribute to the plan of care when using the airway, breathing, circulation approach to client care is auscultating breath sounds to determine the client's need for suctioning. With inactivity, secretions can pool in the airways, diminishing breath sounds and causing crackles and dyspnea.
A nurse is caring for a client who is receiving positive-pressure mechanical ventilation. Which of the following interventions should the nurse implement to prevent complications? (Select all that apply.) a) Elevate the head of the bed to at least 30°. b) Verify the prescribed ventilator settings daily. c) Apply restraints if the client becomes agitated. d) Administer pantoprazole as prescribed. e) Reposition the endotracheal tube to the opposite side of the mouth daily.
a) Elevate the head of the bed to at least 30°. d) Administer pantoprazole as prescribed. e) Reposition the endotracheal tube to the opposite side of the mouth daily.
The nurse is caring for a postoperative client who has a chest tube connected to suction and a water seal drainage system. Which of the following indicates to the nurse that the chest tube is functioning properly? a) Fluctuation of the fluid level within the water seal chamber b) Absence of fluid in the drainage tubing c) Continuous bubbling within the water seal chamber d) Equal amounts of fluid drainage in each collection chamber
a) Fluctuation of the fluid level within the water seal chamber Fluctuation of fluid within the water seal chamber occurs with inspiration and expiration until the client's lungs have re-expanded or the system is occluded.
A nurse is assessing a client immediately after the provider removed the client's endotracheal tube. Which of the following findings should the nurse report to the provider? a) Stridor b) Copious oral secretions c) Hoarseness d) Sore throat
a) Stridor Stridor, or a high-pitched crowing sound heard during inspiration, is a result of laryngeal edema. This finding indicates possible obstruction of the client's airway. Therefore, the nurse should report it to the provider immediately.
A nurse is preparing to suction a client who has a tracheostomy. Identify the sequence of actions the nurse should take. a) Adjust the suction. b) Apply suction while rotating the catheter. c) Don sterile gloves. d) Check the function of the suction catheter. e) Insert the catheter without suction. f) Hyperoxygenate the client. g) Assess for secretion clearance.
a, c, d, f, e, b, g a) Adjust the suction. c) Don sterile gloves. d) Check the function of the suction catheter. f) Hyperoxygenate the client. e) Insert the catheter without suction. b) Apply suction while rotating the catheter. g) Assess for secretion clearance.
A nurse who is caring for a mechanically ventilated client responds to a high pressure alarm. What action of the nurse is correct? Select all that apply a.Assess for kinked tubing b.Assess the cuff for leaks c.Assess for worsening of disease d.Assess for coughing and gagging e.Assess for cracked humidification jar
a.Assess for kinked tubing c.Assess for worsening of disease d.Assess for coughing and gagging a,c,d: kinked tubing, worsening of disease, and coughing/gagging all cause increased pressure; leaks at the cuff and a cracked humidification jar cause low pressure
What classification of leukemia is clonal proliferation of immature hematopoietic cells?
acute leukemia
What are examples of disorders of effective transport?
anemias: - iron deficiency anemia - folate deficiency anemia - B12 deficiency anemia
What term is defined as complete lack of oxygen in body tissues?
anoxia
What type of chemotherapeutic drug kills cancer cells by inhibiting mitosis and preventing cell division?
antimitotic
A nurse is providing dietary teaching for a client who has chronic obstructive pulmonary disease. Which of the following instructions should the nurse include? a) "Eat 3 large meals each day." b) "Limit water intake with meals." c) "Reduce protein intake." d) "Use a bronchodilator 1 hour before eating."
b) "Limit water intake with meals." The nurse should instruct the client to limit low nutrient liquids during meals to prevent early satiety and increase intake of nutrient dense foods.
A nurse is providing teaching to a client who has neutropenia. Which of the following information should the nurse include in the teaching? a) Eat plenty of fresh fruits and vegetables. b) Avoid crowds. c) Perform mild exercise, such as gardening. d) Take temperature weekly.
b) Avoid crowds.
A nurse on a medical-surgical unit is performing an admission assessment of a client who has COPD with emphysema. The client reports that he has a frequent productive cough and is short of breath. The nurse should anticipate which of the following assessment findings for this client? a) Respiratory alkalosis b) Increased anteroposterior diameter of the chest c) Oxygen saturation level 96% d) Petechiae on chest
b) Increased anteroposterior diameter of the chest The nurse should anticipate an increased anteroposterior diameter of the chest (barrel chest) because of chronic hyperinflation of the lungs.
A nurse is planning care for a child who has suspected epiglottitis. Which of the following actions should the nurse take? a) obtain a throat culture b) place the child in an upright position c) transport the child to radiology for a throat x-ray d) visualize the epiglottis with a tongue depressor
b) place the child in an upright position Placing the child in an upright position will assist in maintaining a patent airway.
A nurse in a PACU is assessing a client who has a newly created colostomy. Which of the following findings should the nurse report to the provider? a) Stoma oozing red drainage b) Shiny, moist stoma c) Purplish-colored stoma d) Rosebud-like stoma orifice
c) Purplish-colored stoma
A nurse is caring for a mechanically ventilated client receiving PEEP. Which of the following is a complication to PEEP a.Hypoventilation b.Barotrauma c.Increased venous return d.Fluid in the alveoli
b.Barotrauma The positive pressure supplied at the end of expiration places the client at risk of barotrauma
Most patients with mucositis will also have myelosuppression. Why is this an added problem?
body will take even longer to replace damaged cells
A female middle adult client tells a nurse that she tested positive for a mutant BRCA1 gene. The nurse should recognize that the client is at an increased risk for which of the following situations? a) Delivering a child who has Down syndrome b) Developing Alzheimer's disease c) Developing breast cancer d) Developing thyroid cancer
c) Developing breast cancer
A nurse caring for a mechanically ventilated client creates a plan of care focusing on promoting optimal communication. Which intervention should the nurse complete first? a. Provide the client with a pad and pencil. b. Change the ET tube to a fenestrated tube. c. Assess the client's ability to communicate. d. Instruct the client how to use a communication board.
c. Assess the client's ability to communicate. While all of these are interventions to promote optimal communication, the nurse must first assess the client's ability to communicate.
What acute respiratory syndrome in children and infants is associated with obstruction of the larynx, hoarseness, and a barking cough?
croup
A nurse is observing the closed chest drainage system of a client who is 24 hr post thoracotomy. The nurse notes slow, steady bubbling in the suction control chamber. Which of the following actions should the nurse take? a) Check the tubing connections for leaks. b) Check the suction control outlet on the wall. c) Clamp the chest tube. d) Continue to monitor the client's respiratory status.
d) Continue to monitor the client's respiratory status. Slow, steady bubbling in the suction control chamber is an expected finding. Therefore, the nurse should continue to monitor the client's respiratory status.
What type of chest tube system uses a one way valve and is controlled by a suction control dial?
dry suction water seal systems (oasis system)
Which of the following foods should be added to a diet of a patient with iron deficiency anemia? a. Whole wheat pastas and skim milk b. Lean cuts of poultry, pork, and fish c. Cooked cereals, such as oats, and bananas d. Beans and dark green, leafy vegetables
d. Beans and dark green, leafy vegetables
Why should patients receiving biologics not be given NSAIDs to help with pain and inflammation the medication may cause?
do not give NSAID because we want the body to produce an inflammatory response
What is the amount of radiation absorbed by the tissue?
dose *Dose is always less than exposure*
What is a problem the nurse should be concerned for in the patient who is experiencing Chemo Induced Nausea and Vomiting (CINV)?
fluid and electrolyte imbalance
What term is defined as insufficient oxygen reaching the cells?
hypoxia
What are the steps of malignant transformation?
initiation promotion progression metastasis
What method of chemo delivery allows fluids and medications to be absorbed by the rich vascular network of the bones?
intraosseous therapy used particularly in emergency situation
What is a general term used to describe a group of malignant disorders affecting the blood and blood-forming tissues of the bone marrow, lymph system, and spleen?
leukemia
What are the initial symptoms of bronchiolitis?
looks like cold virus • Rhinorrhea • Intermittent fever • Pharyngitis • Coughing • Sneezing • Wheezing • Possible ear or eye infection
What stage of therapy when treating leukemia involves lower doses of the same drugs for a prolonged period?
maintenance • Usually, every 3-4 weeks for several months • Generally, NOT effective in AML and is not done
What is the normal value for hemoglobin? What does a hemoglobin lab value tell you?
male: 14-17 g/dL female: 12-16 g/dL • main component of red blood cells (erythrocytes) • acts as the vehicle in the transportation of oxygen.
What is the normal value for hematocrit? What does it tell you?
male: 42-52% female: 36-48% • measures the mass of the red blood cell. • The HCT is generally three times the HGB.
What are abnormal cells growing in the wrong place or at the wrong time?
malignant cells
What form of ventilation involves using pressure to pull the thorax outward and allows air to flow into lungs that mimics the work of breathing?
negative pressure ventilators
What are symptoms of ovarian cancer?
nonspecific; increased abdominal girth, pelvic pressure, bloating, constipation, back pain etc
What type of traumatic pneumothorax is caused by a wound in the chest wall is large enough to allow air to pass freely in and out of the thoracic cavity with each attempted respiration?
open pneumothorax
What step of malignant transformation occurs when the tumor takes on a new life of its own?
progression
What step of malignant transformation are substances that enhance the growth of initiated cells (may even be normal hormones or other body proteins)?
promotion
What cancer treatment destroys cancer cells with minimal effect on surrounding normal cells
radiation
What diagnostic tests can be performed to diagnose cancer?
radiographic tests: MRI, CT, US, mammogram Direct visualization: colonoscopy, endoscopy Lab tests: CBC, Chem panel, genetic or tumor marker tests (BRACA gene) Pathology: aspiration biopsy cytology, incisional biopsy, excisional biopsy, smears, washings, scrapings
What ventilator mode changes the frequency of gas entering and exiting the lungs?
rate
What is the most common type of hemolytic anemia?
sickle cell anemia
Why should you not swab a child's throat if you suspect epiglottitis? What diagnostic test should be performed instead?
swabbing the throat will cause more irritation and swelling and may cause blockage of the airway Other diagnostic tests that can be performed include a lateral neck x-ray
What is the amount of air that goes into the lungs on inspiration also referred to as?
tidal volume
What ventilator setting is the amount of air going into the lungs with each breath?
volume
After radiation treatment, a client reports dryness, redness, and scaling of his skin occurring within the designated radiation treatment markings. The nurse should instruct the client to take which of the following actions? a) Apply hydrating lotions. b) Apply moist heat. c) Sit in the sun for 10 min per day. d) Wash with plain soap and water.
a) Apply hydrating lotions.
What are symptoms of a simple pneumothorax?
• Trachea is midline • Expansion of the chest is decreased • Breath sounds may be diminished or absent (on affected side) • Percussion of the chest may reveal normal sounds or hyperresonance (echos d/t air in chest)
What are the symptoms of epiglottitis?
• Absence of cough, drooling, agitation • Sitting upright with chin pointing out, mouth opened, tongue protruding (to move tongue out of way to help breathing) • Dysphonia (altered voice) • Dysphagia • Inspiratory stridor • Suprasternal and substernal retractions • Sore throat, high fever, restlessness
What occurs during a tension pneumothorax?
• Air is drawn into the pleural space from a lacerated lung or through a small opening or wound in the chest wall. • The air that enters the chest cavity with each inspiration is trapped; it cannot be expelled during expiration through the air passages or the opening in the chest wall • With each breath, tension is increased, causing the lung to collapse and the heart, the great vessels, and the trachea to shift toward the unaffected side of the chest (mediastinal shift). • May be a complication of other types of pneumothorax
What are assessments findings of acute spasmodic laryngitis croup?
• Barky cough • Restlessness • Difficulty breathing • Hoarseness • Nightime episodes of laryngeal obstruction
How is it determined what chemotherapy drug, dose, and timing are used?
• Calculated therapy • Type of cancer • Size of patient • Maximize killing of cancer cells while minimizing damage to healthy cells • Usually, a specified number of doses every 3-4 weeks • Usually administered IV or oral but may also be administered via additional routes.
What are signs and symptoms of colorectal cancer?
• Constipation or diarrhea • Black tarry stool or bright red blood • Changes in shape of stool (polyps can change diameter/shape of intestine) • Abdominal bloating or pain • Palpable Mass • Weight loss • Intestinal Obstruction • Anemia of unknown source
How is folate deficiency anemia treated?
• Consumption of green leafy vegetables, citrus fruits, and beans. • Decrease ETOH intake • Folic Acid supplementation
What are types of breast cancer?
• DCIS- ductal carcinoma in situ- proliferation of malignant cells inside milk ducts without invasion of surrounding tissue • Does not metastasize, however can develop into invasive form • Invasive- many forms; originate within breast structure, ie: ductal, lobular epithelium
How is lung cancer diagnosed and treated?
• Diagnostic tests- CXR, CT, sputum cytology Management • look for cure; chemo/radiation/surgical or combo • manage symptoms • relieve breathing issues • reduce fatigue • provide psychological support
What is involved in Bone Marrow & Hematopoietic Stem Cell Transplantation?
• Goal is CURE but high potential for complications • Allows client to receive higher doses of chemo and radiation • Damaged bone marrow is replaced by healthy autologous or donor marrow • Stem Cells are reinfused after wiping out all mature blood cells • RESCUE therapy after high doses of chemotherapy
What symptoms may occur when bronchiolitis begins progressing?
• Increased coughing and sneezing • Fever • Tachypnea and retractions • Refusal of bottle feeds • Copious secretions
What are treatment options for a patient with a pneumothorax?
• Needle aspiration (thorocentesis): put needle in and draw air out • Chest tube insertion • Thoracotomy: opening of chest wall to remove what is inside • Video Assisted thoracoscopic Surgery (VATS) • Autotransfusion: take blood out of hemothorax and put it back in to the patient
How is ovarian cancer diagnosed and treated?
• Pelvic exam & imaging does not always detect! • If find enlarged ovary on exam, must investigate • Considered benign when no invasion of surrounding tissues invaded Treatment • Surgical • chemo
What types of surgeries may be performed on cancer patients? Why might these surgeries be performed?
• Prophylactic Surgery: Removes at risk tissue • Diagnostic Surgery: Removal of all or part of a suspected lesion for examination and testing • Curative Surgery: Removes all cancer tissue • Second-look surgery: "re-diagnosis" after treatment; if pt notices regrowth, may need to look for more tumor
What teaching should be given to patients at risk of peripheral neuropathy secondary to chemo?
• Protect feet and other body areas where sensation is reduced • Be sure shoes are long enough and wide enough to prevent creating sores or blisters. • Inspect feet daily (with a mirror) for open areas or redness. • Avoid extremes of temperature • Use gloves when washing dishes or gardening. • Eat foods that are high in fiber (e.g., fruit, whole grain cereals, vegetables). • Use "Falls Prevention" strategies during all activities.
What is the nurses role in caring for a child with epiglottitis?
• Protect the airway • Prepare for intubation • Provide humidified oxygen • Continuous SpO2 monitoring • Administer corticosteroids • Administer IVF • Administer antibiotics if warranted
What are causes of Acute laryngotracheobronchitis associated with croup?
• RSV • Influenza A&B • Mycoplasma pneumonia • Parainfluenza, types 1,2,3
What are nonsurgical treatment options for colorectal cancer?
• Radiation therapy • Chemotherapy • Monoclonal antibody therapy •Intrahepatic arterial chemotherapy •Symptom management
What is a patient's risk of infection based on their ANC?
• Risk ANC (per mm 3) • Not significant 1500-2000 • Minimal 1000-1500 • Moderate 500-1000 • Severe < 500
What symptoms may occur in severe bronchiolitis?
• Tachypnea (greater than 70/min • Listlessness • Apneic spells • Poor air exchange • Poor breath sounds • Cyanosis
What are symptoms of a tension pneumothorax?
• Trachea is shifted away from the affected side • Chest expansion may be decreased or fixed in a hyper-expanded state • Breath sounds are diminished or absent • Percussion reveals is hyper-resonanance • Respiratory Distress • decreased cardiac output
How is vitamin B 12 treated?
• Vitamin B12 replacement • Use of assistive devices to promote gait stability • Consumption of animal products (fish, meat, poultry, eggs, milk, and milk products) and fortified cereals.
What are symptoms of decreased cardiac output to monitor for?
• restlessness • apprehension • confusion • tachycardia • pallor • cyanosis • diaphoresis • transient HTN • decreased urine output
What are primary prevention methods for cancer?
•Avoid carcinogens • Modify risk factors • Remove "at risk" tissues • Chemoprevention •Vaccination • Healthy diet • Regular physical activity •Smoking cessation •Avoidance of excessive exposure to sunlight •Prophylactic surgery
What are surgical treatment options for colorectal cancer?
•Polypectomy •Partial Colectomy • Radical Colon Resection • Radical Colon Resection with Colostomy •Abdominal-Perineal Resection
What lab values are associated with folate deficiency anemia?
↑ MCV levels (Megaloblastic, large RBC) ↓ Folate
What lab values are associated with Vitamin B12 deficiency?
↑ MCV levels, (Megaloblastic, large RBC) ↓ Vitamin B12
What lab values are associated with blood loss anemia?
↓ H/H ↓ MCV levels (normal initially) ↑ Reticulocyte Progression of bleeding leads to ↓ Iron, % saturation, ferritin levels.
What lab values are associated with Iron deficiency anemia?
↓ MCV (Microcytic, small RBC) ↓ reticulocytes, iron, % saturation, ferritin ↑ TIBC (total iron binding capacity)
What are symptoms of folate deficiency anemia?
▪ Tachycardia on exertion ▪ Fatigue, weakness ▪ Pallor of skin and oral mucosa. ▪ Red beefy tongue ▪ Mild jaundice, ▪ Angular cheilosis, ▪ Brittle, rigid, concave nails
What are symptoms of iron deficiency anemia?
▪ Tachycardia on exertion (d/t compensating to deliver more O2) ▪ Fatigue ▪ Weakness ▪ Pallor of skin and oral mucosa. Severe - smooth red tongue - brittle and ridged nails - angular cheilosis (mouth sores on corners of mouth) - restless leg syndrome
What are symptoms of Vitamin B12 deficiency?
▪ Tachycardia on exertion, ▪ Fatigue ▪ Weakness, ▪ Pallor of skin and oral mucosa. ▪ Red beefy tongue ▪ Mild jaundice, ▪ Angular cheilosis ▪ Brittle, rigid, concave nails, ▪ Paresthesia, mild confusion, balance disturbances
What are examples of disorders of ineffective ventilation?
- COPD - Pneumothorax/ Hemothorax - Cystic Fibrosis - Bronchiolitis - Pulmonary edema
What are nursing interventions to prevent infection and trauma in a ventilated patient?
- prevent ventilator associated pneumonia (VAP) - brush teeth (SAGE suction oral care) - trach care (sterile) - release pressure of balloon at ordered intervals to prevent trauma to larynx (deflate cuff)
How is the severity of COPD determined?
- pulmonary function test to Dx and monitor progression - spirometry - grades of COPD: FEV1 (Forced Expiratory Volume in one second)/ FVC (Forced Vital Capacity)
What vital signs can indicate alteration in gas exchange?
- Tachycardia - Decreased SaO2 - Elevated Temperature - Alterations in RR
How is iron deficiency anemia treated?
• Oral or IV iron supplementation • Consumption of foods high in iron: meat, organ meat, beans, leafy green vegetables, raisins, and molasses • Consuming iron rich foods with a source of vitamin C (ie: OJ) will enhance absorption. • Transfusion of PRBCs if anemia is severe
What are nursing interventions to enhance gas exchange in a ventilated patient?
- Assess and maintain patency of ETT • Verify ETT is secure in placement • Suction PRN - When stable, turn Q2 hrs - After extubation, encourage deep breathing/Incentive spirometer
What nursing interventions should be implemented for a patient with COPD?
- Assessment (know their baseline) - Clearing the airway (coughing, suction) - Improving the breathing pattern (prevent exacerbations) - Improve activity tolerance - Monitor & manage complications - Health promotion & education - Pursed lip breathing - positioning (tripoding) - expectorants to expel mucus - encourage fluids - adaptive equipment (shower chair, bedside commode)
How are alterations in gas exchange diagnosed?
- Chest Xray - VQ Scan (looks how much of breath is getting perfused) - Complete Blood Count - Positron Emission Tomography (PET scan to look for inflammation of tissues) - Sputum culture - CT Scan - Mantoux Skin Test (TB test) - Bronchoscopy - Pulmonary Function Test - Arterial Blood Gases
What other clinical manifestations indicate alterations in gas exchange?
- Cyanosis (usually of fingers/toes, lips, and mucus membranes) - Clubbing of the nail beds (long term alteration in gas exchange) - Chest pain - Tactile Fremitus (feel chest vibration while pt says "99") - respiratory excursion (altered function of diaphragm muscle)
What are examples of disorders of effective perfusion?
- Decreased cardiac output - Shock - Pulmonary Embolism
What breathing patterns can indicate alteration in gas exchange?
- Dyspnea - Orthopnea - Tachypnea - Apnea - Use of accessory muscles
What are nursing interventions to promote optimal levels of mobility in a ventilated patient?
- Encourage ambulation, repositioning in chair, completion of active and passive ROM exercises - Q2 turns
What is the nurse's role when caring for a patient on a ventilator?
- Enhance Gas Exchange - Promote Effective Airway Clearance - Prevent Trauma and Infection - Promoting Optimal Level of Mobility - Promoting Optimal Communication - Monitor for Potential Complications - Promote Coping - DO NOT touch vent settings
What are nursing interventions to promote optimal communication in a ventilated patient?
- Fenestrated ET tube (Speaking valve) - Provide charts, writing materials - Therapeutic communication
What are the signs of right sided heart failure (cor pulmonale)?
- Peripheral edema - JVD - Tachycardia - Supraventricular arrhythmias R ventricular failure d/t R ventricle working too hard to push blood to the lungs
What should you monitor for in a patient who presents with a cough?
- Productive or Nonproductive - Sputum Color - Sputum Consistency - Hemoptysis
What assessment findings may be seen in a COPD patient?
- accessory muscle use - abd muscle use w/ inspiration - prolonged expiration - adventitious lung sounds - central cyanosis - right sided heart failure (cor pulmonale) - clubbing of fingers - altered mental status - increased anxiety - hypercapnia (lead t/t resp acidosis)
What chest configurations can indicate or cause an alteration in gas exchange?
- barrel chest: seen in COPD - funnel chest: pectus excavatum; lungs can't fully expand - pigeon chest: chest pushed outward - kyphoscoliosis: abnormal curvature of spine
What are the clinical manifestations of COPD?
- chronic cough - sputum production - dyspnea - weight loss - use of accessory muscles - respiratory insufficiency - frequent infections - exacerbations - respiratory failure
What is the pathophysiology of emphysema?
- recurrent infection and chronic inflammatory response - destruction of alveolar walls - changes in alveolar structure result in panlobular and/or centrilobular emphysema - panlobular: destruction of the bronchiole, alveolar duct, and alveolus/hyperinflation - Centrilobular: damage to the lobule - decreased size of pulmonary capillary bed - increased dead space, altered gas exchange
What is the pathophysiology of chronic bronchitis?
- smoke or environmental pollutants irritate airways - inflammation of the airways, lung parenchyma and pulm vasculature - increased number of goblet cells and enlarged submucosal glands - hypersecretion of mucus - reduces ciliary function (cells can't move mucus) - further narrowing of bronchial lumen - damage and fibrosis to adjacent alveoli - altered function of alveolar macrophages - increased susceptibility of infection, exacerbation of chronic bronchitis
What lung sounds can indicate alterations in gas exchange?
- stridor: high pitched wheeze on inspiration d/t upper airway swelling - wheeze: can be on inspiration or expiration - rhonchi: "junky" sound from mucus - crackles: usually heard in lung bases. Sounds like rubbing hair by your ear
What are nursing interventions to promote effective airway clearance in a ventilated patient?
- suctioning - chest physiotherapy (cupped hand on back of chest to break up mucus)
What are risk factors of COPD?
- tobacco use/smoking (80-90% of cases) - secondhand smoke - increased age - occupational exposure (dust, chemicals) - air pollution - genetic abnormalities
What are causes of low pressure ventilator alarms? How do you fix the problem?
1. ET tube disconnected from ventilator: Reconnect tube 2. Displaced tube: Check placement. If extubation or displacement has occurred ventilate manually & call MD immediately 3. Leaking cuff: Listen for leak, assess cuff. If cuff pressure can't be maintained call MD. 4. Vent malfunction: Disconnect patient and ventilate manually 5. Leak in ventilator circuit: Check all connections, assess tubes and humidification jar for holes, cracks & replace if needed
What are causes of high pressure ventilator alarms? How do you fix the problem?
1. Obstruction due to kinked tubing, secretions in airway, biting ET tube, condensation in large bore tubing: Unkink tubing, suction, insert bite block, remove condensation from large bore tubing 2. Intubation into R main stem bronchus: Check tube position, call MD if needed 3. Coughing, gagging, attempting to talk: If patient fights the ventilator, administer sedative or neuromuscular blocking agent as ordered. 4. Chest wall resistance: Reposition patient to improve chest expansion 5. Failure of high-pressure relief valve: Replace faulty equipment 6. Bronchospasm: Assess for cause, report to MD, treat patient as ordered. 7. Worsening disease (↑ airway pressure, ↓ lung compliance): Assess lung sounds for consolidation, barotrauma, wheezing. Call MD
A nurse is planning teaching for a client following a traditional open cholecystectomy. Which of the following is the priority learning need for the client? A.T-tube care B.Pain management C.Coughing and deep breathing exercises
Coughing and deep breathing exercises The greatest risk to the client is respiratory compromise. Therefore, learning how to perform coughing and deep breathing exercises to promote lung expansion and secretion removal is the client's priority learning need.
When does the air trapping occur in COPD patients?
During expiration - During inspiration, the airways enlarge and open, allowing air to flow into the alveoli. - During expiration, the airway narrows and closes, trapping air into the alveoli. This prevents fresh air from entering the alveoli and alters gas flow
What type of anemia occurs as a result of defective red blood cell production? What are examples of this type of anemia?
Hypoproliferative Anemia Includes iron deficiency anemia, vitamin B12 deficiency anemia, and folate deficiency anemia
A nurse is preparing an adolescent client who has pneumonia for percussion, vibration, and postural drainage. Prior to the procedure, which of the following nursing actions should the nurse complete first? a) Auscultate lung fields. b) Assess pulse and respirations. c) Assess characteristics of her sputum. d) Instruct to slowly exhale with pursed lips.
a) Auscultate lung fields. The first action the nurse should take when using the airway, breathing, circulation (ABC) approach to client care is to auscultate lung fields to provide knowledge of which lung areas are most affected and would be the focus of the procedure.
A nurse is caring for a client who has a central venous catheter and develops acute shortness of breath. Which of the following actions should the nurse take first? a) Clamp the catheter. b) Position the client in left lateral Trendelenburg. c) Initiate oxygen therapy. d) Auscultate breath sounds.
a) Clamp the catheter. The greatest risk to this client is injury from further air entering the central venous catheter; therefore, the first action the nurse should take is to clamp the catheter.
A nurse is reviewing the laboratory results of a client who has acute leukemia and received an aggressive chemotherapy treatment 10 days ago. Which of the following hematologic laboratory values should the nurse expect? (Select all that apply.) a) Decreased platelet count b) Increased hemoglobin count c) Decreased leukocyte count d) Increased platelet count e) Decreased erythrocyte count
a) Decreased platelet count c) Decreased leukocyte count e) Decreased erythrocyte count
A nurse is caring for a client who has emphysema. Which of the following findings should the nurse expect to assess in this client? (Select all that apply.) a) Dyspnea b) Bradycardia c) Barrel chest d) Clubbing of the fingers e) Deep respirations
a) Dyspnea c) Barrel chest d) Clubbing of the fingers
A home health nurse is teaching a child's parents about endotracheal suctioning. Which of the following information should the nurse include in the teaching? a) Apply suction when inserting the catheter. b) Apply suction for less than 10 seconds. c) Set the suction pressure to 110 mm Hg. d) Allow the child to rest for 10 to 15 seconds after each suctioning attempt.
b) Apply suction for less than 10 seconds. Prolonged suctioning can cause damage to tissues and induce hypoxia. Hypoxia can interfere with stages of respiration, cellular absorption, and blood transport.
A nurse is caring for a client who has myelosuppression after receiving chemotherapy. The nurse should monitor the client for which of the following adverse effects? a) Anorexia and malnutrition b) Bleeding from the gums c) Diarrhea and dehydration d) Full body alopecia
b) Bleeding from the gums
A nurse is caring for a client who has a chest tube in place to a closed chest drainage system. Which of the following findings should indicate to the nurse that the client's lung has re-expanded? a) Oxygen saturation of 95% b) No fluctuations in the water seal chamber c) No reports of pleuritic chest pain d) Occasional bubbling in the water-seal chamber
b) No fluctuations in the water seal chamber Fluctuation stops when the lung has re-expanded, but the nurse should check for other indications of re-expansion, such as equal breath sounds bilaterally, because fluctuation can also stop when the tubing is obstructed, a dependent loop hangs below the rest of the tubing, or the suction source is not functioning.
A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. Which of the following actions should the nurse take to reduce the risk of ventilator-associated pneumonia? a) Position the head of the client's bed in the flat position. b) Turn the client every 4 hr. c) Brush the client's teeth with a suction toothbrush every 12 hr. d) Provide humidity by maintaining moisture within the ventilator tubing.
c) Brush the client's teeth with a suction toothbrush every 12 hr. The nurse should brush the client's teeth every 12 hr and rinse the client's mouth with an antimicrobial rinse to reduce the growth of bacteria.
A nurse is preparing a client for a radiation treatment who is postoperative following a mastectomy. The nurse should inform the client to expect which of the following adverse effects from the treatment? a) Alopecia b) Diarrhea c) Fatigue d) Anorexia
c) Fatigue
A nurse is assessing a client who is 1 day postoperative following a lobectomy and has a chest tube drainage system in place. Which of the following findings by the nurse indicates a need for intervention? a) Chest tube eyelets not visible b) Continuous bubbling in the suction control chamber c) Presence of tidal fluctuation in the water seal chamber d) Development of subcutaneous emphysema
d) Development of subcutaneous emphysema Subcutaneous emphysema is an indication that air is trapped in and under the skin, which be the result of a pneumothorax and should be reported to the provider.
A nurse is caring for a client who has chronic obstructive pulmonary disease (COPD). The client tells the nurse, "I can feel the congestion in my lungs, and I certainly cough a lot, but I can't seem to bring anything up." Which of the following actions should the nurse take to help this client with tenacious bronchial secretions? a) Maintaining a semi-Fowler's position as often as possible b) Administering oxygen via nasal cannula at 2 L/min c) Helping the client select a low-salt diet d) Encouraging the client to drink 2 to 3 L of water daily
d) Encouraging the client to drink 2 to 3 L of water daily COPD is a term for two diseases of the respiratory system: chronic bronchitis and emphysema. Maintaining hydration through the consumption of adequate fluids will help liquefy thick secretions and facilitate their expectoration.
A nurse is teaching for a client who is to begin taking tamoxifen to treat breast cancer. The nurse should instruct the client to expect which of the following findings as an adverse effect of the medication? a) Tinnitis b) Constipation c) Urinary retention d) Hot flashes
d) Hot flashes
A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan? a) Restrict the client's fluid intake to less than 2 L/day. b) Provide the client with a low-protein diet. c) Have the client use the early-morning hours for exercise and activity. d) Instruct the client to use pursed-lip breathing.
d) Instruct the client to use pursed-lip breathing. Pursed-lip breathing lengthens the expiratory phase of respiration and also increases the pressure in the airway during exhalation. This action reduces airway resistance and decreases trapped air for clients who have COPD.
How is COPD managed medically?
• Smoking cessation • Medication management • Manage exacerbations • Identify underlying cause & treat • Pulmonary rehab • Providing supplemental O2 • Nutritional therapy • Hospitalization • ABGs • Ventilatory support
A nurse is creating the plan of care for a client who is immunosuppressed. Which of the following precautions should the nurse include in the plan? (Select all that apply.) a) Don a mask, gloves, and gown. b) Restrict visitors who have active infections. c) Limit the client from bathing daily. d) Instruct the client to eat cooked foods only. e) Dispose of all linen in the trash after use.
a) Don a mask, gloves, and gown. b) Restrict visitors who have active infections. d) Instruct the client to eat cooked foods only.
A nurse is developing a plan of care for a client who is postoperative. Which of the following interventions should the nurse include in the plan to prevent pulmonary complications? a) Perform range-of-motion exercises b) Place suction equipment at the bedside c) Encourage the use of an incentive spirometer d) Administer an expectorant
c) Encourage the use of an incentive spirometer Incentive spirometry expands the lungs and promotes gas exchange after surgery which can help prevent pulmonary complications.
A nurse is caring for a client with a tracheostomy. The client's partner has been taught to perform suctioning. Which of the following actions by the partner should indicate to the nurse a readiness for the client's discharge? a) Attending a class given about tracheostomy care b) Verbalizing all steps in the procedure c) Performing the procedure independently d) Asking appropriate questions about suctioning
c) Performing the procedure independently The nurse should recognize that the client is ready for discharge when the spouse demonstrates an ability to perform the procedure that will need to be performed independently at home.
A client is receiving treatment for stage IV ovarian cancer and asks the nurse to discuss her prognosis. The client plans to have aggressive surgical, radiation, and chemotherapy treatments. Which of the following prognoses should the nurse discuss with the client? a) Good b) Guarded c) Poor d) Very good
c) Poor
