Questions and Answers
What is the primary cause of a pneumothorax?
Which of the following symptoms is associated with a pneumothorax?
What might absent or decreased breath sounds on the affected side indicate?
Which of the following symptoms would suggest the presence of hypoxia in a patient?
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What is the purpose of anticoagulant therapy in the management of pulmonary embolism?
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Which diagnostic test provides a direct anatomical view of the pulmonary vessels?
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What complication might arise from the administration of anticoagulants?
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Why is monitoring of partial thromboplastin time (PTT) necessary during heparin therapy?
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Which medication would be used for long-term anti-coagulation after a thrombus or embolism?
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What is a key indication of respiratory alkalosis in a patient experiencing tachypnea?
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What is indicated by the presence of elevated levels of D-dimer in a patient's blood test?
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Which nursing intervention is critical when monitoring a patient with DVT?
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What is a possible sound associated with a penetrating chest injury during inspiration?
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Which of the following assessments would indicate hypoxia?
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What imaging test is primarily used to assess for lung expansion or collapse?
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What is the purpose of a Heimlich valve in managing a chest tube?
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In assessing a patient for pneumothorax, what vital sign change is most likely to occur?
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What nursing diagnosis is appropriate for a patient with ineffective breathing pattern due to pneumothorax?
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What is the purpose of needle thoracostomy in the management of pneumothorax?
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What is a characteristic feature of small cell lung cancer?
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What kind of lung cancer accounts for approximately 30% of cases?
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What is a common clinical manifestation of pulmonary edema?
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Which medication is primarily used to reduce alveolar and systemic edema in pulmonary edema?
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How does acute pulmonary embolus primarily affect blood flow in the lungs?
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What symptom is indicative of severe respiratory distress in pulmonary edema?
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Which of the following describes 'atelectasis' in relation to pulmonary embolus?
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What nursing intervention is crucial for patients experiencing pulmonary edema?
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Which factor may lead to non-cardiogenic pulmonary edema?
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What is the initial interpretation of ABG in pulmonary edema at onset?
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Which cardiac medication can help reduce anxiety in pulmonary edema patients?
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In which positioning is a patient with pulmonary edema most likely to have maximal gas exchange?
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Which clinical manifestation is a sign of moderate to severe pulmonary embolus?
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What are common symptoms associated with central lesions in lung cancer?
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What may present as a result of metastasis in lung cancer patients?
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Which surgical treatment would not require post-operative chest tube drainage?
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Which finding indicates a possible pleural effusion in a lung cancer patient during assessment?
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Which of the following is a recommended nursing intervention for a lung cancer patient post-surgery?
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What is the primary aim of medical management for lung cancer patients?
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What can cause clubbing of the fingers in lung cancer patients?
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Which factor is NOT a subjective symptom of lung cancer?
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What is a hallmark sign that indicates possible advanced lung cancer and its effects?
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Which of the following techniques can help avoid venous stasis?
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What is the correct method for applying antiembolism hose?
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What is an essential dietary consideration for a patient on Coumadin therapy?
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What is the primary purpose of monitoring ABGs in a patient with impaired gas exchange?
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What complication should be monitored for in patients receiving anticoagulation therapy?
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What is one of the primary causes of ARDS?
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What might be an indication of hypoxia in a patient?
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What does an arterial blood gas indicate when there is an increased PaCO2?
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What is the primary goal of medical management for ARDS?
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In the treatment of pulmonary edema in ARDS, which medication is commonly used?
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What nursing intervention is prioritized to maintain gas exchange in ARDS?
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Which of the following respiratory statuses would indicate a worsening condition in an ARDS patient?
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Why is prone positioning significant for ARDS patients?
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What is a consequence of hypoxemia during ARDS?
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What does a decreased HCO3 indicate in terms of respiratory function?
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Which of the following is a common environmental allergen that can trigger asthma?
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What is a key physical sign of bronchiectasis in a patient?
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Which diagnostic test is considered the gold standard for diagnosing bronchiectasis?
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What is a common symptom of bronchiectasis observed during morning episodes?
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What is one of the late signs of bronchiectasis that healthcare providers should monitor for?
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Why are corticosteroids prescribed mainly during acute exacerbations in patients with respiratory diseases?
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What is a significant aspect of patient teaching for someone with emphysema regarding their diet?
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Which medication type is often administered to alleviate anxiety in patients experiencing respiratory distress?
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What is the impact of high flow oxygen on patients with COPD?
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Which of the following actions is most important for infection control in patients with COPD?
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What should patients with emphysema be taught about fluid consumption?
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How often should patients with COPD receive the flu vaccine?
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Which agent is critical for diuresis in certain respiratory patients?
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What is an essential component of care management for patients with COPD?
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In the context of respiratory diseases, what is a common cause of chronic bronchitis?
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Which symptom is most indicative of an acute asthma attack?
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What tool can help a patient monitor the severity of asthma symptoms?
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Which medication should not be used as the sole therapy for persistent asthma?
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What should be monitored during an acute asthma attack?
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What condition is characterized by severe and unrelenting asthma symptoms unresponsive to medication?
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Which of the following indicates that a patient may be experiencing respiratory distress?
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What is a common side effect associated with medications used to manage asthma?
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What is the main pathophysiological change in emphysema?
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What is a common clinical manifestation of emphysema?
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What is the normal range of peak flow for most individuals?
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What would a chest x-ray typically reveal in a patient with emphysema?
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What is a primary nursing intervention to manage asthma effectively?
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What is a likely consequence of untreated chronic bronchitis?
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A PaCO2 value of 22-26 mmHg indicates what condition?
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What is a common objective assessment finding in chronic obstructive pulmonary disease?
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Which of the following ABG results indicates respiratory acidosis?
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What is the expected effect of the albuterol and ipratropium nebulizer treatment?
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Which symptom is commonly associated with chronic bronchitis and is most pronounced in the morning?
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What is a potential late clinical manifestation of chronic bronchitis?
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Which diagnostic test can help indicate the presence of hypoxia in chronic bronchitis patients?
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Which medication class is commonly used to facilitate airway dilation in chronic bronchitis management?
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Which objective assessment finding signifies increased respiratory effort in chronic bronchitis patients?
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What nutritional considerations are important for patients with chronic bronchitis?
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In assessing patients with chronic bronchitis, which vital sign should be closely observed for sudden changes?
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Which surgical procedures require chest tubes post-operatively?
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What type of fluid accumulation is characteristic of pulmonary edema?
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Which medication is primarily used to reduce alveolar and systemic edema in pulmonary edema?
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What common medication might be administered alongside oxygen therapy in pulmonary edema management?
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What clinical manifestation is associated with central lesions in lung cancer?
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Which diagnostic test is more precise for identifying the location and size of a lung tumor?
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Which surgical procedure involves the removal of an entire lung?
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What is the expected outcome for patients with ineffective airway clearance due to lung cancer surgery?
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What nursing intervention is appropriate for improving the quality of life for lung cancer patients?
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In nursing diagnoses for lung cancer, which outcome is associated with the diagnosis of fear?
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What clinical manifestation is commonly associated with pulmonary embolism?
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What is a common diagnostic test used to confirm the presence of deep vein thrombosis (DVT)?
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What medication is primarily used for long-term anticoagulation following a thrombus or embolism?
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What is the primary purpose of administering anticoagulant therapy in pulmonary embolism management?
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Which nursing intervention can help assess the severity of a patient's hypoxemia?
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What diagnostic test is commonly used to visualize pulmonary blood flow and ventilation?
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What condition is indicated by hypoxia, elevated pulmonary vascular resistance, and atelectasis?
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Which medication may be administered to dissolve a pulmonary embolism?
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What should be monitored to prevent complications during heparin therapy?
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In emergency situations, what procedure may be required to remove a large thrombus from the pulmonary artery?
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Which of the following techniques is NOT recommended to avoid venous stasis?
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What is a critical aspect of Coumadin therapy that patients must understand?
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What phase of acute respiratory distress syndrome (ARDS) is characterized by uncontrolled inflammation?
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Which symptom should be monitored as a sign of potential bleeding complications during anticoagulation therapy?
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In which phase of ARDS does pulmonary edema resolve and a fibrin matrix form?
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What is the primary risk associated with untreated pulmonary embolism?
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Which medication is considered an antidote for heparin?
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What should be done to assist a patient with impaired gas exchange related to pulmonary issues?
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What clinical manifestation may indicate a pneumothorax?
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Which of the following assessment findings is consistent with a tension pneumothorax?
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What is the purpose of chest tube insertion in the management of pneumothorax?
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What immediate nursing intervention should be prioritized for a patient presenting with a suspected tension pneumothorax?
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What psychological response might a patient experience related to the feeling of air hunger with a pneumothorax?
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What finding on an ABG test is expected in a patient with a pneumothorax?
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Study Notes
Enabling Learning Objectives
- Explain the etiology of acute respiratory disorders: pneumothorax, lung cancer, pulmonary edema, pulmonary embolus, ARDS, and acute respiratory failure.
- Instruction includes handouts, scenarios, and discussion in a classroom environment.
Pneumothorax
- Accumulation of air or gas in pleural space leads to lung collapse.
- Causes include:
- Chest trauma (laceration, puncture, fractured ribs)
- Ruptured bleb due to emphysema
- Spontaneous events
- Disruption of normal negative pressure prevents lung inflation.
- Tension pneumothorax is life-threatening and requires immediate intervention.
- Clinical signs:
- Absent/decreased breath sounds
- Sharp pleuritic pain and dyspnea
- Tachycardia, tachypnea, and hypotension
- Diagnostic tests: chest x-ray shows lung collapse and mediastinal shift, ABG indicates hypoxemia and acidosis.
- Medical management includes chest tube insertion, Heimlich valve usage, and needle thoracostomy for tension pneumothorax.
- Nursing interventions focus on maintaining airway patency, monitoring vital signs, and patient education about avoiding irritants and recognizing symptoms.
Lung Cancer
- Lung cancer is the leading cause of cancer-related deaths, accounting for 27% of cancer fatalities.
- Primary tumors often arise from colon or kidney metastasis; smoking is a major contributing factor (87% of cases).
- Clinical manifestations can be peripheral (asymptomatic until later stages) or central (hemoptysis, dyspnea).
- Diagnostic tests include chest x-ray, CT scans, and bronchoscopy with biopsy.
- Treatment varies by type and stage, ranging from surgical interventions (lobectomy, pneumonectomy) to chemotherapy and radiation.
- Prognosis is poor, with only 15.9% of patients surviving five years or longer.
Pulmonary Edema
- Defined as fluid accumulation in lung interstitium and alveoli, primarily due to severe left ventricular failure.
- Clinical signs: dyspnea, tachypnea, pink frothy sputum, hypoxia, and cyanosis.
- Diagnostic tests show CXR results indicating alveolar edema and pleural effusion; ABG assesses oxygenation status.
- Medical management includes oxygen therapy and medications like Lasix and morphine to reduce pulmonary congestion.
- Nursing care emphasizes monitoring respiratory status, ensuring optimal positioning, and educating patients about fluid restrictions and breathing techniques.
Pulmonary Embolus
- Occurs when a foreign substance, such as a blood clot, enters the pulmonary artery, obstructing blood flow.
- Risk factors include prior thrombophlebitis, recent surgeries or pregnancy, and long-term contraceptive use.
- Clinical manifestations are sudden chest pain, unexplained dyspnea, hemoptysis, and hypotension.
- Obstruction leads to ventilation-perfusion mismatch, regional bronchoconstriction, and pulmonary edema.
- Assessment involves determining the severity of symptoms and identifying risk factors for thrombus formation.
Summary
- Comprehensive understanding of the etiology, clinical manifestations, diagnostic tests, medical management, and nursing interventions is essential for effective care of patients with acute respiratory disorders.### Pleuritic Chest Pain and Cough Assessment
- Pleuritic chest pain often indicates conditions affecting the pleura, leading to sharp, localized pain during respiration.
- The nature of a patient's cough can provide insight into respiratory issues; it should be evaluated for type and frequency.
- Observe for signs of tachypnea (rapid breathing), tachycardia (increased heart rate), and symptoms of hypotension (low blood pressure).
- Auscultation of the chest may reveal crackles or decreased breath sounds, indicative of underlying pulmonary issues.
- The presence of a pleural friction rub suggests irritation of the pleura, commonly associated with pneumonia or other pleural conditions.
- Anxiety in patients can correlate with sensations of air hunger, often stemming from hypoxia.
Diagnostic Tests for Pulmonary Issues
- Arterial Blood Gas (ABG) tests may reveal hypoxia; respiratory alkalosis may occur due to tachypnea, eventually leading to respiratory acidosis.
- Chest X-ray remains normal initially, may show small infiltrates and enlarged pulmonary artery after 24 hours due to atelectasis.
- CT angiogram has become the preferred method for diagnosing pulmonary embolism (PE).
- Ventilation-Perfusion (V/Q) scan can visualize blood flow and ventilation in the lungs using radiopaque isotopes.
- Pulmonary arteriogram is the gold standard for detecting PE, providing anatomical views of pulmonary vessels.
- D-dimer levels are elevated in the presence of a thrombus or embolus, indicating clot degradation.
- Venous ultrasound is effective for confirming or excluding deep vein thrombosis (DVT).
Medical Management of PE
- Anticoagulant therapy such as Heparin (monitored via PTT) prevents further clot formation and allows breakdown of existing clots.
- Low molecular weight heparin (e.g., Lovenox) provides similar benefits without the need for lab monitoring.
- Coumadin is used for long-term anticoagulation, requiring regular INR monitoring; vitamin K is the antidote.
- Thrombolytics may be administered to dissolve pulmonary emboli.
- Filter devices can be placed in the inferior vena cava to block emboli from reaching pulmonary arteries without preventing DVT.
- Embolectomy may be necessary for large thrombus removal, requiring urgent intervention.
Nursing Interventions for PE
- Assess sensorium and respiratory status, including routine monitoring of vital signs and oxygen saturation.
- Elevate the head of the bed to 30 degrees to enhance ventilation and administer oxygen as prescribed.
- Document capillary refill and peripheral pulses frequently to gauge cardiac output.
- For DVT treatment, maintain bed rest and utilize TED hose.
- Monitor for bleeding signs associated with anticoagulation therapy, including epistaxis and hemoptysis.
- Educate patients on avoiding venous stasis through position changes, loose clothing, and regular activity.
Prognosis and Learning Points
- Untreated PE has a mortality rate of 30%; timely diagnosis and intervention can reduce mortality to 2-8%.
- Key antidotes for anticoagulants include Protamine sulfate for heparin and vitamin K for Coumadin.
Acute Respiratory Distress Syndrome (ARDS) Overview
- ARDS, also known as non-cardiogenic pulmonary edema, is a severe syndrome characterized by hypoxemia and reduced lung compliance.
- It progresses through three phases: acute (inflammation), proliferative (resolution of edema), and fibrotic (severe lung damage).
- Common causes include pneumonia, trauma, aspiration, and shock, with sepsis being a primary precursor.
- Pathophysiological changes lead to increased permeability of the alveolar capillary membrane, resulting in pulmonary edema and gas exchange impairment.
Clinical Manifestations of ARDS
- Symptoms usually appear within 12-24 hours post-injury, with respiratory distress and altered breath sounds within days.
- Patients may exhibit signs of altered sensorium due to hypoxemia and increased CO2 retention.
- Assessment includes monitoring for dyspnea, altered level of consciousness, and auscultation for abnormal lung sounds.
Medical Management of ARDS
- Supportive treatment focuses on maintaining oxygenation and addressing the underlying cause of the syndrome.
- Mechanical ventilation may be necessary for severe cases, utilizing PEEP to enhance gas exchange.
- Diuretics can help manage pulmonary edema, and morphine can provide sedation and decrease respiratory effort.
Nursing Interventions for ARDS
- Continuous monitoring of respiratory status, lung sounds, and vital signs is essential.
- Positioning patients optimally (e.g., prone) can improve ventilation and reduce mortality.
- Interventions include providing oxygen, assessing for changes, and preparing for potential mechanical ventilation.
Chronic Obstructive Pulmonary Disease (COPD) Overview
- Emphysema primarily affects individuals in their 40s and 50s, characterized by the destruction of alveolar structures and reduced elasticity.
- Leading causes include cigarette smoking and genetic factors like alpha-1 antitrypsin (ATT) deficiency.
- Patients often experience exertional dyspnea, weight loss, and may require supplemental oxygen in advanced stages.
Assessment and Diagnosis in COPD
- Key assessment components include history of symptoms, family history of respiratory disease, and objective measurements of vitals (e.g., tachycardia, cyanosis).
- Pulmonary function tests can help determine disease severity by measuring lung capacity and residual volume.### Emphysema Overview
- Characterized by volume retention in lungs at end expiration and increased lung compliance.
- Airway resistance rises due to bronchiolar narrowing.
Arterial Blood Gas (ABG) Analysis
- Decreased partial pressure of oxygen (PaO2) and increased partial pressure of carbon dioxide (PaCO2).
- pH levels can be low-normal, elevated, or decreased, commonly indicating respiratory acidosis.
- Bicarbonate (HCO3) levels are increased.
Diagnostic Imaging
- Chest x-ray shows lung hyperinflation, widened intercostal spaces, and a flattened diaphragm.
- Notable increase in anterior-posterior (AP) diameter, resembling a barrel chest.
Laboratory Tests
- Alpha1-antitrypsin assay may indicate enzyme deficiency linked to emphysema, especially in nonsmokers.
- Complete blood count reveals elevated erythrocytes, hemoglobin, and hematocrit, suggesting secondary polycythemia due to chronic hypoxia.
Medical Management
- Long-term strategies include home oxygen therapy and chest physiotherapy.
- Acute exacerbations may necessitate mechanical ventilation.
-
Medications:
- Bronchodilators like Albuterol (short-acting) and Salmeterol (long-acting) facilitate bronchiolar dilation.
- Anticholinergics such as ipratropium (Atrovent) reduce bronchospasm.
- Antibiotics are often prescribed to prevent pulmonary infections.
- Corticosteroids help reduce pulmonary inflammation but are usually limited to acute situations.
- Diuretics may aid in fluid management.
- Oxygen therapy is critical for enhancing oxygen saturation.
- Anti-anxiety medications can help manage anxiety but require monitoring for respiratory depression.
Nursing Interventions
- Focus on alleviating anxiety and maximizing air exchange.
-
Oxygenation Protocols:
- Elevate head of the bed for easier breathing.
- Administer low-flow oxygen (1-2 L) through a nasal cannula to prevent respiratory drive depression.
- Nutrition advice emphasizes higher protein and caloric intake, divided into small daily meals.
- Educate on smoking cessation to significantly slow disease progress.
Infection Control
- Annual flu vaccinations and pneumococcal vaccinations every five years are recommended.
- Instruct patients to avoid contact with those exhibiting respiratory infections.
Prognosis
- Emphysema generally considered irreversible.
- COPD ranks as the third leading cause of death in the U.S., affecting 16 million and resulting in approximately 120,000 deaths annually.
Nursing Diagnoses for Emphysema
-
Ineffective airway clearance:
- Interventions aim to mobilize secretions and improve airway patency.
-
Activity intolerance:
- Focus on balancing activity with rest to accommodate respiratory limitations.
Chronic Bronchitis Overview
- Defined as a recurrent chronic productive cough lasting a minimum of three months for at least two years.
- Common causes include smoking, irritants, and lung infections.
Pathophysiology
- Impaired ciliary function and mucous gland hyperplasia lead to excessive mucous production.
- Resulting chronic inflammation can cause airway obstruction and increased resistance.
Clinical Manifestations
- Persistent productive cough, especially in the morning, dyspnea, and accessory muscle use.
- Cyanosis and cor pulmonale may develop in advanced stages.
Assessment Techniques
- Gather comprehensive smoking history and symptom details.
- Monitor vital signs for signs of respiratory distress, including wheezing.
Diagnostic Tests
- CBC often shows polycythemia and elevated white blood cells (WBCs).
- ABGs may indicate respiratory acidosis, while PFTs indicate increased airway resistance.
Medical Management
- Focus on symptomatic relief and optimal airflow.
- Common medications include bronchodilators, corticosteroids, mucolytics, and antibiotics.
Nursing Interventions
- Promote secretion management, provide frequent rest, and maintain hydration.
- Ensure low-flow oxygen therapy and proper nutrition.
Prognosis
- Chronically irreversible condition contributing to significant morbidity and mortality.
Asthma Overview
- Asthma is characterized by episodic airway obstruction due to increased bronchial reactivity.
- Classified into extrinsic (allergy-induced) and intrinsic (triggered by internal factors).
Clinical Manifestations
- Mild symptoms include dyspnea and wheezing; severe attacks can cause respiratory distress and status asthmaticus.
Assessment Protocols
- Collect data on medication use, triggers, and quality of life.
- Monitor for signs of severe distress, such as hypoxia and cyanosis.
Diagnostic Tests
- ABGs and PFTs evaluate oxygenation status.
- CBC may reveal eosinophilia indicating an allergic response.
Medical Management
- Two therapy categories: maintenance (preventive) and rescue (acute relief).
- Inhaled corticosteroids and bronchodilators are vital in both management types.
Nursing Interventions
- Encourage avoidance of allergens and education on medication use.
- Monitor for symptom severity, especially during exercise or exposure to triggers.
Bronchiectasis Overview
- Symptoms often arise following respiratory infections, characterized by morning coughing and foul-smelling sputum.
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Description
This quiz aims to explore the etiology of various acute respiratory disorders, including pneumothorax, lung cancer, pulmonary edema, and more. Students will engage with handouts and scenarios to deepen their understanding in a classroom setting. The goal is to ensure comprehension of these critical medical conditions.