Nursing Care for COPD and Pneumonia Patients
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Questions and Answers

Which physiological process is most directly impaired in a patient with pneumonia affecting gas exchange?

  • Perfusion
  • Diffusion (correct)
  • Cardiac Output
  • Ventilation

    • Considering Mr. Edwards' history of COPD and current pneumonia, which of the following acid-base imbalances is he most at risk for developing?

  • Metabolic acidosis
  • Metabolic alkalosis
  • Respiratory acidosis (correct)
  • Respiratory alkalosis

    • What is the primary reason lying down increases Mr. Edwards' shortness of breath?

  • Exacerbation of his COPD due to positional changes
  • Reduced blood pressure when lying flat
  • Increased chest pain intensity in a supine position
  • Increased venous return and fluid redistribution impairing lung expansion (correct)

    • Mr. Edwards' oxygen saturation is 86% on room air. Which of the following oxygen delivery methods is most appropriate to initiate, considering his history and current condition?

    <p>Nasal cannula starting at 2 L/min, titrating to effect (C)</p> Signup and view all the answers

    Which nursing intervention is most important to include in Mr. Edwards' plan of care to address his thick, yellow sputum?

    <p>Encouraging increased fluid intake (A)</p> Signup and view all the answers

    In a patient with atelectasis, which physiological process is directly compromised?

    <p>Alveolar ventilation (C)</p> Signup and view all the answers

    Excessive oxygen administration in COPD patients can lead to hypoventilation by diminishing which physiological drive?

    <p>The hypoxic drive to breathe (A)</p> Signup and view all the answers

    A patient experiencing numbness and tingling in the hands/feet, along with rapid respiration, is MOST likely suffering from:

    <p>Hyperventilation (D)</p> Signup and view all the answers

    A patient reports experiencing fatigue that seems to be worsening over the past few weeks. Why is it important for you to consider this symptom in relation to their respiratory health?

    <p>Subjective fatigue can be an early sign of a worsening chronic underlying respiratory condition. (A)</p> Signup and view all the answers

    Which of the following is a LATE sign of hypoxia?

    <p>Cyanosis (B)</p> Signup and view all the answers

    Pulmonary congestion, crackles in lung bases, and shortness of breath on exertion are MOST indicative of:

    <p>Left-sided heart failure (D)</p> Signup and view all the answers

    When assessing a patient complaining of chest pain, what specific characteristics of the pain are critical to evaluate to determine its origin and potential severity?

    <p>Location, intensity, duration, radiation, frequency, and associated symptoms. (C)</p> Signup and view all the answers

    During a physical examination, you observe that a patient is using their accessory muscles to breathe. What does this observation suggest about the patient's respiratory status?

    <p>The patient is experiencing increased work of breathing and possible respiratory distress. (D)</p> Signup and view all the answers

    Peripheral edema, weight gain, and distended neck veins are MOST indicative of:

    <p>Right-sided heart failure (D)</p> Signup and view all the answers

    Why is it unsafe to palpate both carotid arteries simultaneously?

    <p>It can obstruct blood flow to the brain, potentially causing a stroke or loss of consciousness. (A)</p> Signup and view all the answers

    Angina pectoris occurs as a result of:

    <p>An imbalance between myocardial oxygen supply and demand (A)</p> Signup and view all the answers

    A physician has ordered a thoracentesis for your patient. What is the primary purpose of this procedure?

    <p>To surgically remove fluid or tissue for analysis, typically from the pleural space. (A)</p> Signup and view all the answers

    Cellular death occurs after how many minutes of inadequate coronary perfusion?

    <p>20 minutes (D)</p> Signup and view all the answers

    A patient with a spinal cord injury at the level of the fourth cervical vertebra is most likely to require mechanical ventilation because:

    <p>The phrenic nerve, which innervates the diaphragm, is compromised. (B)</p> Signup and view all the answers

    Which of the following factors directly affects the work of breathing?

    <p>The rate and depth of breathing. (C)</p> Signup and view all the answers

    A decrease in lung compliance would result in which of the following?

    <p>Increased effort to expand the lungs. (B)</p> Signup and view all the answers

    Which of the following processes is primarily responsible for moving respiratory gases from the alveoli into the blood?

    <p>Diffusion (B)</p> Signup and view all the answers

    What is the primary function of pulmonary circulation?

    <p>To facilitate gas exchange at the alveolar-capillary membrane. (A)</p> Signup and view all the answers

    Which of the following best describes the role of hemoglobin in oxygenation?

    <p>Transporting the majority of oxygen in the blood. (A)</p> Signup and view all the answers

    Which of the following is a true statement regarding the process of ventilation?

    <p>It involves the movement of gases into and out of the lungs. (D)</p> Signup and view all the answers

    A patient is experiencing a decrease in perfusion. Which of the following is most likely affected?

    <p>The ability of the cardiovascular system to transport oxygenated blood to the tissues. (B)</p> Signup and view all the answers

    When performing tracheal suctioning, which action should be prioritized?

    <p>Performing tracheal suctioning before pharyngeal suctioning. (C)</p> Signup and view all the answers

    Which intervention is most appropriate for mobilizing pulmonary secretions in a patient with a weak cough?

    <p>Performing chest physiotherapy (CPT) with percussion. (B)</p> Signup and view all the answers

    A patient with COPD is receiving oxygen therapy. What is the MOST important consideration regarding the oxygen administration?

    <p>Cautiously administering oxygen, monitoring for respiratory depression. (A)</p> Signup and view all the answers

    Following a review of Mr. Edwards' lab results, which finding is MOST indicative of a bacterial infection?

    <p>Elevated White Blood Cell Count (WBC) and Neutrophil percentage. (B)</p> Signup and view all the answers

    A patient with cystic fibrosis is having difficulty clearing thick secretions. Which technique would be MOST effective in assisting this patient?

    <p>Performing a manually assisted cough (quad cough). (A)</p> Signup and view all the answers

    A patient is diagnosed with bacterial pneumonia, and Streptococcus pneumoniae is identified in the sputum culture. Which intervention should the nurse prioritize based on the provided information?

    <p>Administering Penicillin, Ceftriaxone, or Azithromycin as prescribed. (B)</p> Signup and view all the answers

    A patient is receiving oxygen therapy at 5 L/min. What nursing intervention is essential to prevent complications?

    <p>Provide humidification. (C)</p> Signup and view all the answers

    What is the primary purpose of using Positive Expiratory Pressure (PEP) devices, such as Acapella or Flutter, in respiratory therapy?

    <p>To facilitate easier exhalation against resistance, aiding in airway clearance. (C)</p> Signup and view all the answers

    What is the MOST critical immediate action to take if a patient's tracheostomy tube becomes obstructed?

    <p>Attempt to replace the tracheostomy tube immediately. (D)</p> Signup and view all the answers

    Which vaccination should a 70-year-old patient who is also a smoker be encouraged to receive, in addition to the annual influenza vaccine?

    <p>Pneumococcal vaccine (B)</p> Signup and view all the answers

    An intubated patient is on mechanical ventilation. What is the primary indication for using an endotracheal tube in this scenario?

    <p>To bypass an upper airway obstruction. (A)</p> Signup and view all the answers

    A patient with a history of prolonged mechanical ventilation requires long-term airway support. Which of the following artificial airways is most appropriate?

    <p>Tracheostomy tube (C)</p> Signup and view all the answers

    Following abdominal surgery, a patient is at risk for developing atelectasis. Which intervention is MOST appropriate to prevent this complication?

    <p>Encouraging the use of incentive spirometry. (D)</p> Signup and view all the answers

    Flashcards

    Cardiopulmonary System

    The system comprising the heart and lungs, responsible for oxygenating blood and removing CO2.

    Ventilation

    The process of moving air in and out of the lungs for gas exchange.

    Hyperventilation

    Rapid or deep breathing that leads to decreased carbon dioxide levels in the blood.

    Oxygen Saturation

    The percentage of hemoglobin binding sites in the bloodstream occupied by oxygen.

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    COPD

    Chronic Obstructive Pulmonary Disease, a group of lung diseases that block airflow.

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    Health Risks Assessment

    Evaluation of factors like family history of diseases such as lung cancer or cardiovascular issues.

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    Dyspnea

    Discomfort or difficulty in breathing that may indicate respiratory problems.

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    Inspection in Physical Exam

    The process of visually assessing a patient from head to toe for abnormalities.

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    Auscultation

    Using a stethoscope to listen to heart and lung sounds to detect abnormalities.

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    Palpation

    The act of feeling with the hands to locate abnormalities in the body, like tenderness or thrills.

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    Gas Exchange Disturbances

    Problems in oxygen uptake due to lung or heart dysfunction.

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    Oxygenation Steps

    The process of oxygenating blood involves ventilation, perfusion, and diffusion.

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    Major Muscle of Respiration

    The diaphragm is crucial for breathing and is controlled by the phrenic nerve.

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    Perfusion

    The ability of the cardiovascular system to circulate oxygenated blood to tissues.

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    Diffusion in Gas Exchange

    The movement of gases based on concentration gradients.

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    Work of Breathing

    The effort required to expand and contract the lungs during respiration.

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    Oxygen Transport by Hemoglobin

    Hemoglobin carries 97% of oxygen in the blood.

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    Atelectasis

    Collapse of alveoli, causing reduced lung ventilation.

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    Hypoxic Drive

    The body's response for breathing triggered by low PaO2.

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    Hypoxia

    Inadequate oxygenation at the cellular level.

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    Altered cardiac output

    Impairment in the heart's ability to pump blood effectively.

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    Myocardial Infarction (MI)

    Heart tissue death due to inadequate blood flow lasting over 20 minutes.

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    Factors influencing oxygenation

    Developmental, lifestyle, and environmental factors affecting oxygen levels.

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    Oxygenation Reevaluation

    The ongoing assessment of a patient's oxygen levels and respiratory status.

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    Tracheal Suctioning Sequence

    Suctioning of the trachea should be done before the pharynx to maintain airway clearance.

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    COPD and Oxygen Therapy

    Patients with COPD may need careful monitoring when given high levels of oxygen.

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    CBC Normal Ranges

    The complete blood count provides crucial information, including normal ranges for WBCs, RBCs, hemoglobin, and more.

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    Sputum Culture Identification

    A lab test that identifies pathogens in sputum, helping to diagnose infections like pneumonia.

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    Tuberculosis Skin Test (PPD)

    A test to determine if someone has been exposed to tuberculosis by injecting a small amount of tuberculin under the skin.

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    Incentive Spirometry

    A device used to help patients improve lung function by encouraging deep breathing to prevent atelectasis.

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    Cough Techniques

    Methods like huff cough and quad cough used to help clear airways in patients with conditions like cystic fibrosis.

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    Airway Maintenance

    Ensuring that large airways are open and free from obstruction to facilitate airflow.

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    Positive Expiratory Pressure (PEP)

    A technique using devices like Acapella to create resistance during exhalation, helping to keep airways open.

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    Nebulization

    A method of administering medication in aerosol form to improve breathing in patients with respiratory conditions.

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    Chest Physiotherapy (CPT)

    Techniques involving manual techniques like percussion to help dislodge thick mucus from the lungs.

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    Artificial Airways

    Devices like endotracheal and tracheostomy tubes used to maintain an open airway in patients needing ventilation support.

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    Study Notes

    Oxygenation-Week 3

    • This week's focus is oxygenation in nursing, specifically cardiopulmonary function, and related clinical outcomes.

    Class Objectives

    • Describe the structure and function of the cardiopulmonary system.
    • Describe physiological processes of ventilation, perfusion, and gas exchange.
    • Identify clinical outcomes of hyperventilation, hypoventilation, and hypoxia.
    • Assess for risk factors affecting client oxygenation.
    • Describe nursing interventions.
    • Evaluate patient responses to oxygenation therapies.
    • Exclude information on nasotracheal suctioning, and sections on cardiovascular physiology or conduction system pages 973-975.

    Case Study (Mr. Edwards)

    • Mr. Edwards, age 62, is hospitalized with a 6-day history of chest pain and shortness of breath.
    • Chest X-ray shows community-acquired right upper lobe pneumonia.
    • He coughs with occasional thick, yellow sputum.
    • Lying down worsens his shortness of breath.
    • A nursing student is assigned to his care.

    History

    • Alcohol abuse, sedentary lifestyle
    • 40-year history of smoking 2 packs per day
    • COPD
    • Works outside the home but unable to participate due to his health.

    Current Vital Signs

    • BP 142/84, HR 110, RR 26, O2 Sat 86% on RA
    • Chest pain with breathing at 4/10.
    • Anxious
    • Fatigue with difficulty getting from bed to chair.
    • RR increased to 32 during transfer.

    Respiratory Physiology

    • Oxygen is a fundamental human need. Low oxygen leads to compromised vital functions.
    • Gas exchange disturbances often stem from ineffective lung function or heart issues.
    • Blood oxygenation depends on ventilation, perfusion, and respiratory gas transport.
    • Cardiovascular system delivers oxygen to tissues.
    • Oxygenation involves ventilation, perfusion, and diffusion.

    Ventilation

    • Moving air in and out of lungs (inspiration/exhalation).
    • Coordinated muscular and elastic lung/thorax actions.
    • Diaphragm is the primary inspiratory muscle, innervated by the phrenic nerve.

    Perfusion

    • Cardiovascular system's ability to pump oxygenated blood to tissues and return deoxygenated blood to lungs.

    Diffusion

    • Respiratory gases' movement across concentration gradients.
    • Organs and respiration muscles must be intact, with central nervous system regulation of respiratory cycles.

    Respiratory Physiology (cont'd.)

    • Diffusion occurs across the alveolar capillary membrane.
    • Hemoglobin carries 97% of oxygen.
    • Venous blood carries carbon dioxide to be exhaled.
    • Central nervous system (CNS) regulates respiratory rate, depth, and rhythm.

    Cardiovascular Physiology

    • Myocardial pump: ventricles move blood during systole. Stroke volume is the ejected volume.
    • Myocardial blood flow involves valves for one-way blood movement.
    • Coronary arteries supply the heart during diastole.
    • Left coronary artery receives most blood supply.
    • Systemic circulation: arteries deliver oxygen and nutrients, veins carry waste. The cardiac output is the amount of blood ejected from the left ventricle per minute.

    Factors Affecting Oxygenation

    • Physiological factors (e.g., respiratory or cardiac issues, reduced oxygen-carrying capacity).

    • Hypovolemia is one cause of reduced oxygenation, linked to shock, dehydration, fluid loss.

    • Other physiological factors: decreased inspired oxygen concentration due to airway blockages, high elevation, or opioid use, and increased metabolic demands (pregnancy, wound healing, exercise).

    • Developmental stage

    • Lifestlye factors

    • Environmental factors

    Assessment

    • Nursing history, health risks
    • Pain, fatigue, dyspnea, cough
    • Environmental/occupational factors (smoking, infections, etc.)
    • Physical exam: inspection, palpation, percussion, auscultation of heart and lungs
    • Cardiovascular and respiratory function tests (Holter monitor, ECG, ABGs, pulmonary function tests, etc.).

    Interventions

    • Health promotion (vaccinations, healthy lifestyle, environmental factors considerations).
    • Acute care (dyspnea management - oxygen therapy, steroids, bronchodilators; airway maintenance -- suctioning, positioning, and humidification; nebulization, positive expiratory pressure (PEP), artificial airways -tracheostomy)
    • Restorative and continuing care (rehabilitation, exercises).

    Evaluation

    • Patient outcomes are compared to expected progress.
    • Oxygenation status is continually assessed.
    • Evaluate symptoms such as breathlessness.
    • Assess intervention effectiveness.

    Safety Guidelines

    • Establish patient baseline vital signs.
    • Limit catheter introductions in suctioning procedures.
    • Use caution with head injuries during suctioning.
    • Review suction procedures.

    Additional Information

    • Complete Blood Count (CBC) results (WBC, RBC, hemoglobin, hematocrit, platelets, etc.).
    • Basic Metabolic Panel (BMP) results (sodium, potassium, chloride, bicarbonate, BUN, creatinine, glucose).
    • Chest X-ray results (consolidation, consistency with bacterial pneumonia)
    • Sputum culture (organism identification and antibiotic sensitivities)

    Medications

    • List of medications (Ceftriaxone, Flovent, Albuterol, Tylenol)

    Critical Thinking

    • Cardiopulmonary physiology knowledge guides assessment approaches.
    • Critical thinking ensures logical patient care.
    • Professional standards guide patient care.

    Additional Clinical Items

    • Revisit Mr. Edwards
    • Review paperwork from clinical packet.
    • How would you address Mr. Edward's case study?
    • Action plan
    • How/Why would you know if the action plan is working?
    • See page 989-990
    • Concept map of relevant nursing diagnoses.

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    Related Documents

    Oxygenation-Week 3 PDF

    Description

    Test your knowledge on nursing interventions and physiological considerations for patients with pneumonia and COPD. This quiz covers topics such as gas exchange impairment, acid-base imbalances, and appropriate oxygen delivery methods. Enhance your understanding of patient care in respiratory conditions.

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