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What indicates that asthma has been successfully diagnosed following treatment with bronchodilators?
Which of the following is considered a reliever drug for asthma treatment?
What is the primary goal of asthma therapy?
What is a critical step in managing asthma when using corticosteroids?
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Which condition is classified under Chronic Obstructive Pulmonary Disease (COPD)?
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What immediate action should be taken if bleeding occurs in a patient taking anticoagulants?
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What is the most common cause of obstructive sleep apnea?
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Which symptom is NOT typically associated with sleep apnea?
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What physical assessment finding may indicate a risk factor for obstructive sleep apnea?
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What blood oxygen level indicates hypoxemia in the context of sleep apnea?
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Which of the following is a long-term effect of untreated obstructive sleep apnea?
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Which symptom may indicate that a patient is unaware of their sleep apnea condition?
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What lifestyle factor can contribute to airway obstruction in sleep apnea patients?
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What is the primary concern with a tension pneumohemothorax?
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Which of the following is a common symptom of tension pneumohemothorax?
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What diagnostic test is specifically mentioned for assessing thoracic involvement?
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What is a potential cause of a pneumothorax?
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In the case of a flail chest, what immediate action is recommended?
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What mechanism should be used to seal an open pneumothorax wound?
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What vital signs should be closely monitored in a patient with a respiratory injury?
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What is a key sign of paradoxical chest wall movement?
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What is the primary cause of chronic bronchitis?
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What occurs during the progression of chronic bronchitis?
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Which condition primarily affects the alveoli?
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Which symptom may indicate a pulmonary embolism?
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What laboratory test is critical for assessing gas exchange in COPD patients?
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Which nursing intervention is essential for a patient at risk for pulmonary embolism?
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What is a common complication associated with COPD?
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What clinical sign may indicate a serious reaction to hypoxemia in a patient?
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How does emphysema primarily affect the diaphragm?
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What is a characteristic feature of chronic bronchitis?
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What condition is indicated by a mediastinal shift?
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Which abnormal sound is associated with pulmonary edema during auscultation?
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What is the purpose of a bronchospy?
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Which lab test is primarily used to assess respiratory acidosis or alkalosis?
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What is a common consequence of excessive fluid drainage post-thoracentesis?
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Which type of pneumonia is primarily caused by aspiration-related factors?
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What is the role of tidal volume in pulmonary function tests?
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What complication should be monitored after chest tube insertion?
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Which diagnostic method is used specifically for assessing ventilation/perfusion ratio in pulmonary embolism cases?
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Which preventative measure is recommended to combat the flu in at-risk populations?
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In the context of tuberculosis, what does latent infection imply?
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What does a sputum culture help determine for pneumonia patients?
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Which vaccine type is considered for flu prevention in the elderly?
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What should be done if a patient with a chest tube shows a sudden stop in drainage?
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Study Notes
Anticoagulant Complications
- Stop the anticoagulant immediately if bleeding occurs. Contact the healthcare provider or Rapid Response Team.
- Heparin-induced thrombocytopenia can lead to decreased platelet count, impaired gas exchange, increased blood carbon dioxide levels, and decreased pH.
Obstructive Sleep Apnea (OSA)
- OSA is most commonly caused by upper airway obstruction by the soft palate or tongue.
- Contributing factors include obesity, large uvula, short neck, smoking, enlarged tonsils or adenoids, and oropharyngeal edema.
- OSA disrupts sleep, preventing deep sleep needed for physiological restoration.
- Apneic periods can result in arterial blood oxygenation levels below 80%.
- Common symptoms include excessive daytime sleepiness, inability to concentrate, morning headaches, irritability, and nocturia.
- Long-term effects include increased risk for hypertension, stroke, cognitive deficits, weight gain, diabetes, and pulmonary/cardiovascular disease.
Asthma
- The most important pulmonary function tests (PFTs) for asthma are forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), measured using a spirometer.
- Asthma is diagnosed when these values increase by 12% or more after treatment with bronchodilators.
- Status asthmaticus is an emergent condition where normal asthma treatment fails to resolve the attack.
- Asthma therapy aims to control and prevent episodes, improve airflow and gas exchange, and relieve symptoms.
- Control therapy drugs are used daily regardless of symptoms; Laba (corticosteroid).
- Reliever drugs are used to stop an attack; SABA (corticosteroid).
Chronic Obstructive Pulmonary Disease (COPD)
- COPD encompasses lower airway disorders that interfere with airflow and gas exchange, including emphysema and chronic bronchitis.
- Emphysema is an alveolar problem, while chronic bronchitis affects the airways.
- Chronic bronchitis involves inflammation of the bronchi and bronchioles, leading to excess mucus production and thickened bronchial walls, impairing airflow.
- Cigarette smoking is the primary risk factor for COPD, alongside asthma.
- COPD compromises gas exchange and oxygenation of tissues, leading to hypoxemia and acidosis.
- Bacterial infections exacerbate COPD symptoms, increasing inflammation, mucus production, and bronchospasm.
- Patients with emphysema have limited diaphragmatic movement due to diaphragmatic flattening.
Pulmonary Embolism (PE)
- PE is a clot originating from a different site that travels and lodges in the lungs.
- A DVT is a clot forming in the leg that can become an embolism upon breaking off.
- Patients at risk for PE should be monitored for shortness of breath, chest pain, and hypotension.
- Symptoms can include a feeling of impending doom due to hypoxemia.
- Patient safety measures include oxygen therapy, high-Fowler positioning, telemonitoring, IV access, and frequent assessment of vital signs and lung sounds.
Pleural Effusions, Pneumothorax, and Hemothorax
- A mediastinal shift is a sign of pressure on the lungs, often caused by pleural effusions, pneumothorax, or hemothorax.
- A tracheal shift indicates a shift of the trachea, usually caused by trauma to the neck or hemo/pneumothorax.
- Both conditions are considered medical emergencies.
- Auscultation can reveal pleural friction rub (scraping sound) in pleural effusions and gurgling sounds (like a washing machine) in pulmonary edema.
- Diagnostic testing includes chest x-ray, CT, MRI, and ABG.
Chest Drainage Systems
- Purpose: Removal of air or fluid from the lungs
- Types: Three-bottle system (most common), water seal, and dry suction water seal.
- Components: Suction control chamber/dry suction chamber, water seal chamber, and collection chamber.
- Bubbling: Gentle bubbling is normal, excessive bubbling indicates an air leak.
- Tidaling: Rise and fall of fluid in the water seal chamber with each breath.
- Complications: Bleeding, pneumothorax, re-accumulation of fluid, subcutaneous emphysema.
- Nursing care: Monitoring vital signs, drainage, and system integrity.
Influenza (Flu) and COVID-19
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Flu is an airborne virus, prevalent during fall and winter.
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It causes acute respiratory infection, which can last for weeks.
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Prevention: Vaccination (inactivated, recombinant, live attenuated, injection, or nasal spray); hand hygiene.
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Diagnosis: Rapid Influenza Diagnostic Test.
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Treatment: Antivirals (Tamiflu), started within 2 days of symptom onset.
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COVID-19:
- Prevention: Vaccination, hand hygiene.
- Diagnosis: Nasal swabs (home or clinic).
- Treatment: Antiviral therapy, supportive care.
- Isolation: Quarantine until fever-free for 24 hours; hospital isolation in negative pressure room.
Pneumonia
- Risk Factors: Elderly, immunocompromised, GERD patients.
- Causes: Infectious (bacteria, viruses, fungi) and non-infectious (toxins, smoke, aspiration).
- Pathophysiology: Inflammation of alveoli filled with fluid/pus, inhibiting gas exchange, leading to coughing, fever, and dyspnea.
- Diagnosis: Labs (CBC, CMP, sputum culture), imaging (x-ray, thoracentesis).
- Treatment: Oxygen therapy, bronchodilators, HOB elevation, antibiotics.
Tuberculosis (TB)
- Transmission: Airborne/droplet transmission.
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Infection:
- Latent: Non-infectious phase.
- Active: Contagious, causing inflammation in the lungs and lymph nodes.
- Risk Factors: Developing countries, close contact with infected individuals, immunocompromised
- Diagnosis: TB skin test, chest X-ray.
- Treatment: Anti-tuberculosis medications.
Pneumohemothorax
- Definition: A condition where air and blood accumulate in the space between the lung and the chest wall (pleural space).
- Causes: Trauma, coronary artery bypass surgery
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Symptoms:
- Respiratory distress
- Diminished lung sounds in one area
- Air hunger (gulping for breath)
- Tension pneumothorax can cause tracheal or mediastinal deviation which requires immediate medical attention.
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Diagnosis:
- Arterial blood gases (ABGs)
- Complete blood count (CBC) with differential (to identify possible infection)
- Coagulation studies (to assess clotting ability)
- D-dimer (to check for inflammation)
- Chest X-ray
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Management:
- Thoracentesis and/or chest tube placement are usually required.
Chest Injury
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Types:
- Blunt trauma (e.g., car accident)
- No open, external wounds.
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Symptoms:
- Pain from trauma
- Respiratory distress
- Paradoxical chest wall movement (chest wall moves inward during inhalation and outward during exhalation)
- Flail chest (a section of the rib cage breaks and moves independently)
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Management:
- Flail chest requires mechanical ventilation with humidified air to support breathing.
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Monitoring:
- ABGs, vital capacity, and signs of worsening hypoxemia/hypercarbia.
Open Pneumothorax ("Sucking Wound")
- Definition: An open wound penetrating the chest wall allowing air to enter and exit the pleural space.
- Causes: Penetrating trauma (e.g., gunshot, stab wound)
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Characteristics:
- Audible air rushing in and out of the wound with each breath.
- The chest wound does not directly puncture the lung, but the loss of pressure prevents air from entering the lung.
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Recognition:
- Chest wound with or without bleeding/foaming
- Audible hissing/sucking sound
- Mediastinal shift (alternating with ventilation)
- Respiratory distress
- Hemoptysis (blood in sputum)
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Management:
- Immediately seal the wound with a one-way valve (three sides sealed) to allow air to escape on inhalation and seal on exhalation.
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Monitoring:
- Closely monitor for tension pneumothorax, blood pressure, heart rate, and pulse patterns.
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Description
This quiz covers essential information regarding anticoagulant complications associated with bleeding and heparin-induced thrombocytopenia. It also delves into Obstructive Sleep Apnea (OSA), its causes, symptoms, and long-term health implications. Test your knowledge on these critical medical topics and their impact on patient care.
