Cyanosis and Chest Configuration
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Cyanosis and Chest Configuration

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Questions and Answers

What is the primary cause of peripheral cyanosis?

  • Elevated blood flow to the extremities
  • Decreased oxygen tension in the blood
  • Vasoconstriction from exposure to cold (correct)
  • An increase in hemoglobin levels
  • Which chest configuration is characterized by a depression in the lower portion of the sternum?

  • Kyphoscoliosis
  • Pigeon Chest
  • Funnel Chest (correct)
  • Barrel Chest
  • Which breath sounds are characterized as loud, harsh, and high-pitched?

  • Bronchial sounds (correct)
  • Crackles
  • Vesicular breath sounds
  • Bronchovesicular sounds
  • At what hemoglobin level does a patient typically start to show cyanosis?

    <p>5 g/dl</p> Signup and view all the answers

    What can significantly affect the assessment of cyanosis?

    <p>Room lighting and the patient's skin color</p> Signup and view all the answers

    Which of the following statements about kyphoscoliosis is true?

    <p>It involves elevation of the scapula and an S-shaped spine.</p> Signup and view all the answers

    Which accessory muscles are primarily used during expiration?

    <p>Internal intercostal and abdominal muscles</p> Signup and view all the answers

    How is central cyanosis assessed?

    <p>By observing the color of the tongue and lips</p> Signup and view all the answers

    What is a primary goal during the preoperative phase for a patient scheduled for a complete laryngectomy?

    <p>Ensure the patient understands they will lose their natural voice</p> Signup and view all the answers

    Which nursing diagnosis is related to the removal of the larynx in a patient undergoing laryngectomy?

    <p>Disturbed body image</p> Signup and view all the answers

    Which of the following interventions can help reduce a patient's anxiety related to cancer diagnosis and impending surgery?

    <p>Facilitating open communication and addressing fears</p> Signup and view all the answers

    In the case of stage III and IV tumors, which treatment option is most likely to be required?

    <p>Total laryngectomy with or without postoperative treatment</p> Signup and view all the answers

    Which of the following techniques is included in speech therapy for patients after laryngectomy?

    <p>Writing, lip speaking, and using word boards</p> Signup and view all the answers

    What is a critical nursing intervention for maintaining a patent airway post-anesthesia?

    <p>Positioning the patient in the semi-Fowler or Fowler position</p> Signup and view all the answers

    Which treatment might be considered for early-stage tumors without lymph node involvement?

    <p>Conservation surgery or external-beam radiation therapy</p> Signup and view all the answers

    Which nursing diagnosis addresses the patient's inability to ingest food post-laryngectomy?

    <p>Imbalanced nutrition: less than body requirements</p> Signup and view all the answers

    What should be done if a patient has claustrophobia before an MRI?

    <p>Administer antianxiety medications</p> Signup and view all the answers

    What is required regarding food and drink before a pulmonary angiography?

    <p>NPO for 6 to 8 hours</p> Signup and view all the answers

    What precaution should be taken regarding allergies before a contrast dye examination?

    <p>Assess for iodine or shellfish allergies</p> Signup and view all the answers

    During an MRI, how long should a patient lie flat and still?

    <p>60 to 90 minutes</p> Signup and view all the answers

    What immediate concern should be monitored after a bronchoscopy procedure?

    <p>Monitor for cough reflex return</p> Signup and view all the answers

    What is the primary purpose of a biopsy in medical procedures?

    <p>To excise tissue for examination of cells</p> Signup and view all the answers

    What should be done prior to performing thoracoscopy?

    <p>Informed consent and NPO</p> Signup and view all the answers

    What side effect may occur during the injection of a radiopaque agent for pulmonary angiography?

    <p>Warm flushing sensation or chest pain</p> Signup and view all the answers

    Which of the following is a method of oxygen delivery at higher flow rates?

    <p>Simple Mask</p> Signup and view all the answers

    Which of the following is not a consideration before a bronchoscopy?

    <p>Administer analgesics post-procedure</p> Signup and view all the answers

    What concentration of oxygen does the nasal cannula provide at a flow rate of 4 L/min?

    <p>36%</p> Signup and view all the answers

    Which type of biopsy involves tissue from glands or lymph nodes?

    <p>Lymph Node Biopsy</p> Signup and view all the answers

    What is a major complication to monitor for after a lung biopsy?

    <p>Shortness of breath</p> Signup and view all the answers

    Why is humidification necessary for high flow rate oxygen therapy?

    <p>It prevents drying of the mucous membranes</p> Signup and view all the answers

    Which oxygen delivery system allows room air to mix with the delivered oxygen?

    <p>Simple Mask</p> Signup and view all the answers

    What is a benefit of using a nasal cannula for oxygen therapy?

    <p>Clients can easily talk and eat while using it</p> Signup and view all the answers

    What is the primary mode of transmission for pulmonary tuberculosis?

    <p>Airborne transmission via droplet nuclei</p> Signup and view all the answers

    Which of the following is NOT a common risk factor for pulmonary tuberculosis?

    <p>Healthy diet and regular exercise</p> Signup and view all the answers

    What instructions should be given to a patient recovering from an infection?

    <p>Increase activities gradually after fever subsides</p> Signup and view all the answers

    Which of the following assessments is important for monitoring potential complications in patients at risk of pulmonary tuberculosis?

    <p>Monitor for signs of respiratory failure</p> Signup and view all the answers

    Which statement accurately reflects a complication that may arise in patients with untreated pulmonary tuberculosis?

    <p>They are likely to experience multiorgan failure</p> Signup and view all the answers

    What should a nurse consider when educating patients about preventing tuberculosis transmission?

    <p>Avoiding exposure to known infective droplets</p> Signup and view all the answers

    Which patient group is particularly vulnerable to pulmonary tuberculosis due to socioeconomic factors?

    <p>Homeless and impoverished persons</p> Signup and view all the answers

    What is a common misconception about the management of pulmonary tuberculosis?

    <p>Stopping antibiotic treatment as soon as symptoms improve is safe</p> Signup and view all the answers

    Study Notes

    Cyanosis

    • Cyanosis is a bluish discoloration of the skin and mucous membranes due to low oxygen levels in the blood
    • A hemoglobin level of 15 g/dl does not show cyanosis until 5 g/dl becomes unoxygenated
    • Patients with anemia rarely manifest cyanosis
    • Patients with polycythemia, a condition with abnormally high red blood cell count, may appear cyanotic even if adequately oxygenated
    • Assessment of cyanosis is affected by factors like room lighting, the patient's skin color, and the distance of blood vessels from the surface of the skin
    • Central cyanosis, assessed by observing the color of the tongue and lips, indicates a decrease in oxygen tension in the blood
    • Peripheral cyanosis, caused by decreased blood flow to the body's periphery, does not necessarily indicate a central systemic problem

    Chest Configuration

    • The normal ratio of the anteroposterior diameter to the lateral diameter of the chest is 1:2
    • Barrel Chest: over inflation of the lungs with an increased diameter of the thorax. It can be associated with conditions like emphysema
    • Funnel Chest (Pectus Excavatum): a depression in the lower portion of the sternum. It occurs with rickets or Marfan’s syndrome
    • Pigeon Chest (Pectus Carinatum): displacement of the sternum with an increased diameter. It occurs with rickets, or severe kyphoscoliosis
    • Kyphoscoliosis: elevation of the scapula and an S-shaped spine. It occurs with osteoporosis and skeletal disorders

    Breathing Patterns and Respiratory Rates

    • Observe for the use of accessory muscles like sternocleidomastoid, scalene, and trapezius muscles during inspiration, and abdominal and internal intercostal muscles during expiration

    Breath Sounds

    • Bronchial sounds: loud, harsh, and high-pitched, typically heard over the trachea or at the right apex
    • Vesicular breath sounds: soft, low-pitched, predominantly inspiratory, appreciated especially at the posterior lung bases
    • Bronchovesicular sounds: heard during inspiration and expiration, with a mid-range pitch and intensity
    • Bronchophony describes vocal resonance that is more intense and clearer than normal
    • Egophony describes voice sounds that are distorted

    Magnetic Resonance Imaging (MRI)

    • Remove all metal items, including hearing aids, hair clips, and medication patches with metallic foil components
    • Nurses should assess for implanted metal devices before MRI
    • Lie flat and remain still for 30 to 90 minutes while the table moves
    • Loud humming or thumping noise is heard; earplugs are offered to minimize it
    • Communicate with MRI staff via a microphone and earphones
    • Patients with claustrophobia should be offered antianxiety medications

    Fluoroscopic Studies

    • Used to assist with invasive procedures like chest needle biopsy or transbronchial biopsy, performed to identify lesions

    Pulmonary Angiography

    • Involves the rapid injection of a radiopaque agent into the vasculature of the lungs for radiographic study of the pulmonary vessels
    • Obtain informed consent before angiography
    • Assess for known allergies to radiopaque dye
    • Check anticoagulation status and renal function
    • NPO for 6 to 8 hours
    • Inform the patient about warm flushing sensation or chest pain during dye injection

    Radioisotope Diagnostic Procedures (Lung Scans)

    • Eg: Ventilation-perfusion scan

    Bronchoscopy

    • Direct inspection and examination of the larynx, trachea, and bronchi through a bronchoscope
    • Informed consent needed
    • NPO for 4-8 hours
    • Preoperative medications to suppress cough reflex, sedate the patient, and relieve anxiety
    • Remove dentures and other oral prostheses
    • Usually performed under local or moderate sedation
    • After the procedure, the patient must not eat until cough reflex returns
    • Respiratory status is monitored for hypoxia, hypotension, tachycardia, dysrhythmias, hemoptysis, and dyspnea
    • Sedation given to patients with respiratory insufficiency may precipitate respiratory arrest

    Thoracoscopy

    • Diagnostic procedure in which the pleural cavity is examined with an endoscope
    • Informed consent and NPO
    • Monitor vital signs, pain level, and respiratory status postoperatively
    • Look for signs of bleeding and infection at the incisional site

    Thoracentesis

    • Aspiration of pleural fluid for diagnostic or therapeutic purposes

    Biopsy

    • The excision of a small amount of tissue, may be performed to permit examination of cells from the pharynx, larynx, and nasal passages
    • Pleural Biopsy: Monitor for complications like shortness of breath, bleeding, or infection
    • Lung Biopsy: Monitor for complications like shortness of breath, bleeding, or infection
    • Lymph Node Biopsy

    Oxygen Therapy

    • Oxygen is a colorless, odorless, tasteless gas that is essential for the body to function properly and to survive
    • Oxygen therapy is the administration of oxygen at a concentration of pressure greater than that found in the environmental atmosphere
    • Air that we breathe contains approximately 21% oxygen
    • When oxygen is used at high flow rates, it should be moistened by passing it through a humidification system to prevent it from drying the mucous membranes of the respiratory tract

    Methods of Oxygen Administration

    • Nasal Cannula
    • Simple Mask
    • Partial Re-Breather Mask
    • Non-Re Breather Mask (NRBM)
    • Venturi Mask
    • Oxygen Hood
    • Oxygen Tent
    • AMBU Bag
    • Tracheostomy Collar
    • T-piece

    Nasal Cannula (Pongs)

    • 1 L/min=24%, 2 L/min =28%, 3 L/min =32%, 4 L/min =36%, 5 L/min =40%, 6 L/min=44%
    • Advantages: Client able to talk and eat with oxygen in place, easily used in home setting, safe and simple, easily tolerated

    Simple Oxygen Mask

    • Delivers 35% to 60% oxygen
    • A flow rate of 6 to 10 liters per minute
    • It has vents on its sides which allow room air to leak in at many places, thereby diluting the source oxygen

    Medical Management of Laryngeal Cancer

    • Treatment options include surgery, radiation therapy, and adjuvant chemoradiation therapy
    • Early-stage tumors and lesions without lymph node involvement may benefit from external-beam radiation therapy or conservation surgery
    • Stage III and IV tumors may require total laryngectomies with or without postoperative radiation therapy or chemotherapy

    Surgical Treatment of Laryngeal Cancer

    • Vocal Cord Stripping, Cordectomy, Laser Surgery, Partial Laryngectomy, Total Laryngectomy

    Speech Therapy

    • Communication includes writing, lip speaking, reading, and word boards
    • Deficient knowledge about the surgical procedure and postoperative course
    • Anxiety related to the diagnosis of cancer and impending surgery
    • Ineffective airway clearance related to excess mucus production secondary to surgical alterations in the airway
    • Impaired verbal communication related to anatomic deficit secondary to removal of the larynx and to edema
    • Imbalanced nutrition: less than body requirements, related to inability to ingest food secondary to swallowing difficulties
    • Disturbed body image and low self-esteem secondary to major neck surgery, change in appearance, and altered structure and function
    • Self-care deficit related to pain, weakness, fatigue, musculoskeletal impairment related to surgical procedure and postoperative course

    Nursing Interventions for Laryngectomy

    • Providing preoperative patient education: If a complete laryngectomy is planned, the patient must understand that their natural voice will be lost. Teach coughing and deep breathing exercises, and assists with return demonstrations
    • Reducing anxiety: Address patient and family's fears and misconceptions, providing opportunities for open communication and discussion. Visits from previous laryngectomy patients can reassure patients about the possibility of rehabilitation
    • Maintaining a patent airway: Position the patient in the semi-Fowler or Fowler position post-anesthesia to promote lung expansion and decrease surgical edema. Administer IV fluids and nutrients, if necessary
    • Promoting Patients' Knowledge: Explain treatments in simple manner and using appropriate language
    • Monitoring and Preventing Potential Complications: Assess for signs and symptoms of shock, multisystem organ failure, and respiratory failure, atelectasis and pleural effusion. Assess for confusion or cognitive changes
    • Teaching patients self-care: Instruct patient to: Continue taking full course of antibiotics as prescribed, increase activities gradually after fever subsides, do breathing exercises, stop smoking, avoid stress, fatigue, sudden changes in temperature, and excessive alcohol intake, take influenza vaccine (pneumovax)

    Pulmonary Tuberculosis (TB)

    • Infectious disease primarily affecting lung parenchyma, caused by Mycobacterium tuberculosis
    • Spreads to various body parts including meninges, kidney, bones, and lymph nodes
    • Infection usually occurs 2 to 10 weeks after exposure
    • Active disease may develop due to compromised immune system response
    • Global public health problem linked to poverty, malnutrition, overcrowding, substandard housing, and inadequate healthcare

    TB Transmission

    • Spread via airborne transmission
    • Infected person releases droplet nuclei through talking, coughing, sneezing, laughing, or singing
    • Larger droplets settle, smaller remain suspended, inhaled by susceptible person

    Risk Factors for TB

    • Close contact with someone who has active TB
    • Immunocompromised status
    • Alcoholism
    • People lacking adequate health care (eg, homeless or impoverished, minorities, children, and young adults)
    • Preexisting medical conditions, including diabetes, chronic renal failure, silicosis, and malnourishment
    • Immigrants from countries with a high incidence of TB (eg, (southeastern Asia, Africa, Latin America)
    • Institutionalization (eg, long-term care facilities, prisons)
    • Living in overcrowded, substandard housing
    • Health care workers -administration of aerosolized medications, sputum induction procedures, bronchoscopy, suctioning, coughing procedures, caring for the immunosuppressed patient, and administering anesthesia and related procedures (e.g., intubation, suctioning)

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    Description

    This quiz covers important medical concepts related to cyanosis and chest configuration. It explores the characteristics, causes, and methods of assessment for cyanosis, along with anatomical considerations of chest dimensions. Test your knowledge of these key topics in respiratory and cardiovascular health.

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