Podcast
Questions and Answers
A patient's peak flow meter reading consistently falls within the red zone. What immediate action should the patient take?
A patient's peak flow meter reading consistently falls within the red zone. What immediate action should the patient take?
- Administer quick-relief medication as prescribed. (correct)
- Increase daily intake of fluids to thin mucus.
- Reduce physical activity to conserve energy.
- Perform gentle chest physiotherapy to loosen secretions.
Which of the following is the MOST likely etiology of COPD?
Which of the following is the MOST likely etiology of COPD?
- Acute bacterial infection of the lower respiratory tract.
- Sudden onset of autoimmune-related lung inflammation.
- Prolonged exposure to airway irritants. (correct)
- Congenital deficiency in surfactant production.
A patient with advanced COPD exhibits barrel chest and uses accessory muscles during respiration. What underlying physiological change is MOST directly responsible for these findings?
A patient with advanced COPD exhibits barrel chest and uses accessory muscles during respiration. What underlying physiological change is MOST directly responsible for these findings?
- Elevated systemic blood pressure causing fluid accumulation in the lungs.
- Increased lung compliance due to destruction of alveolar spaces. (correct)
- Reduced airway resistance resulting in increased airflow velocity.
- Decreased pulmonary artery pressure leading to right ventricular hypertrophy.
Which spirometry finding is MOST indicative of COPD?
Which spirometry finding is MOST indicative of COPD?
During a 6-minute walk test, a COPD patient's oxygen saturation drops to 87%. Based on this result, what intervention is MOST appropriate?
During a 6-minute walk test, a COPD patient's oxygen saturation drops to 87%. Based on this result, what intervention is MOST appropriate?
An arterial blood gas (ABG) result from a patient with COPD exacerbation shows hypoxemia and hypercapnia. Which of the following acid-base imbalances is MOST likely present?
An arterial blood gas (ABG) result from a patient with COPD exacerbation shows hypoxemia and hypercapnia. Which of the following acid-base imbalances is MOST likely present?
A patient with COPD presents with increased dyspnea, wheezing, and a productive cough with greenish sputum. Which of the following conditions is MOST likely contributing to this change in status?
A patient with COPD presents with increased dyspnea, wheezing, and a productive cough with greenish sputum. Which of the following conditions is MOST likely contributing to this change in status?
A patient with COPD is being discharged home. Which statement indicates they understand pursed-lip breathing?
A patient with COPD is being discharged home. Which statement indicates they understand pursed-lip breathing?
During a thoracentesis, what position should the nurse assist the patient to maintain?
During a thoracentesis, what position should the nurse assist the patient to maintain?
A patient is suspected of having a pulmonary embolism (PE). Which assessment finding is LEAST likely to be associated with a PE?
A patient is suspected of having a pulmonary embolism (PE). Which assessment finding is LEAST likely to be associated with a PE?
Which intervention is the priority when managing a patient experiencing an acute asthma exacerbation?
Which intervention is the priority when managing a patient experiencing an acute asthma exacerbation?
A patient with asthma has a peak flow reading in the yellow zone. What should the nurse advise the patient to do?
A patient with asthma has a peak flow reading in the yellow zone. What should the nurse advise the patient to do?
What is the primary reason for administering IV steroids to a patient experiencing an asthma exacerbation?
What is the primary reason for administering IV steroids to a patient experiencing an asthma exacerbation?
Which of the following is NOT an expected outcome following a thoracentesis that involves fluid removal?
Which of the following is NOT an expected outcome following a thoracentesis that involves fluid removal?
A patient with a history of DVT is scheduled for major surgery. Which intervention is most important to reduce the risk of pulmonary embolism (PE)?
A patient with a history of DVT is scheduled for major surgery. Which intervention is most important to reduce the risk of pulmonary embolism (PE)?
A patient with asthma is using a peak flow meter daily. Which statement indicates that the patient understands how to use the meter correctly?
A patient with asthma is using a peak flow meter daily. Which statement indicates that the patient understands how to use the meter correctly?
Following a thoracentesis, a patient's oxygen saturation suddenly decreases, and they report increased shortness of breath. What is the nurse's priority action?
Following a thoracentesis, a patient's oxygen saturation suddenly decreases, and they report increased shortness of breath. What is the nurse's priority action?
A patient is prescribed a short-acting beta-agonist (SABA) inhaler for asthma. What should the nurse teach the patient about the use of this medication?
A patient is prescribed a short-acting beta-agonist (SABA) inhaler for asthma. What should the nurse teach the patient about the use of this medication?
A patient presents with a pH of 7.25, elevated CO2 levels, and is showing signs of increased work of breathing. Which condition is the MOST likely?
A patient presents with a pH of 7.25, elevated CO2 levels, and is showing signs of increased work of breathing. Which condition is the MOST likely?
A COPD patient's ABG reveals uncompensated respiratory acidosis. Besides bronchodilators, what other intervention is MOST appropriate?
A COPD patient's ABG reveals uncompensated respiratory acidosis. Besides bronchodilators, what other intervention is MOST appropriate?
A patient with COPD is prescribed low-flow oxygen. What is the MOST important goal for oxygen saturation in this patient population?
A patient with COPD is prescribed low-flow oxygen. What is the MOST important goal for oxygen saturation in this patient population?
Which of the following tasks related to oxygen administration can be delegated to an LPN for a STABLE patient with COPD?
Which of the following tasks related to oxygen administration can be delegated to an LPN for a STABLE patient with COPD?
Which intervention is MOST important to include in the collaborative care plan for a patient with COPD to help manage their ADLs?
Which intervention is MOST important to include in the collaborative care plan for a patient with COPD to help manage their ADLs?
A patient with IDD is observed to have frequent throat clearing, drooling, and a history of recurrent chest infections. What is the MOST appropriate initial action?
A patient with IDD is observed to have frequent throat clearing, drooling, and a history of recurrent chest infections. What is the MOST appropriate initial action?
A patient with IDD and a history of asthma is being assessed. What additional screening is MOST crucial due to the increased prevalence of co-existing conditions?
A patient with IDD and a history of asthma is being assessed. What additional screening is MOST crucial due to the increased prevalence of co-existing conditions?
Why are respiratory disorders a leading cause of mortality in individuals with intellectual and developmental disabilities (IDD)?
Why are respiratory disorders a leading cause of mortality in individuals with intellectual and developmental disabilities (IDD)?
A patient with suspected pneumonia has undergone a chest X-ray. Which finding on the X-ray would be most indicative of pneumonia?
A patient with suspected pneumonia has undergone a chest X-ray. Which finding on the X-ray would be most indicative of pneumonia?
Following a bronchoscopy, a patient develops new onset dyspnea and a decreased oxygen saturation. What is the priority nursing intervention?
Following a bronchoscopy, a patient develops new onset dyspnea and a decreased oxygen saturation. What is the priority nursing intervention?
A client with COPD who has been on home oxygen therapy is admitted to the hospital with increased dyspnea and confusion. Which initial action by the nurse is MOST appropriate?
A client with COPD who has been on home oxygen therapy is admitted to the hospital with increased dyspnea and confusion. Which initial action by the nurse is MOST appropriate?
A patient with epistaxis is actively bleeding. What is the priority nursing intervention?
A patient with epistaxis is actively bleeding. What is the priority nursing intervention?
An older adult with COPD is being discharged home. Which statement indicates the BEST understanding of oxygen safety?
An older adult with COPD is being discharged home. Which statement indicates the BEST understanding of oxygen safety?
A patient presents to the emergency department with a nosebleed that is not stopping after 30 minutes of direct pressure. What type of epistaxis is most likely occurring?
A patient presents to the emergency department with a nosebleed that is not stopping after 30 minutes of direct pressure. What type of epistaxis is most likely occurring?
Which of the following nursing interventions is most important in preventing hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP)?
Which of the following nursing interventions is most important in preventing hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP)?
Which instruction is most important for a nurse to provide to a patient being discharged after treatment for epistaxis?
Which instruction is most important for a nurse to provide to a patient being discharged after treatment for epistaxis?
A patient is diagnosed with a pleural effusion secondary to pneumonia. Which type of fluid would the nurse anticipate being drained during a thoracentesis?
A patient is diagnosed with a pleural effusion secondary to pneumonia. Which type of fluid would the nurse anticipate being drained during a thoracentesis?
After a thoracentesis to remove pleural fluid, a patient reports feeling lightheaded and dizzy. The nurse assesses hypotension and tachycardia. What is the most likely cause of these findings?
After a thoracentesis to remove pleural fluid, a patient reports feeling lightheaded and dizzy. The nurse assesses hypotension and tachycardia. What is the most likely cause of these findings?
A nurse is caring for a patient with a posterior nosebleed. What is the MOST important assessment to monitor for?
A nurse is caring for a patient with a posterior nosebleed. What is the MOST important assessment to monitor for?
Which of the following is a significant risk factor contributing to the development of tuberculosis (TB)?
Which of the following is a significant risk factor contributing to the development of tuberculosis (TB)?
A patient is suspected of having pneumonia but cannot produce a sputum sample. Which diagnostic test might be performed to obtain a sample for analysis?
A patient is suspected of having pneumonia but cannot produce a sputum sample. Which diagnostic test might be performed to obtain a sample for analysis?
A patient with pneumonia has a white blood cell (WBC) count of 17,000/μL. How should the nurse interpret this result?
A patient with pneumonia has a white blood cell (WBC) count of 17,000/μL. How should the nurse interpret this result?
A patient with active tuberculosis is started on a multi-drug regimen. What is the primary rationale for using multiple drugs?
A patient with active tuberculosis is started on a multi-drug regimen. What is the primary rationale for using multiple drugs?
Following a bronchoscopy, the nurse is closely monitoring the patient. Which finding would require immediate intervention?
Following a bronchoscopy, the nurse is closely monitoring the patient. Which finding would require immediate intervention?
The nurse is teaching a patient with active TB about preventing the spread of infection. Which statement by the patient indicates a need for further teaching?
The nurse is teaching a patient with active TB about preventing the spread of infection. Which statement by the patient indicates a need for further teaching?
A patient presents with a cough, fever, and green sputum. Which assessment finding would be most indicative of pneumonia upon auscultation?
A patient presents with a cough, fever, and green sputum. Which assessment finding would be most indicative of pneumonia upon auscultation?
A nurse is caring for a patient newly diagnosed with active tuberculosis. Which intervention is MOST important to implement?
A nurse is caring for a patient newly diagnosed with active tuberculosis. Which intervention is MOST important to implement?
A patient with a history of tuberculosis (TB) presents with a night sweats, a persistent cough, and recent weight loss. Which action should the nurse take FIRST?
A patient with a history of tuberculosis (TB) presents with a night sweats, a persistent cough, and recent weight loss. Which action should the nurse take FIRST?
A patient who is HIV positive is undergoing tuberculin testing. An induration of what size would be considered a positive result?
A patient who is HIV positive is undergoing tuberculin testing. An induration of what size would be considered a positive result?
Following a motor vehicle accident, a client is diagnosed with a pleural effusion. The nurse understands this condition involves:
Following a motor vehicle accident, a client is diagnosed with a pleural effusion. The nurse understands this condition involves:
The physician has ordered a sputum culture for a patient suspected of having tuberculosis (TB). When should the nurse collect the sputum specimen?
The physician has ordered a sputum culture for a patient suspected of having tuberculosis (TB). When should the nurse collect the sputum specimen?
Assessments that show pneumonia
Assessments that show pneumonia
A patient is diagnosed with pneumonia and started on intravenous antibiotics. After 72 hours, which finding would indicate that the treatment is effective?
A patient is diagnosed with pneumonia and started on intravenous antibiotics. After 72 hours, which finding would indicate that the treatment is effective?
A patient is being treated for pneumonia. Which assessment finding indicates that the treatment is effective?
A patient is being treated for pneumonia. Which assessment finding indicates that the treatment is effective?
A patient is being treated for pneumonia. Which nursing intervention is most important to promote airway clearance?
A patient is being treated for pneumonia. Which nursing intervention is most important to promote airway clearance?
A patient with pneumonia is experiencing pleuritic chest pain. Which intervention would be most appropriate to manage this symptom?
A patient with pneumonia is experiencing pleuritic chest pain. Which intervention would be most appropriate to manage this symptom?
A nurse is caring for a patient with pneumonia who is experiencing pleuritic chest pain. Which intervention is most appropriate to promote comfort?
A nurse is caring for a patient with pneumonia who is experiencing pleuritic chest pain. Which intervention is most appropriate to promote comfort?
A nurse is providing discharge teaching to a patient recovering from pneumonia. Which statement by the patient indicates a good understanding of self-care?
A nurse is providing discharge teaching to a patient recovering from pneumonia. Which statement by the patient indicates a good understanding of self-care?
A patient with a history of heart failure is admitted with a pleural effusion. What type of fluid is most likely causing the effusion?
A patient with a history of heart failure is admitted with a pleural effusion. What type of fluid is most likely causing the effusion?
A patient with pneumonia develops a pleural effusion. The nurse anticipates the provider will order which procedure to remove the fluid?
A patient with pneumonia develops a pleural effusion. The nurse anticipates the provider will order which procedure to remove the fluid?
Flashcards
Epistaxis
Epistaxis
Bleeding from the nose.
Anterior Bleed
Anterior Bleed
Most common type of nosebleed; usually stops with self-treatment.
Posterior Bleed
Posterior Bleed
Nosebleed closer to the throat; may need medical intervention due to risk of aspiration. Hard to assess blood loss.
Initial Epistaxis Treatment
Initial Epistaxis Treatment
Apply direct pressure while tilting the head forward.
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Secondary Epistaxis Treatment
Secondary Epistaxis Treatment
Cauterization or internal pressure (gauze, balloon).
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Tuberculosis Risk Factors
Tuberculosis Risk Factors
Homelessness, poor neighborhoods, close proximity living, IV drug users, poor access to care, immunocompromised.
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Tuberculosis Symptoms
Tuberculosis Symptoms
Slow onset (2-3 weeks), dry cough, night sweats, fever, weight loss, fatigue, malaise, pleuritic chest pain.
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Tuberculosis Isolation
Tuberculosis Isolation
Airborne isolation: single, negative pressure room and N-95 masks.
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Active TB Treatment
Active TB Treatment
Four-drug combination therapy for at least 2 months.
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Tuberculosis Prevention
Tuberculosis Prevention
Cover cough/sneeze, wash hands, wear mask outside negative pressure room.
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Tuberculosis Infectiousness
Tuberculosis Infectiousness
Infectious for 2 weeks after starting treatment. Discontinue isolation after 3 negative sputum tests.
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Tuberculosis (TB)
Tuberculosis (TB)
Bacterial infection, most commonly affecting the lungs, but can spread.
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Epistaxis Definition
Epistaxis Definition
A respiratory disorder characterized by blood coming from the nose.
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Epistaxis Focused Assessment
Epistaxis Focused Assessment
Focused assessment of respiratory and neuro status, vital signs, and swallowing ability.
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Epistaxis Patient Education
Epistaxis Patient Education
Avoid NSAIDs, aspirin, and vigorous nose blowing.
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Peak Flow Meter - Red Zone
Peak Flow Meter - Red Zone
Administer quick relief medication. Indicates a serious problem requiring immediate action and rescue medications should be administered.
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Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
A group of lung diseases that obstruct airflow and are not fully reversible; includes chronic bronchitis and emphysema.
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Cause of COPD
Cause of COPD
Chronic inflammation resulting from consistent exposure to noxious stimuli like smoking, pollutants, or gases.
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COPD Assessment Findings
COPD Assessment Findings
Shortness of breath, fatigue, underweight, barrel chest, accessory muscle use, wheezing, cyanosis, polycythemia.
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Spirometry
Spirometry
A diagnostic test that measures the amount of air you can exhale forcefully in one second (FEV1) and the total amount of air you can exhale (FVC).
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COPD Spirometry Results
COPD Spirometry Results
Reduced FEV1/FVC ratio, indicating less air exhaled in the first second compared to the total amount exhaled.
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6-Minute Walk Test
6-Minute Walk Test
A test that measures how far a patient can walk in 6 minutes; a drop in O2 saturation to 88% or lower qualifies the patient for home O2.
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COPD Chest X-Ray Findings
COPD Chest X-Ray Findings
May show hyperinflation of lungs and a flattened diaphragm.
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Pleural Effusion
Pleural Effusion
Fluid accumulation in the pleural space.
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Thoracentesis
Thoracentesis
Insertion of a needle to remove fluid, obtain specimen, or instill medications in the pleural space.
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Pulmonary Embolism (PE)
Pulmonary Embolism (PE)
Clot that lodges in the pulmonary circulation, often originating from a DVT.
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Pulmonary Embolism (PE) Symptoms
Pulmonary Embolism (PE) Symptoms
Sudden shortness of breath, tachypnea, and pleuritic chest pain.
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Pulmonary Embolism (PE) Risk Factors
Pulmonary Embolism (PE) Risk Factors
Immobility, recent surgery, history of DVT, cancer, obesity, smoking.
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Normal PaO2 (ABG)
Normal PaO2 (ABG)
PaO2 normal range: 80-100 mm Hg.
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Asthma Treatment
Asthma Treatment
Supplemental oxygen, monitor signs & symptoms, use peak flow at home
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Asthma Priorities
Asthma Priorities
Correct hypoxia, improve ventilation, give short acting bronchodilators
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Peak Flow Meter - Green Zone
Peak Flow Meter - Green Zone
80-100% of personal best; continue medications and monitoring.
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Peak Flow Meter - Yellow Zone
Peak Flow Meter - Yellow Zone
50-80% of personal best; indicates caution, something is triggering asthma.
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Mycobacterium Tuberculosis
Mycobacterium Tuberculosis
A bacterium resistant to decolorizing chemicals after staining, often identified in sputum samples.
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Tuberculin Skin Test
Tuberculin Skin Test
An immune response indicating possible TB infection; size matters for interpretation.
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Pneumonia Symptoms
Pneumonia Symptoms
Green or yellow sputum, fever, and changes in mental status.
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Pneumonia Respiratory Assessment
Pneumonia Respiratory Assessment
Rhonchi/crackles, bronchial sounds, increased fremitus, egophony, dyspnea, and decreased O2 saturation.
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Infiltrates (Chest X-Ray)
Infiltrates (Chest X-Ray)
Areas of lung tissue filled with fluid or inflammatory cells.
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Leukocytosis with Bands
Leukocytosis with Bands
Elevated white blood cell count, often with increased immature neutrophils.
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Bronchoalveolar Lavage
Bronchoalveolar Lavage
Obtaining samples from the lung using a flexible tube for diagnostic testing.
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Bronchoscopy
Bronchoscopy
Direct visualization of the airways for diagnosis, biopsy, or foreign body removal.
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Post-Bronchoscopy Care
Post-Bronchoscopy Care
NPO until gag reflex returns, monitoring VS during conscious sedation.
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Undesirable Bronchoscopy Outcomes
Undesirable Bronchoscopy Outcomes
Dyspnea, SOB, tachycardia, and decreased O2 saturation.
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Transudative Effusion
Transudative Effusion
Watery fluid (e.g., heart failure, cirrhosis).
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Exudative Effusion
Exudative Effusion
Protein-rich fluid (e.g., pneumonia, cancer, pulmonary embolism).
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Pleural Effusion Treatment
Pleural Effusion Treatment
Diuretics, chemotherapy/radiation, or thoracentesis.
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Pleural Effusion Assessment
Pleural Effusion Assessment
Dyspnea, cough, and sharp chest pain worsened by inhalation.
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Respiratory Acidosis
Respiratory Acidosis
A condition where the lungs can't remove enough carbon dioxide, leading to a buildup in the body and decreased pH.
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COPD Exacerbation Treatment
COPD Exacerbation Treatment
Short-acting bronchodilators, Steroids, Antibiotics (if bacterial infection)
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High Flow Oxygen Therapy
High Flow Oxygen Therapy
A therapy delivering oxygen at higher flow rates than traditional methods, often via Venturi mask or high-flow nasal cannula.
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Target O2 Saturation for COPD
Target O2 Saturation for COPD
88-92%
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ADL Considerations in COPD
ADL Considerations in COPD
Space activities, allow for rest, gradually increase duration of walks.
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O2 Safety Education
O2 Safety Education
Instructions on how to safely use oxygen at home.
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Oxygen Administration Roles
Oxygen Administration Roles
RNs can titrate, LPNs adjust for stable patients, ULAP can not administer or titrate.
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Nutrition for COPD
Nutrition for COPD
High calorie, frequent small meals
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IDD
IDD
Patients with Intellectual and Developmental Disabilities.
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Assessing Aspiration Risk (IDD)
Assessing Aspiration Risk (IDD)
Drooling more than coughing constantly, difficulty swallowing (choking or throat clearing, drool, aversion to food, weight loss, frequent chest infections, asthma).
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Respiratory Disorders
- Respiratory disorders are the #1 cause of death for individuals with Intellectual and Developmental Disabilities (IDD).
- Chapters 29, 30, and 31 address various respiratory disorders.
- Primary concerns for respiratory disorders are oxygenation and ventilation.
- Topics covered include Epistaxis, Tuberculosis, Pneumonia, Pleural effusion, Pulmonary embolism, Asthma, and COPD
Epistaxis (Nosebleed)
- Risk factors include trauma (surgery), low humidity, infection, allergies, overuse of decongestant sprays, tumors, and medications that affect bleeding.
- Anterior bleeds involve blood coming out of the nose, are the most common, easy to visualize, and usually stop with self-treatment.
- Posterior bleeds pose a risk for blood clots, are closer to the throat, make it harder to assess blood loss, may require medical intervention, and raise concern for aspiration of blood.
- Initial treatment involves applying pressure and tipping the head forward.
- Secondary treatment may include cauterizing the capillaries or applying internal pressure with gauze or a balloon.
Epistaxis Focused Assessment, Expected Outcomes, and Patient Education
- Assess respiratory status, neuro status (LOC), vital signs (BP), and swallowing abilities.
- Contusion could be a new cause or sign of epistaxis.
- Expected outcomes include controlled bleeding and normal focused assessments (respiratory, neuro, VS, swallowing).
- Patient education focuses on the cause, humidification, stopping nasal sprays, treating infection, and avoiding NSAIDS, aspirin, and vigorous nose blowing.
Tuberculosis (TB)
- TB is most frequently a pulmonary problem but can affect kidneys, bones, meninges, and other tissues.
- Active TB has a high risk of passing on infection, while latent TB involves having the bacteria without the same risk of transmission.
- Social determinants of health include homelessness, poor neighborhoods, close proximity living, IV drug use, and poor access to care
- Put patient into a negative pressure isolation room and keep door closed
- Mycobacterium resists decolonizing chemicals after staining
Tuberculosis cont.
- Nursing assessment includes slow onset of symptoms (2-3 weeks post-exposure), dry cough, night sweats, fever, weight loss, fatigue, malaise, pleuritic chest pain, crackles, dyspnea, and hemoptysis.
- Nursing interventions involve airborne isolation (single room, negative pressure, N-95 masks/HEPA), appropriate drug therapy (4-drug combo, at least 2 months), contact tracing for 3, and teaching.
Tuberculosis cont.
- Teaching involves preventing spread (cover cough, sneeze), washing hands, patient wears a mask outside of neg pressure room and infectious for 2 weeks after starting treatment
- Identify and screen close contacts for TB: discontinue airborne isolations with 3 negative sputum tests on 3 different days.
- Active TB requires penetrating all walls to kill bacteria.
- Non-adherence to treatment contributes to multi-drug resistance and increases the risk for reinfection or resistant organisms
Diagnostic Tests for TB:
- Fluorochrome or Acid-fast Bacilli Sputum: Negative result is normal; positive result from 3 samples indicates TB
- Tuberculin Skin Test (Mantoux): Induration measured to determine positive test reaction.
- Interferon-Y Release Assay (blood test)(IGRA): Blood test for INF-gamma release form T cells - one test, no reader bias, but higher cost.
- Chest X-Ray: Identifies active TB or old lesions.
Pneumonia
- With pneumonia, new confusion could be a sign.
- Pneumonia is often secondary diagnosis to upper respiratory problem
- Community-acquired pneumonia (CAP) is diagnosed within 48 hours of hospitalization.
- Aspiration pneumonia can occur with CAP or HAP (hospital acquired pneumonia) and involves entry of oral/gastric contents into the lower airway.
- Smoking is a main risk factor.
- Risk factors for aspiration pneumonia: impaired gag reflex, swallowing problems, intubation. Best intervention is to have the patient brush their teeth.
- Ventilator Associated Pneumonia (VAP/VAE) is diagnosed when on vent for > 48 hrs.
- Routine oral care significantly decreases risk of HAP/VAP.
Pneumonia cont.
- Clinical presentation includes cough, fever, chills, tachycardia, pleuritic chest pain, green/yellow sputum, changes in level of consciousness, diaphoresis, headache, myalgias, fatigue, and dyspnea.
- Focused respiratory assessment of the lungs reveals Rhonchi or crackles, bronchial breath sounds, increased fremitus, egophony, dyspnea, and changes in O2 saturation with activity.
- Pneumonia is most often bacterial, requiring antibiotics as treatment as soon as possible with a response time of 48 -72 hours.
- Viral pneumonia requires antivirals.
Pneumonia cont.
- Supportive treatments are: oxygen if needed, antipyretics, analgesics, hydration, and promoting activity with rest.
- Prevention involves keeping the HOB at least 30 degrees, assisting with eating, assessing gag reflex, monitoring gastric residuals, mobilizing, encouraging cough, deep breathing, IS, and maintaining oral hygiene.
Diagnostic Studies for PNA (Pneumonia):
- Clear lung fields are normal, infiltrates is abnormal
- CBC with differential: Leukocytosis (WBC) count usually greater than 15,000/μL
- Bronchoscopy, broncho-alveolar lavage pulmonary is normal. Obtain more sensitive specimen and find infective agent
- A pocked of fluid will usually resolve with pneumonia on its own
- Other tests: Blood cultures, Thoracentesis
Bronchoscopy
- Consists of direct visualization of bronchi to obtain biopsy specimens, diagnose procedure
- Nursing interventions: Position patient in fowlers, remains NPO until gag reflex returns, monitor VS during sedation because it will slow vital signs
- Blood-tinged mucous post procedure is an expected outcome
- Maintain adequate VS [O2 sat, RR]
- New (dyspnea, SOB, tachycardia) decreased O2 sat is not alright
Pleural Effusion
- Abnormal amount of fluid in chest tubes
- Use slideshow w/ chest tubes
- Transudative (watery fluid) is caused by heart failure
- Exudative (protein rich fluid) is caused by pneumonia
- Treatment interventions are: Diuretics, Chemotherapy, Thoracentesis to drain fluid but 1-1.2 L should be removed at one time max
Assessment and Diagnostics of Pleural effusion
- Assessment 4 D's include: Dyspnea; cough; and occasional sharp, non-radiating chest pain that is worse on inhalation, Decreased movement of chest on the affected side, Dullness to percussion, and Diminished breath sounds of the affected area.
- Tests for diagnostic: Chest X-Ray, Ultrasound, CT Scan, and Thoracentesis w/ fluid analysis
Thoracentesis
- Performed when there’s an insertion of large bore needle through the chest wall into the pleural space
- Indications: Obtain specimen for diagnostic, Removal of fluid or Instill medications. Make sure to maintain vital signs and oxygenation, check for local anesthetic
- Keep patient sitting up for this
- Expected: Pt sitting up, leaning over table
- Unexpected Outcomes: Decreased BP, increased HR, bleeding and decreased O2 saturation
Pulmonary Embolism (PE)
- Acute PE prevents O2 from moving across the lung membranes
- Clot lodges in the pulmonary circulation in acute PE
- It’s sudden
- Risk factors: immobility, recent surgery, history of DVT, Cancer, obesity, oral contraceptives, prolonged air travel, smoking, clotting disorder
PE Diagnostics
- The goal would be to prevent the clot from migrating across the lung membranes so ventilation can occur
- High CO2 and a lower O2 would be expected
- Tests: High-Resolution multi detector Computed tomographic angiography (CT-angio, sprial CT): gold-standard for detecting clots
PE Interventions/Teaching
- Nursing interventions: Evaluate chest pain and rule out MI, auscultate breath sounds, assess respiratory rate-pattern/O2 saturation
- Medication Interventions: IV Herapin, Warfarin, assess for bleeding, stool, and NG drainage
- Teaching: signs & symptoms of PE (likely the underlying clot is still there-so is the risk), new medications and follow up labs
Asthma
- Definition: Recurrent wheezing. triggers air from moving in and out
- 11 people each day die from asthma
- Social Determinates of Health are higher if rates of poorer housing and if lower socio-economic status
- Treatment: Some air moving in and out of bronchiole space. Squeezes bronchiole and namows it
Asthma cont.
- Assess: Wheezing, coughing and increased work of breathing
- If it is a respiratory failure: needs to be enough space in bronchi for air to move and create the wheezing sound
- Assess for hypoxemia, inability to use complete sentences, rr>30
Asthma & Diagnostic Tests
- Diagnostics tests include: chest X-Ray, Allergy Testing, oximetry, ABG, and histamine.
- The best test for chronic asthma patient: pulmonary function
- Need to understand: how much breath can go in and for out
Asthma Cont.
- Main goals for Interventions: O2 saturation goal > 90% Priority: correct hypoxia and improve ventilation
- Meds: Steriods need profound systemic functions properties
- Main Goal for Asthma to monitor signs and symptoms and use peak flow at home
Peak Flow Meter
- Visual objective meter about reading.
- Green: 80-100% of personal best-indicates to use medicine or continue to monitor it
- Yellow: 50-80% indicates caution if something is triggered
- Red: lower than 50% to seek or call for medical attention
Chronic Obstructive Pulmonary Disease (COPD)
- Gradual onset diagnosis typically >55 yrs old, but younger patients may be diagnosed as well.
- Includes chronic bronchitis & emphysema. The result of long-term exposure to smoking or pollutants.
- Result of chronic inflammation, and consistent exposure to noxious stimulus [smoking, pollutants, particles, gases]
- 4th leading cause of death affecting 15 million people
- risks: heart failure, pulmonary embolism, and long term smoking
COPD cont.
- Assessment: Dyspnea, Fatigue, underweight, barrel chest, changes in skin color
- Too many red blood cells due to Kidneys detecting low 02 levels & Normal Chest becomes Barrel Chest
- Symptoms of COPD; SOB, fatigue with everywhere activities
COPD Tests:
- Spirometry- Gold Standard and red blood cells
- ABG: What might you expect to see for a patient diagnosed with COPD 2 years ago?
- PH should be: High Low or Normal
- CO2 should be high low or normal
- Less air exhaled than inhaled
COPD & Exacerbations
- Primary Causes: Bacterial/Viral Infections. Uncompensated ABG and right-sided heart failure
- Assessment:Increased work of breathing
- Interventions include: Altered level of consciousness (new/ worse confusion),Unstable Blood Pressure (hypotension) and Right sided heart failure
COPD Treatments
- Short acting bronchodilators, Steroids & antibiotics (if bacterial infection) is goal
- Treatment: Goal to have the saturation 88-92% saturation and have 10-13 1/min
COPD Interventions
- Remove triggers and breathing with pursed lips
- Consider patients for ADL and vaccine
- O2 safety, breathing and nutrition if the patient meets criteria
IDD Collaboration
- Respiratory disorders are the number 1 cause of death for people with IDD and have impaired function for IDD/ALS patients
- Assess drooling more than coughing constantly
- Collaborate
- Intervene: Refer to speech and language pathologist if speech impairments are found
Asthma/ COPD
- Both are more prevalent in IDD pts, smokers and others
- Need to screen for asthma, spirometry/ functions: look at the functions to check for wheezing
- Screen for smoking and for obstructive sleeping
- Genetic abnormalities
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