Test 2 - Gas exchange, asthma, pulmonary embolism, anemia, pneumonia, cystic fibrosis
A 2-year-old has just been diagnosed with CF. The parents ask the nurse what early respiratory symptoms they should expect to see in their child. Which is the nurse's best response?
"You can expect your child to develop wheezing respirations."
A female child with CF is hospitalized with constipation. The parent asks the nurse what will need to be done to relieve the child's constipation. Which is the nurse's best response?
"Your child will likely be given GoLYTELY to relieve her constipation."
ProTime (prothrombin)
11-13.5 seconds
sodium (Na) level
136-145
Serum albumin level
3.5-5
potassium (k) level
3.5-5
Asthma triad:
Nasal polyps asthma sensitivity to aspirin and NSAIDs
The nurse is administering oral glucocorticoids to a patient with asthma. What assessment finding would the nurse identify as a therapeutic response to this medication?
No observable respiratory difficulty or shortness of breath over the last 24 hours. (Glucocorticoids (corticosteroids) decrease inflammation and prevent bronchospasm in the patient with asthma.)
pneumococcal vaccine
PCV13, bacterial pneumonia for 65 or older adults
what is the recommendation when a patient has Tb and then family members also test positive for Tb?
person with a positive TST should have a chest x-ray to assess for active TB disease. Individuals with a diagnosis of TB must be reported to the public health authorities for identification and assessment of contacts and risk to the community.
cystic fibrosis can sometimes be initially diagnosed as what
pneumonia
LLL Crackles started up after it was diminished breath sounds
position patient on right side
what is asthma called for children at times and why
reactive airway disease because they can outgrow it
symptoms of asthma
recurrent episodes of wheezing, breathlessness, cough, and tight chest expiration prolonged
why are corticosteroids recommended for patient with respiratory condition?
reduce swelling and mucus production, bronchial hyperresponsiveness antiinflammatory
why give pancreatic enzymes to cystic fibrosis patient?
the pancreas also makes thick mucus that blocks the release of enzymes needed for proper digestion Unless a snack is pure sugar (such as a clear popsicle, hard candy or fruit juice),
A patient has severe exacerbation of asthma, what's the most concern to the nurse is:
unable to speak and sweating profusely
who is more likely to have asthma, women or men
women, 76% more likely
Primary Prevention for impaired gas exchange
• Infection control • Smoking cessation • immunizations • preventing postoperative complications
treatment for tuberculosis
• Isoniazid • Rifampin (Rifadin, Rimactane) • Ethambutol (Myambutol) • Pyrazinamide • Adherence is difficult, taken simultaneously -hard on liver so cut out alcohol, make ligaments looser *Types of drugs* o Antihistamine o Decongestants o Glucocorticoids o brochodilators
nursing interventions for patient with difficulty with gas exchange.
• nutrition therapy • positioning • Chest physiotherapy • Postural drainage • Oxygen therapy devices • Airway suctioning • Endotracheal tubes and tracheostomy tubes • Mechanical intubation • Chest tube management - smoking cessation
symptoms of acute asthma exacerbation
◦ High fever ◦ chills ◦ generalized flu symptoms ◦ pleuritic pain ◦ productive cough ◦ leukocytosis similar to pneumonia
anemia symptoms
*pallor*, jaundice, pruritis glossitis, cheilitis hemoglobin for severity
triggers for asthma
-allergens -exercise, cold induced -air pollutants -occupation - may take long time -respiratory infection - Increase inflammation and hyper-responsiveness of the tracheobronchial system -nose and sinus problems - rhinitis and nasal polyps -drugs and food additives - salicylates -Gastroesophageal Reflux Disease -emotional stress
creatinine level
0.6-1.5
INR
0.8-2 if on blood thinner - 2-3 if risk for clot formation - 2.5-3.5
urine specific gravity level
1.010-1.025
Magnesium level
1.7-2.2
Phosphorus level
2.4-4.1
HCO (bicarbonate)
22-26 metabolic
PaCO
35-45
in asthma, inflammatory mediators cause early or late phase response?
early phase response
best oral iron supplement
ferrous sulfate in acidic environment
When a patient is screened for Tb, when does the Tb test need to be read?
48-72 hours after administration
yellow zone for peak flow in asthma
50-80% of personal best caution, asthma is being triggered
pH level
7.35-7.45
BUN level
8-25
PaO
80-100
Calcium level
9-10.5
The nurse would anticipate that which of the following patients will need to be treated with insertion of a chest tube?
A patient experiencing a problem with a pneumothorax. -When air is allowed to enter the pleural space, the lung will collapse and a chest tube will be inserted to remove the air and reestablish negative pressure in the pleural space
Highest mortality rate of nosocomial infections
hospital acquired pneumonia
side effects for asthma patient who's taking short acting beta agonist
increased heart rate, shakiness, cramping, anxiety, breathlessness
goal for asthma
keep oxygen sat at 90 or above
Nurse suspects development of a pleural effusion upon finding what
localized absence of breath sounds
pulmonary embolism affects upper or lower lobes more?
lower lobes
best diagnostic test for asthma
ABGs
What is cystic fibrosis
lungs and digestive system become clogged with thick sticky mucus. Symptoms usually start in early childhood and include: persistent cough. recurring chest and lung infections. poor weight gain elevated NaCl
Tuberculosis involves what 2 organs of body?
lungs and kidneys
Hct (hematocrit)
male: 42-52% female: 37-47%
Hb (hemoglobin)
male:14-18 female:12-16
once you test positive for TB, you take the test again?
no, positive for life ( take chest x-ray every year)
asthma - quick relief medication
Anticholinergics (emergency) Systemic corticosteroids Short acting beta agonists (bronchodilators) Inhaled short-acting beta2-agonist (for acute asthma)
When evaluating the concept of gas exchange, how would the nurse best describe the movement of oxygen and carbon dioxide?
Gas moves from an area of high pressure to an area of low pressure across the alveolar membrane
anticoagulation for pulmonary embolism
Heparin - subq recommended in stomach Antidote - protamine sulfate Coumadin - oral Antidote - vitamin K
diagnostic tests for pulmonary embolism
D-dimer *Spiral (helical) CT scan* - most frequent Ventilation-perfusion (V/Q) scan Pulmonary angiography
Niox Mino
Measures fractional exhaled nitric oxide - increased in asthma patients
Nursing care for patient is scheduled for a bronchoscopy
NPO
nursing interventions for patient with difficulty with gas exchange. how could increasing fluid intake help this patient?
Fluids help minimize mucosal drying and maximize ciliary action to move secretions
asthma - long term control medication
Inhaled corticosteroids (ICSs) - most effective Long-acting beta2-agonists Cromolyn sodium or neocromil - alternative Leukotriene modifiers - alternative Immunotherapy - alternative for age 12 Anti-IgE and Theophylline
The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The patient tells the nurse he is having a "hard time breathing." His respiratory rate is 32 breaths per minute, his pulse is 120 beats per minute, and the oxygen saturation is 90%. What would be the best nursing intervention for this patient?
Initiate oxygen via a nasal cannula, and begin at a flow rate of 3 L/min. -The normal respiratory drive is a person's level of carbon dioxide (CO2) in the arterial blood. The COPD patient had compensated for his chronic high levels of CO2, and his respiratory drive is dependent on his oxygen levels, not his CO2 levels
A 7-month-old is taken to the pediatrician's office with a low-grade fever, nasal congestion, and a mild cough. Which should the nursing care management of this child include?
Instilling saline nose drops and bulb suctioning
A patient is having the arterial blood gas (ABG) measured. What would the nurse identify as the parameters to be evaluated by this test?
Status of acid-base balance in arterial blood Partial pressure of oxygen and carbon dioxide
Which of the following statements about the inheritance of CF is most accurate?
The child of a mother who has CF and a father who is a carrier of the gene for CF has a 50% chance of acquiring CF
The parents of a 5-week-old have just been told that their child has CF. The mother had a sister who did of CF when she was 19 years of age. The parents are sad and ask the nurse several questions about CF and the current projected life expectancy. What is the nurse's best initial intervention?
The nurse should listen to the parents and be available to them anytime during the day to answer their questions
The parent of an 18-year-old with CF is excited about the possibility of the child receiving a double lung transplant. What should the parent understand?
The transplant will not cure the child of CF but will allow the child to have a longer life
The nurse caring for a female pediatric client with cystic fibrosis sends a stool for analysis. The results show an excessive amount of azotorrhea and steatorrhea (excessive fat and protein). What does the nurse realize about the laboratory values?
They reflect that the patient is not compliant with taking her enzymes
The parent of a 10-month-old with CF asks the nurse how to meet the child's increased nutritional needs. Which is the nurse's best suggestion?
You may need to change your child to a higher-calorie formula
for a pt with cystic fibrosis, when is the best time to do the child's chest physiotherapy (CPT) in relation to eating?
You should do the first CPT 30 minutes before feeding the child breakfast.
A 5-year-old female is diagnosed with pharyngitis. The child is complaining of throat pain. which of the following statements by the mother indicates that she needs more education regarding the care and treatment of her daughter's throat pain?
a."I will have my daughter gargle with warm saline three times a day." b."I will offer my daughter ice chips several times a day." c."I will give my daughter Tylenol every 4 to 6 hours as needed." d.*"I will give my daughter her amoxicillin until all doses of the antibiotic are gone."*
if a patient has a bronchodilator and a steroid inhaler both ordered, which would be used first?
bronchodilator
big risk factor for pulmonary embolism
deep vein thrombosis
most common symptom of pulmonary embolism
dyspnea/shortness of breath
