Medical Terminology: Cyanosis & Chest Configuration

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Questions and Answers

What hemoglobin level typically leads to the manifestation of cyanosis in a patient?

15 g/dl (correct)

10 g/dl

12 g/dl

5 g/dl

Which condition is likely to result in peripheral cyanosis?

Polycythemia

Dehydration

Anemia

Exposure to cold (correct)

What is the normal ratio of anteroposterior diameter to lateral diameter of the chest?

1:2 (correct)

1:1

1:3

1:1.5

Which chest configuration is characterized by a depression in the lower portion of the sternum?

Funnel Chest Signup and view all the answers

Which accessory muscle is commonly used during inspiration?

Sternocleidomastoid Signup and view all the answers

What type of breath sounds are characterized as loud, harsh, and high pitched?

Bronchial Signup and view all the answers

Which term describes vocal resonance that is more intense and clearer than normal?

Bronchophony Signup and view all the answers

Which condition is associated with a S-shaped spine due to elevation of the scapula?

Kyphoscoliosis Signup and view all the answers

What is the main purpose of posting 'No Smoking—Oxygen In Use' signs?

To prevent fire hazards Signup and view all the answers

Which of the following is NOT recommended while using oxygen?

Climbing stairs Signup and view all the answers

What is the minimum distance an oxygen tank should be kept from sources of flame?

15 ft Signup and view all the answers

What should a patient do before undergoing postural drainage?

Inhale bronchodilators Signup and view all the answers

How long should a patient remain in each position during postural drainage?

10 to 15 minutes Signup and view all the answers

What characterizes allergic rhinitis?

Result of exposure to allergens Signup and view all the answers

What should be evaluated first during the initial postural drainage sessions?

Skin color and pulse Signup and view all the answers

What can cause nonallergic rhinitis?

Infection from the common cold Signup and view all the answers

What typically causes pleural effusion?

Collection of fluid from infectious processes like pneumonia or tumors Signup and view all the answers

Which of these is a common clinical manifestation of a large pleural effusion?

Shortness of breath leading to acute respiratory distress Signup and view all the answers

What is the main purpose of performing a thoracentesis?

To remove fluid and relieve symptoms such as dyspnea Signup and view all the answers

What is the typical amount of fluid found normally in the pleural space?

5 to 15 ml Signup and view all the answers

Which diagnostic method is NOT used for assessing pleural effusion?

Chromosomal analysis Signup and view all the answers

Which position may help alleviate pain for a patient with pleural effusion?

Sitting upright and leaning forward Signup and view all the answers

What is the goal of chemical pleurodesis?

To prevent further accumulation of pleural fluid Signup and view all the answers

Which of the following is crucial for preventing the spread of TB infection?

Covering mouth and nose when coughing and sneezing Signup and view all the answers

Which symptom is typically associated with pulmonary tuberculosis?

Weight loss Signup and view all the answers

What is the significance of a 10 mm induration on a tuberculin skin test?

Usually significant in individuals with normal immunity Signup and view all the answers

Which of the following is NOT a first-line medication for tuberculosis treatment?

Ethionamide Signup and view all the answers

What should be emphasized to patients regarding the adherence to tuberculosis medication?

Missed doses can lead to drug resistance Signup and view all the answers

What is the main goal of promoting airway clearance in TB patients?

To reduce the risk of infection transmission Signup and view all the answers

What does a nonsignificant reaction on the skin test indicate?

The immune system did not react to tuberculin Signup and view all the answers

What is the typical duration for the administration of first-line TB medications?

6 to 12 months Signup and view all the answers

Which test is used to detect the presence of active TB infection?

Sputum culture Signup and view all the answers

What is a key indicator of severe pneumonia observable on a patient's body?

Flushed cheeks Signup and view all the answers

What is the primary method to minimize contamination during sputum sample collection?

Rinse the mouth with water Signup and view all the answers

Which of the following treatments is NOT a supportive measure for pneumonia?

Immediate surgical intervention Signup and view all the answers

Which nursing diagnosis relates to the amount of fluid intake during pneumonia treatment?

Risk for deficient fluid volume Signup and view all the answers

What should be encouraged to improve airway patency in a pneumonia patient?

Intake of 2 to 3 L of fluids per day Signup and view all the answers

Which positioning is recommended for a pneumonia patient to promote breathing and comfort?

Semi-Fowler's position Signup and view all the answers

What is the main purpose of using humidified air for pneumonia patients?

To prevent dehydration of secretions Signup and view all the answers

What type of vaccination is advised for individuals at high risk of pneumonia?

Pneumococcal vaccination Signup and view all the answers

Study Notes

Cyanosis

A patient with a hemoglobin level of 15 g/dl does not demonstrate cyanosis until 5 g/dl is unoxygenated.
A patient with anemia rarely manifests cyanosis.
A patient with polycythemia may appear cyanotic even if adequately oxygenated.
Central cyanosis is assessed by observing the color of the tongue and lips.
Peripheral cyanosis results from decreased blood flow to the body's periphery (fingers, toes, or earlobes).

Chest Configuration

The normal ratio of the anteroposterior diameter to the lateral diameter is 1:2
Barrel Chest: overinflation of the lungs causing an increase in the diameter of the thorax
Funnel Chest (Pectus Excavatum): a depression in the lower portion of the sternum, occurs with rickets or Marfan’s syndrome
Pigeon Chest (Pectus Carinatum): displacement of the sternum. There is an increase in the diameter, occurs with rickets, or severe kyphoscoliosis.
Kyphoscoliosis: elevation of the scapula and a corresponding S-shaped spine, occurs with osteoporosis and skeletal disorders

Breathing Patterns and Respiratory Rates

Use of Accessory Muscles: Observe sternocleidomastoid, scalene, and trapezius muscles during inspiration, and the 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.

Oxygen Safety

Post “No Smoking—Oxygen In Use” signs on doors.
Notify local fire department and electric company of oxygen use in home.
Never use paint thinners, cleaning fluids, gasoline, aerosol sprays, and other flammable materials while using oxygen.
Keep all methods of oxygen delivery at least 15 ft away from matches, candles, gas stove, or other source of flame, and 5 ft away from television, radio, and other appliances.
Keep oxygen tank out of direct sunlight.
When traveling in automobile, place oxygen tank on floor behind front seat.

Postural Drainage

Uses gravity to remove bronchial secretions.
Secretions drain from affected bronchioles into the bronchi and trachea, removed by coughing or suctioning.
Instruct patient to inhale bronchodilators and mucolytic agents before postural drainage

Nursing Management (Postural Drainage)

Performed two to four times daily, before meals, and at bedtime.
Prescribed bronchodilators, water, or saline may be nebulized and inhaled before drainage.
Patient is made comfortable in each position and provided with emesis basin, sputum cup, and paper tissues.
Patient remains in each position for 10 to 15 minutes, breathing in and out slowly to keep airways open.
If coughing is not possible, mechanical suctioning may be necessary.
After the procedure, the amount, color, viscosity, and character of expelled sputum are noted.
Skin color and pulse are evaluated the first few times.

Upper Respiratory Tract Disorders: Rhinitis

A group of disorders characterized by inflammation and irritation of the mucous membranes of the nose.
Often coexists with other respiratory disorders, such as asthma.
Can be acute or chronic, and allergic or nonallergic.
Causes: temperature changes, odors, infection, age, systemic disease, use of OTC and prescribed nasal decongestants, and foreign body presence.
Allergic rhinitis: exposure to allergens (Dust mite, pet dander, trees), medications.
Nonallergic rhinitis due to the common cold.

Severe Pneumonia

Flushed cheeks; lips and nail beds demonstrating central cyanosis.
Sputum purulent, rusty, blood-tinged.
Appetite is poor, and the patient is diaphoretic and tires easily.

Assessment and Diagnostic Findings (Pneumonia)

History, physical examination, chest x-ray, blood culture, and sputum examination.
Sputum sample obtained by:
- Rinsing the mouth with water to minimize contamination by normal oral flora.
- Breathing deeply several times.
- Coughing deeply.
- Expectorating the raised sputum into a sterile container.
Sputum can be obtained by nasotracheal or orotracheal suctioning with a sputum trap or by fiberoptic bronchoscopy.
Prevention: Pneumococcal vaccination.

Pharmacologic Therapy (Pneumonia)

Antibiotics.
Combination therapy may also be used.
Supportive treatment includes hydration, antipyretics, antitussive medications, antihistamines, or nasal decongestants.
Bed rest is recommended until infection clears.
Oxygen therapy is given for hypoxemia.
Respiratory support includes high inspiratory oxygen concentrations, endotracheal intubation, and mechanical ventilation.
For those at high risk, pneumococcal vaccination is advised.

Nursing Diagnoses (Pneumonia)

Ineffective airway clearance related to copious tracheobronchial secretions.
Fatigue and activity intolerance related to impaired respiratory function.
Risk for deficient fluid volume related to fever and a rapid respiratory rate.
Imbalanced nutrition: less than body requirements.
Deficient knowledge about the treatment regimen and preventive measures.

Nursing Interventions (Pneumonia)

Improving Airway Patency:
- Encourage hydration: fluid intake (2 to 3 L/day) to loosen secretions.
- Provide humidified air using a high-humidity face mask.
- Encourage patient to cough effectively, and provide correct positioning, chest physiotherapy, and incentive spirometry.
- Provide and monitor oxygen therapy.
Promoting Rest and Conserving Energy:
- Encourage the patient to rest and avoid overexertion.
- Patient should assume a comfortable position to promote rest and breathing (eg, semi-Fowler’s position) and should change positions frequently to enhance secretion clearance and pulmonary ventilation and perfusion.
Promoting Fluid Intake and Maintaining Nutrition:
- Encourage fluids (2 L/day minimum with electrolytes and calories).

Clinical Manifestations (Tuberculosis)

Low-grade fever, cough, night sweats, fatigue, and weight loss.
Nonproductive cough, which may progress to mucopurulent sputum with hemoptysis.

Assessment and Diagnostic Methods (Tuberculosis)

TB skin test (Mantoux test); QuantiFERON-TB Gold (QFT-G) test.
Chest x-ray.
Acid-fast bacillus smear.
Sputum culture.

Tuberculin Skin Test

Tubercle bacillus extract (tuberculin) is injected into the forearm's inner layer.
0.1 mL of PPD is injected, creating an elevated wound 6-10 mm in diameter.
Test results are recorded 48 to 72 hours after injection.
The size of the induration determines the significance of the reaction.
- 0 to 4 mm is not significant.
- 5 mm or greater may be significant in people considered at risk.
- 10 mm or greater is usually significant in people with normal or mildly impaired immunity.
A significant reaction indicates past exposure to M. tuberculosis or vaccination with the bacille Calmette-Guérin (BCG) vaccine.
A significant reaction does not necessarily mean active disease is present in the body.
A nonsignificant (negative) skin test means the person's immune system did not react to the test and that latent TB infection or TB disease is not likely.

Medical Management (Tuberculosis)

Pulmonary TB is treated primarily with antituberculosis agents for 6 to 12 months.
Pharmacologic Therapy:
- First-line medications: isoniazid or INH (Nydrazid), rifampin (Rifadin), pyrazinamide, and ethambutol (Myambutol) daily for 8 weeks and continuing for up to 4 to 7 months.
- Second-line medications: capreomycin (Capastat), ethionamide (Trecator), para-aminosalicylate sodium, and cycloserine (Seromycin).
- Vitamin B (pyridoxine) usually administered with INH.

Nursing Management (Tuberculosis)

Promoting airway clearance:
- Encourage increased fluid intake.
- Instruct about best position to facilitate drainage.
Advocating adherence to treatment regimen:
- Explain that TB is a communicable disease and that taking medications is the most effective way of preventing transmission.
- Instruct about the risk of drug resistance if the medication regimen is not strictly and continuously followed.
Carefully monitor vital signs and observe for spikes in temperature or changes in the patient’s clinical status.
Promoting activity and adequate nutrition:
- Plan a progressive activity schedule.
- Small, frequent meals and nutritional supplements
- Identify facilities (eg, shelters, soup kitchens, meals on wheels) that provide meals in the patient’s neighborhood
Preventing Spreading of TB Infection:
- Instruct the patient about important hygiene measures, including mouth care, covering the mouth and nose when coughing and sneezing, proper disposal of tissues, and handwashing.

Pleural Effusion

Collection of fluid in the pleural space, usually secondary to other diseases (eg, pneumonia, pulmonary infections, nephrotic syndrome, connective tissue disease, neoplastic tumors, congestive HF).
Normally, the pleural space contains a small amount of fluid (5 to 15 ml), which acts as a lubricant that allows the pleural surfaces to move without friction.
Pleural fluid accumulates due to an imbalance in hydrostatic or oncotic pressures (transudate) or as a result of inflammation by bacterial products or tumors (exudate).

Clinical Manifestations (Pleural Effusion)

Large effusion: shortness of breath to acute respiratory distress.
Small to moderate effusion: Dyspnea may not be present.
Dullness or flatness to percussion over areas of fluid, minimal or absence of breath sounds, decreased fremitus, and tracheal deviation away from the affected side.

Assessment and Diagnostic Methods (Pleural Effusion)

Physical examination.
Chest X-ray.
Chest CT scan.
Thoracentesis and Pleural fluid analysis.
Pleural biopsy.

Medical Management (Pleural Effusion)

Thoracentesis is performed to remove fluid, collect specimen for analysis, and relieve dyspnea.
Chest tube and water-seal drainage may be necessary for drainage and lung re-expansion.
Chemical pleurodesis: drugs are instilled into the pleural space to obliterate the space and prevent further accumulation of fluid.
Surgical pleurectomy (insertion of a small catheter attached to a drainage bottle) or implantation of a pleuroperitoneal shunt.

Nursing Management (Pleural Effusion)

Prepare and position patient for thoracentesis and offer support throughout the procedure.
Monitor chest tube drainage and water-seal system; record the amount of drainage at prescribed intervals.
Assist patient to assume positions that are least painful.
Administer pain medication as prescribed and needed to continue frequent turning and ambulation.

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Description

This quiz explores the concepts of cyanosis and various chest configurations, including definitions and characteristics. It also covers the conditions under which cyanosis may or may not be present and details about different chest shapes and associated conditions. Test your understanding of these crucial medical terms and definitions.