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?

5 g/dl Signup and view all the answers

What can significantly affect the assessment of cyanosis?

Room lighting and the patient's skin color Signup and view all the answers

Which of the following statements about kyphoscoliosis is true?

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

Which accessory muscles are primarily used during expiration?

Internal intercostal and abdominal muscles Signup and view all the answers

How is central cyanosis assessed?

By observing the color of the tongue and lips Signup and view all the answers

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

Ensure the patient understands they will lose their natural voice Signup and view all the answers

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

Disturbed body image 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?

Facilitating open communication and addressing fears Signup and view all the answers

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

Total laryngectomy with or without postoperative treatment Signup and view all the answers

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

Writing, lip speaking, and using word boards Signup and view all the answers

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

Positioning the patient in the semi-Fowler or Fowler position Signup and view all the answers

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

Conservation surgery or external-beam radiation therapy Signup and view all the answers

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

Imbalanced nutrition: less than body requirements Signup and view all the answers

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

Administer antianxiety medications Signup and view all the answers

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

NPO for 6 to 8 hours Signup and view all the answers

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

Assess for iodine or shellfish allergies Signup and view all the answers

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

60 to 90 minutes Signup and view all the answers

What immediate concern should be monitored after a bronchoscopy procedure?

Monitor for cough reflex return Signup and view all the answers

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

To excise tissue for examination of cells Signup and view all the answers

What should be done prior to performing thoracoscopy?

Informed consent and NPO Signup and view all the answers

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

Warm flushing sensation or chest pain Signup and view all the answers

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

Simple Mask Signup and view all the answers

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

Administer analgesics post-procedure Signup and view all the answers

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

36% Signup and view all the answers

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

Lymph Node Biopsy Signup and view all the answers

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

Shortness of breath Signup and view all the answers

Why is humidification necessary for high flow rate oxygen therapy?

It prevents drying of the mucous membranes Signup and view all the answers

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

Simple Mask Signup and view all the answers

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

Clients can easily talk and eat while using it Signup and view all the answers

What is the primary mode of transmission for pulmonary tuberculosis?

Airborne transmission via droplet nuclei Signup and view all the answers

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

Healthy diet and regular exercise Signup and view all the answers

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

Increase activities gradually after fever subsides Signup and view all the answers

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

Monitor for signs of respiratory failure Signup and view all the answers

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

They are likely to experience multiorgan failure Signup and view all the answers

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

Avoiding exposure to known infective droplets Signup and view all the answers

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

Homeless and impoverished persons Signup and view all the answers

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

Stopping antibiotic treatment as soon as symptoms improve is safe 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.