Respiratory

Which GI comorbidities may be sign in a patient with Cystic Fibrosis? (S/A) Celiac disease Rectal prolapse Meconium ileus Chronic vomiting

Rectal prolapse Meconium ileus

Upper airway infections

Rhinitis Rhinosinusitis Pharyngitis

A child is anxious, drooling, and sitting forward with the neck extended to breathe. These signs indicate: tuberculosis (TB) asthma cystic fibrosis epiglottitis

epiglottitis

Which disease(s) is included in both upper and lower respiratory? (select all) Epiglottitis Croup Asthma RSV

Epiglottitis Croup

Which statement by the child's mother indicates an understanding of how to administer the supplemental enzymes? "I will stop the enzymes if my child is receiving antibiotics." "Decrease the dose by half if my child is having frequent, bulky stools." "Between meals is the best time for me to give the enzymes." "The enzymes should be given at the beginning of each meal and snack."

"The enzymes should be given at the beginning of each meal and snack."

ARDS treatments

-ABX to treat infection -Corticosteriods for inflammation -Diuretics to eliminate fluid -Norepinephrine to restore BP Dopamine to increase CO, increase systolic pressure -Surfactant therapy -Extracorporeal Membrane Oxygenation -Ventilator

A patient with acute respiratory distress syndrome (ARDS) is receiving oxygen by nonrebreather mask, but arterial blood gas measurements continue to show poor oxygenation. Which action does the nurse anticipate that the health care provider will prescribe? 1.Perform endotracheal intubation and initiate mechanical ventilation. 2.Immediately begin continuous positive airway pressure (CPAP) via the patient's nose and mouth. 3.Administer furosemide (Lasix) 100 mg IV push immediately (STAT). 4.Call a code for respiratory arrest.

1.Perform endotracheal intubation and initiate mechanical ventilation. A nonrebreather mask can deliver nearly 100% oxygen. When the patient's oxygenation status does not improve adequately in response to delivery of oxygen at this high concentration, refractory hypoxemia is present. Usually at this stage, the patient is working very hard to breathe and may go into respiratory arrest unless health care providers intervene by providing intubation and mechanical ventilation to decrease the patient's work of breathing.

The nurse is admitting a patient for whom a diagnosis of pulmonary embolus must be ruled out. The patient's history and assessment reveal all of these findings. Which finding supports the diagnosis of pulmonary embolus? 1.The patient was recently in a motor vehicle crash. 2.The patient participated in an aerobic exercise program for 6 months. 3.The patient gave birth to her youngest child 1 year ago. 4.The patient was on bed rest for 6 hours after a diagnostic procedure.

1.The patient was recently in a motor vehicle crash. Patients who have recently experienced trauma are at risk for deep vein thrombosis (DVT) and pulmonary embolus (PE). None of the other findings are risk factors for PE. Prolonged immobilization is also a risk factor for DVT and PE, but this period of bed rest was very short.

The nurse is supervising an RN who floated from the medical-surgical unit to the emergency department. The float nurse is providing care for a patient admitted with anterior epistaxis (nosebleed). Which directions would the supervising nurse clearly provide to the RN? Select all that apply. 1.Position the patient supine and turned on his side. 2.Apply direct lateral pressure to the nose for 5 minutes. 3.Maintain standard body substance precautions. 4.Apply ice or cool compresses to the nose. 5.Instruct the patient not to blow the nose for several hours. 6.Teach the patient to avoid vigorous nose blowing.

2 3 4 5 6 The correct position for a patient with an anterior nosebleed is upright and leaning forward to prevent blood from entering the stomach and to avoid aspiration. All of the other instructions are appropriate according to best practice for emergency care of a patient with an anterior nosebleed.

The nurse is supervising a nursing student who is providing care for a thoracotomy patient with a chest tube. What finding would the nurse clearly instruct the nursing student to report immediately? 1.Chest tube drainage of 10 to 15 mL/hr 2.Continuous bubbling in the water-seal chamber 3.Reports of pain at the chest tube site 4.Chest tube dressing dated yesterday

2.Continuous bubbling in the water-seal chamber Continuous bubbling indicates an air leak that must be identified. With the health care provider's (HCP's) order, an RN can apply a padded clamp to the drainage tubing close to the occlusive dressing. If the bubbling stops, the air leak may be at the chest tube insertion, which will require the RN to notify the HCP. If the air bubbling does not stop when the RN applies the padded clamp, the air leak is between the clamp and the drainage system, and the RN must assess the system carefully to locate the leak. Chest tube drainage of 10 to 15 mL/hr is acceptable. Chest tube dressings are not changed daily but may be reinforced. The patient's reports of pain need to be assessed and treated. This is important but is not as urgent as investigating a chest tube leak.

The nurse is the preceptor for an RN who is undergoing orientation to the intensive care unit. The RN is providing care for a patient with acute respiratory distress syndrome (ARDS) who has just been intubated in preparation for mechanical ventilation. The preceptor observes the RN performing all of these actions. For which action must the preceptor intervene immediately? 1.Assesses for bilateral breath sounds and symmetrical chest movement 2.Uses an end-tidal carbon dioxide detector to confirm endotracheal tube (ET) position 3.Marks the tube 1 cm from where it touches the incisor tooth or nares 4.Orders chest radiography to verify that tube placement is correct

3.Marks the tube 1 cm from where it touches the incisor tooth or nares The ET should be marked at the level where it touches the incisor tooth or nares. This mark is used to verify that the tube has not shifted. The other three actions are appropriate after ET placement. The priority at this time is to verify that the tube has been correctly placed. Use of an end-tidal carbon dioxide detector is the gold standard for evaluating and confirming ET position in patients who have adequate tissue perfusion.

When assessing a 22-year-old patient who required emergency surgery and multiple transfusions 3 days ago, the nurse finds that the patient looks anxious and has labored respirations at a rate of 38 breaths/min. The oxygen saturation is 90% with the oxygen delivery at 6 L/min via nasal cannula. Which action is most appropriate? 1.Increase the flow rate on the oxygen to 10 L/min and reassess the patient after about 10 minutes. 2.Assist the patient in using the incentive spirometer and splint his chest with a pillow while he coughs. 3.Administer the ordered morphine sulfate to the patient to decrease his anxiety and reduce the hyperventilation. 4.Switch the patient to a nonrebreather mask at 95% to 100% fraction of inspired oxygen (FIO2) and call the health care provider to discuss the patient's status.

4.Switch the patient to a nonrebreather mask at 95% to 100% fraction of inspired oxygen (FIO2) and call the health care provider to discuss the patient's status. The patient's history and symptoms suggest the development of acute respiratory distress syndrome (ARDS), which will require intubation and mechanical ventilation to maintain oxygenation and gas exchange. The HCP must be notified so that appropriate interventions can be taken. Application of a nonrebreather mask can improve oxygenation up to 95 to 100%. The maximum oxygen delivery with a nasal cannula is an Fio2 of 44%. This is achieved with the oxygen flow at 6 L/min, so increasing the flow to 10 L/min will not be helpful. Helping the patient to cough and deep breathe will not improve the lung stiffness that is causing his respiratory distress. Morphine sulfate will only decrease the respiratory drive and further contribute to his hypoxemia.

·Which medication should the nurse anticipate the healthcare provider ordering for the patient diagnosed with ARDS? o An aminoglycoside antibiotic o A synthetic surfactant o A potassium cation o A non-steroidal anti-inflammatory drug

A synthetic surfactant Surfactant therapy may be prescribed to reduce the surface tension in the alveoli. The surfactant helps maintain open alveoli, decreases the work of breathing, improves compliance, and helps prevent atelectasis.

The patient diagnosed with ARDS is transferred to the intensive care unit and placed on a ventilator. Which intervention should the nurse implement first? o Confirm that the ventilator settings are correct. o Verify that the ventilator alarms are functioning properly. o Assess the respiratory status and the pulse ox reading. o Monitor the patients arterial blood gas results.

Assess the respiratory status and the pulse ox reading. o Assessment is the first part of the nursing process and is the first intervention the nurse should implement when caring for a patient on a ventilator. Tube placement needs to be assessed any time the patient is moved.

Cancer of the Larynx: s/sx

Characterized by hoarseness and/or voice characteristics, palpable jugular nodes, pain when swallowing, and unexplained earache.

What are the side effects of anticholinergic bronchodilators? (select all) Cough Increased secretions Dry mouth Constipation

Cough Dry mouth Constipation

What is the most common debilitating disease of childhood among those of European descent? Cystic fibrosis BPD Pneumonia Asthma

Cystic fibrosis

Major sign of Acute Respiratory Distress Syndrome (ARDS)

HYPOXIA in the presence of high oxygen: Decreased arterial oxygen level (PaO2) while administering high levels of oxygen; oxygen is unable to cross the alveolar membrane

· The patient has just been diagnosed with a PE. Which intervention should the nurse implement? o Administer oral anticoagulants. o Assess the patient's bowel sounds. o Prepare the patient for a thoracentesis. o Institute and maintain bedrest.

Institute and maintain bedrest o Bed rest reduces metabolic demands and tissue needs for oxygen.

·The nurse suspects a patient may be developing ARDS. Which assessment data confirm the diagnosis of ARDS? o Low arterial oxygen when administering a high concentration of oxygen. o The patient has dyspnea and tachycardia and is feeling anxious. o Bilateral breath sounds clear and the pulse of reading is 95% o The patient has jugular vein distension and frothy sputum.

Low arterial oxygen when administering a high concentration of oxygen. The classic sign of ARDS is decreased arterial oxygen level (PaO2) while administering high levels of oxygen; the oxygen is unable to cross the alveolar membrane

Non-invasive respiratory therapy

Oxygen therapy Incentive spirometry Small-volume nebulizer Chest physiotherapy

The patient is getting out of bed and becomes very anxious and has a feeling of impending doom. The nurse thinks the patient may be experiencing a pulmonary embolism. Which action should the nurse implement first? o Administer oxygen 10L via nasal cannula. o Place the patient in a high semi fowlers position o Obtain a stat pulse ox reading. o Auscultate the patient's lung sounds.

Place the patient in a high semi fowlers position o Placing the patient in high semi fowlers maximizes lung expansion and reduces venous return to the right side of the heart, thus lowering pressures in the pulmonary vascular system. o The patient needs oxygen, but the nurse can do something that will help the patient before applying the oxygen. o Assessing the patient is indicated, but it is not the first intervention in this situation.

Infant with RSV bronchiolitis in resp distress; copious secretions, increased work of breathing, cyanosis, resp rate 78 Attempt to calm infant: place in his mother's lap and offer a bottle Request an order for a stat chest radiograph from MD Suction secretions, provide 100% oxygen via mask, anticipate resp failure Begin bag-valve-mask ventilatation

Suction secretions, provide 100% oxygen via mask, anticipate resp failure

The charge nurse is making rounds. Which patient should the nurse assess first? o The 29-year-old patient diagnosed with reactive airway disease who is complaining that the nurse caring for him was rude. o The 76-year-old patient diagnosed with heart failure who has 2+ edema of the lower extremities. o The 15-year-old patient diagnosed with Diabetic Ketoacidosis after a bout with the flu who has a blood glucose reading of 189mg/dL o The 62-year-old patient diagnosed with COPD and Pneumonia who is receiving O2 by nasal cannula at 2 L per minute.

The 29-year-old patient diagnosed with reactive airway disease who is complaining that the nurse caring for him was rude. The charge nurse is responsible for all patients. At times it is necessary to see patients with a psychosocial need before other patients who have situations that are expected and are not life threatening. TEST-TAKING HINT: All of the answer options except one (1) have expected data listed.

Obstructive Sleep Apnea

a disorder in which a person, while asleep, stops breathing because his or her throat closes; the condition results in frequent awakenings during the night

Small-Volume Nebulizer (Mini-Nebulizer Therapy)

a handheld apparatus that disperses a moisturizing agent or medication, such as a bronchodilator or mucolytic agent, into microscopic particles and delivers it to the lungs as the patient inhales

Which factors contribute to infants' and children's increased risk for upper airway obstruction compared to adults? Underdeveloped cricoid cartilage and narrow nasal passages. Cylinder-shaped larynx and underdeveloped sinuses. Small tonsils and narrow nasal passages. Underdeveloped cricoid cartilage and smaller tongue.

Underdeveloped cricoid cartilage and narrow nasal passages.

Surfactant Therapy

beractant Survanta, calfactant Infasurg, proactant alfa Curosurf Require intubation for administration. may be prescribed to reduce the surface tension in the alveoli. The surfactant helps maintain open alveoli, decreases the work of breathing, improves compliance, and helps prevent atelectasis.

Chest Physiotherapy

includes postural drainage, chest percussion and vibration, coughing and breathing retraining. to remove bronchial secretions, improve ventilation, and increase the efficiency of the respiratory muscles.

Rhinitis

inflammation of the mucous membranes of the nose

Rhinosinusitis

inflammation of the nares and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid sinuses; replaces the term sinusitis

Pharyngitis

inflammation of the pharynx

Incentive Spirometry

method of deep breathing that provides visual feedback to encourage the patient to inhale slowly and deeply to maximize lung inflation and prevent or reduce atelectasis

Epistaxis

nosebleed

cor pulmonale treatment

rest, correction of arrhythmia, diuretics, na restriction

cor pulmonale

right ventricular hypertrophy and heart failure due to pulmonary hypertension

Tracheostomy

surgical creation of an opening into the trachea through the neck