Pulmonary Disorders

What are signs of a late asthmatic response?

- Air trapping - Hyperinflation distal to obstructions - Increased work of breathing - Hypoxemia

What are some things you'd notice in your assessment if a patient was in the exudative phase of ARDS?

- Restlessness, apprehension, tachypnea - Respiratory alkalosis - PaO2 and CXR may be normal initially- progresses to refractory hypoxemia and interstitial infiltrates **Abnormal CXR could be delayed (after 24hrs)**

What S&S would you see in tension pneumothorax?

- Tracheal deviation - Hyperresonant on defective side - Trachea shift to the opposite side - Absent breath sounds

Who's at risk for tension pneumo?

- Trauma - Mechanical ventilation especially on PEEP and prolonged support with ARDS - Subclavian CVC insertion - Emphysema - Status asthmatics - Malfunctioning chest tube in patients with air leak - Conversion of pneumothorax to a tension pneumothorax after intubation

A client with a history of ventricular tachycardia is provided with an implantable cardioverter/defibrillator (ICD) device to prevent sudden cardiac death. Upon discharge, the nurse provides instructions to the client and family. The nurse instructs the client:

"Avoid industrial equipment and television transmission towers."

Breathing pattern most seen in heart failure and head injury?

Cheyne-Stokes Alternating periods of deep and shallow breathing; apnea lasting 15 to 60 seconds, followed by ventilations that increase in volume until a peak is reached, after which ventilation decreases again to apnea

Acute respiratory failure (ARF)

Alveolary hypoventilation Ventilation/Perfusion mismatching Clinical symptoms may not be reliable ABG used to determine course PAO2 <60 and/or PCO2 >50

A client who was found to be unconscious in their home is brought to the emergency room via ambulance. On admission, several laboratory tests are performed including arterial blood gases. The following values are obtained: pH: 7.53, pO2 94, O2Sat 96%, pCO2 40, Bicarbonate(HCO3)44, Base Excess: +3 The nurse knows that a medical diagnosis that would be consistent with these values would be:

Bulemia. In bulimia, eating binges may occur as often as several times daily for many months. These binges cause a sense of self-disgust, which leads to compensatory behaviors like self-induced vomiting. Vomiting can be associated with metabolic alkalosis due to the loss of electrolytes and acid in the emesis.

How could ALI and ARDS be identified?

Characterized by noncardiac pulmonary edema and disruption of alveolar-capillary membrane

What could happen from Bullous Emphysema?

Creates pneumothorax--> tension pneumo-->chest tube

Palpation sounds like ______ in hemothorax? pneumothorax?

Dull/Hyperresonant

What are the phases of ARDS?

Exudative: 24 hours after initial insult; humoral mediators damage alveolar capillary membrane Proliferative:7-10 days disordered healing begins; Type II cells multiply Fibrotic:2-3 weeks; cellular granulation and collagen deposition resulting in pulmonary fibrosis

A client is admitted to the telemetry unit with complaints of heart palpitations, confusion, dizziness, and fatigue. In assessing the client for left-sided heart failure, the nurse would expect to report:

Frothy-pink-tinged sputum.

Your assessment of the patient receiving mechanical ventilation is critical to prevention and early detection of problems. The impact of mechanical ventilation may include:

Gastric distention

A college basketball player collapses during a game and is revived with an external defibrillator. The client is admitted to the coronary care unit and diagnosed with Long Q-T syndrome. Because of this diagnosis, the nurse includes in a discussion with the client and the client's parents education about the:

Genetic basis of this syndrome. Long Q-T syndrome is inherited in an autosomal-dominant pattern of inheritance with most individuals inheriting the gene from an affected parent. The diagnosis of this condition in one child in a family means that the other individuals in the family should also be tested for the presence of this life-threatening arrhythmia and is most successfully managed with beta blocker medication.

Please match the acid base disorders with the clincal condition/situation: Each answer is used only once.

Heroin overdose Correct A. Respiratory acidosis Recent diuretic use Correct C. Metabolic alkalosis Diabetic ketoacidosis Correct D. Metabolic acidosis Mechanical ventilation for head injury Correct B. Respiratory alkalosis

An elderly client is admitted to the emergency room. The client states "I didn't take my heart pill or my water pill this morning because I was sick to my stomach." The client's records show that the client has been taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 20 mg every morning. Laboratory values obtained on admission to the emergency room show a potassium level of 3.1mEq/L. The nurse places the client on a cardiac monitor, which shows a heart rate is 52 and frequent premature ventricular contractions (PVCs). Which action does the nurse take when the client states a desire to urinate?

Obtain a bedside commode or urinal for the client.

The emergency room nurse admits a client with multiple injuries following a motor vehicle accident. The client's respirations are shallow and labored. The client is intubated and placed on a ventilator. The nurse knows the first action immediately following intubation is:

Listening for bilateral breath sounds.

Which side should the patient lie on to prevent atelectasis following a lobectomy? What about a pneumonectomy?

Lobectomy-nonoperative side down-affected lung dependent as little as possible, turn frequently Pneumonectomy-supine or operative side down during initial post op period-surgeon will indicate when side to side is safe

What are medications that trigger Asthma? What should they switch to?

NSAIDS AND ASA trigger. Instruct patient to switch to Tylenol

What side should you lie a patient who has LLL PNA?

On their right side (good side. This will allow for better perfusion

What's a good tool for Asthma patients to take home to monitor their progression?

Peak flow meter

What is a shunt?

Perfusion without ventilation Unoxygenated blood returning to left side of heart

When do you most often see patients with Atelectasis?

Post surgical

A client has just returned to the unit after a right pneumonectomy. The nurse should position the client:

Slightly toward the right side. Current theory states that either the back or slightly toward the operative side are both appropriate positions. After a pneumonectomy, the operative side should be slightly dependent so that fluid in the pleural space remains below the level of the bronchial stump, and the inoperative side can fully expand. However, it is believed that if the client is positioned completely on the operative side, this may put pressure on the bronchial stump.

What is Acute Lung Injury (ALI)

Systemic process considered to be the pulmonary manifestation of multiple organ dysfunction syndrome

Your patient has had a RUL lobectomy and is now returning from the recovery room; the fluid in the chest tube water seal has stopped fluctuating. The nurse most appropriately interprets this assessment to indicate :

The tubing may be kinked.

What is tension pneumothorax?

This condition occurs when air leaks into the space between the lungs and chest wall. A blunt or penetrating chest injury, certain medical procedures, or lung disease can cause a pneumothorax.

Match the values with the acid-base disorder and use each answer only once:

pH 7.1, HCO3 8 Correct A. Metabolic acidosis pH 6.9, HCO3 24 Correct C. Respiratory acidosis pH 7.6, PCO2 40 mmHg Correct B. Metabolic alkalosis pH 7.54, HCO3 24 Correct D. Respiratory alkalosis