Bronchoscopy and Stages of Shock

Questions and Answers

What should a nurse do if excessive bubbling is observed in the water-seal chamber after a procedure?

Check the system for leaks. (correct)

Increase the flow of oxygen.

Ignore it, as it is a common occurrence.

Change the drainage system immediately.

What is the next step if a nurse finds a break or major leak in the drainage system?

Start oxygen therapy.

Notify the family of the patient.

Flush the drainage tube with saline.

Clamp the chest tube immediately. (correct)

Which condition signifies that the drainage tube may be clogged?

No drainage is observed. (correct)

The lung is fully expanded.

Bright red and copious drainage.

Constant bubbling in the chamber.

Which sign requires immediate correction of a malfunctioning drainage system?

Mediastinal shift to the opposite side. Signup and view all the answers

Which assessment should a nurse NOT perform when monitoring a patient post-operatively?

Checking the EKG for rhythm abnormalities. Signup and view all the answers

What is considered a normal characteristic of drainage post-operatively?

Bloody drainage that is not excessive. Signup and view all the answers

Which of the following describes an effect of hypokalemia on an EKG?

Flattened T wave. Signup and view all the answers

What indicates the need for notifying a physician after assessing a patient’s drainage?

Presence of subcutaneous emphysema. Signup and view all the answers

What is the main dietary recommendation for correcting malnutrition while minimizing respiratory stress?

A high-protein, high-calorie diet with controlled calorie intake Signup and view all the answers

How should fluids be consumed to ensure maximum food intake?

Fluids should be consumed between meals to avoid interfering with food intake Signup and view all the answers

What is a crucial step in using an incentive spirometer effectively?

Hold the breath for 2–6 seconds after inhalation Signup and view all the answers

What condition is particularly targeted by nursing care to prevent complications?

Atelectasis resulting from improper lung aeration Signup and view all the answers

What might be a symptom of a thoracic aortic aneurysm?

Dysphagia or difficulty swallowing Signup and view all the answers

What is the recommended frequency for repeating incentive spirometer exercises while awake?

10–20 times per hour Signup and view all the answers

What is a vital instruction regarding posture when using an incentive spirometer?

Sit upright unless contraindicated Signup and view all the answers

Which behavior should clients avoid during the incentive spirometer exercise?

Rushing through the procedure Signup and view all the answers

What is a potential complication of bronchoscopy related to airway obstruction?

Bronchospasm Signup and view all the answers

How long must a client abstain from food or drink before undergoing bronchoscopy to reduce aspiration risk?

6 hours Signup and view all the answers

Which medication is usually administered before bronchoscopy to dry secretions?

Atropine Signup and view all the answers

What stage of shock involves the body's initial attempt to stabilize physiological functions?

Compensation stage Signup and view all the answers

Which neurotransmitters are released by the sympathetic nervous system during shock?

Epinephrine and norepinephrine Signup and view all the answers

Which physiological effect can occur when the vagus nerve is stimulated during bronchoscopy?

Bradycardia Signup and view all the answers

Which compensatory mechanism prevents fluid loss during shock?

Activation of the renin–angiotensin–aldosterone system Signup and view all the answers

What is a potential cardiovascular complication resulting from bronchoscopy?

Arrhythmias Signup and view all the answers

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.