Questions and Answers
What should a nurse do if excessive bubbling is observed in the water-seal chamber after a procedure?
What is the next step if a nurse finds a break or major leak in the drainage system?
Which condition signifies that the drainage tube may be clogged?
Which sign requires immediate correction of a malfunctioning drainage system?
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Which assessment should a nurse NOT perform when monitoring a patient post-operatively?
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What is considered a normal characteristic of drainage post-operatively?
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Which of the following describes an effect of hypokalemia on an EKG?
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What indicates the need for notifying a physician after assessing a patient’s drainage?
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What is the main dietary recommendation for correcting malnutrition while minimizing respiratory stress?
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How should fluids be consumed to ensure maximum food intake?
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What is a crucial step in using an incentive spirometer effectively?
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What condition is particularly targeted by nursing care to prevent complications?
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What might be a symptom of a thoracic aortic aneurysm?
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What is the recommended frequency for repeating incentive spirometer exercises while awake?
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What is a vital instruction regarding posture when using an incentive spirometer?
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Which behavior should clients avoid during the incentive spirometer exercise?
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What is a potential complication of bronchoscopy related to airway obstruction?
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How long must a client abstain from food or drink before undergoing bronchoscopy to reduce aspiration risk?
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Which medication is usually administered before bronchoscopy to dry secretions?
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What stage of shock involves the body's initial attempt to stabilize physiological functions?
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Which neurotransmitters are released by the sympathetic nervous system during shock?
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Which physiological effect can occur when the vagus nerve is stimulated during bronchoscopy?
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Which compensatory mechanism prevents fluid loss during shock?
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What is a potential cardiovascular complication resulting from bronchoscopy?
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Study Notes
Bronchoscopy
- Enables direct visualization of the larynx, trachea, and bronchi.
- Clients often feel anxious; thorough explanations are essential throughout the procedure.
- Fasting for at least 6 hours prior reduces the risk of aspiration.
- Local anesthesia suppresses swallow, cough, and gag reflexes, increasing aspiration risk.
- Pre-procedure medications include atropine (to dry secretions) and sedatives/narcotics.
- Vagus nerve stimulation can lead to hypotension, bradycardia, or arrhythmias during the procedure.
- Potential complications include bronchospasm, laryngospasm, edema, hypoxemia, bleeding, perforation, aspiration, and cardiac arrhythmias.
Stages of Shock
- Compensatory stage: Initial response where physiological mechanisms stabilize conditions to achieve homeostatic stability.
- Compensatory mechanisms involve catecholamine release and activation of the renin-angiotensin-aldosterone system.
- Antidiuretic and corticosteroid hormone production is also initiated.
Catecholamines in Shock
- Catecholamines (epinephrine, norepinephrine) stimulate sympathetic nervous system responses.
- They increase heart rate and myocardial contractility but can strain an already failing heart in cardiogenic shock.
Postoperative Care and Drainage System Management
- Bubbling in the water-seal chamber is expected initially; excessive bubbling indicates possible leaks.
- Bloody drainage is normal but should not be bright red or excessive.
- The drainage system must remain patent; blockage can prevent lung expansion and cause mediastinal shift.
- Malfunctions in the drainage system require immediate corrective actions.
- If a leak occurs, clamp the chest tube with hemostats and notify the physician.
- Monitor drainage characteristics, including amount, color, and bubble patterns.
- Assess dressings for drainage and skin integrity; check for subcutaneous emphysema.
- Evaluate the client's color, neurologic status, heart rate, respiratory patterns, and pain levels.
- Keep the drainage chamber below chest level for effective drainage.
EKG Findings with Potassium Imbalances
- Normal ECG shows standard waveforms.
- Hypokalemia: ST-segment depression, flattened T wave, and presence of a U wave.
- Hyperkalemia: Prolonged PR interval, widened QRS, ST-segment depression, and tall, peaked T wave.
Nutrition Management
- High-protein, high-calorie diet recommended for recovery; avoid excessive calories to reduce respiratory stress.
- Small, frequent feedings of nutrient-dense foods are beneficial; liquid supplements help maximize intake.
- Encourage fluid intake between meals to avoid interfering with eating.
- Weight loss encouraged for obese clients with emphysema to enhance breathing.
Incentive Spirometer Teaching
- Position the client upright unless contraindicated.
- Mark a goal for inhalation for motivation.
- Exhale normally before placing the mouthpiece securely.
- Inhale slowly to the predetermined volume, holding the breath for 2-6 seconds.
- Exhale normally and repeat the exercise 10-20 times per hour while awake, following a physician's order.
- Advise slowing down if dizziness occurs during the procedure.
Aortic Aneurysm Symptoms
- Many aneurysms remain asymptomatic until a physical exam or major hemorrhage reveals them.
- Symptoms may include pain or discomfort, and pressure-related issues, like bronchial obstruction, dysphagia, or dyspnea from thoracic aortic aneurysms.
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Description
This quiz covers important aspects of bronchoscopy, including the procedure's purpose, required preparations, and potential complications. It also discusses the stages of shock and physiological responses involved in maintaining homeostasis. Understanding these concepts is crucial for managing patient care in critical situations.