Pulmonary Nursing Procedures Quiz

Pulmonary Function Tests and Care

• Pulmonary function tests evaluate lung function and capacity.
• For clients experiencing hypoxia or respiratory distress, position in High Fowler's position, encourage pursed-lip breathing, and administer oxygen as prescribed.

Bronchoscopy

• Clients undergoing bronchoscopy should fast for 8-12 hours beforehand.
• Post-procedure, keep client NPO until gag reflex returns.

Sputum Culture and Sensitivity

• Collect sputum from deep within the bronchi, preferably morning sputum.
• Use a sterile container.

Thoracentesis

• Thoracentesis removes fluid from the chest cavity.
• Position the patient sitting upright, head resting on a bedside table.

Tuberculin Skin Test (PPD)

• Read PPD 48-72 hours after intradermal wheal production.
• Induration >10mm indicates positive reaction.
• For HIV/immunosuppressed, >5mm may indicate a positive reaction.

Arterial Blood Gases (ABGs)

• ABGs assess acid-base balance.
• Place ABG sample on ice and rush to lab for analysis.

Adventitious Breath Sounds

• Common adventitious breath sounds are crackles, rhonchi, wheezes, and pleural friction rubs.

Breath Odors

• Fruity breath: ketoacidosis
• Sweet/musty: liver failure
• Urine-like: uremia/renal failure
• Foul: lung abscess/bronchiectasis

Nasal Flaring

• Nasal flaring in infants indicates respiratory distress.

Asthma

• Asthma involves recurring episodes of labored breathing with wheezing.
• Etiology: extrinsic (antigen-antibody reaction triggered by food, drugs, inhaled particles).
• Nursing interventions: bronchodilators (Albuterol), nebulizers (Atrovent), and High Fowler's position.

Pneumothorax/Hemothorax

• Partial or complete lung collapse due to air/blood in pleural space.
• Manifestations: respiratory distress, cough (possible hemoptysis), chest pain, possible mediastinal shift.

Chronic Obstructive Pulmonary Disease (COPD)

• COPD includes emphysema, chronic bronchitis, bronchiectasis, and bronchial asthma.
• Common link: recurrent airflow obstruction.

Emphysema

• Emphysema involves loss of lung elasticity and alveolar destruction.
• Characteristics: barrel chest, clubbing of fingers.
• Interventions: diaphragmatic and pursed-lip breathing to reduce respiratory rate and increase alveolar ventilation.
• Oxygen: low concentration (1-2 L/min) often indicated. Caution: high CO2 levels may stop breathing with high oxygen concentrations.

Pulmonary Edema

• Caused by fluid in lungs due to left ventricular failure.
• Characterized by pink, frothy sputum, dyspnea, confusion.

Pulmonary Embolism

• Occurs when a pulmonary artery is blocked by a thrombus originating from a peripheral vein.
• Manifestations: dyspnea, cyanosis, unexplained hemoptysis, apprehension.

Pursed-Lip Breathing

• Slows expiration, prevents lung unit collapse, helps control rate/depth of respirations.

Chest Tubes

• Purpose: remove fluid/air from pleural space.
• Observe for fluctuation in water-seal chamber with respirations.
• Continuous bubbling in water-seal = abnormal.
• Continuous bubbling in suction = normal.
• Do not clamp chest tube during transport/ambulation.
• If tube dislodges, apply petroleum jelly gauze, notify physician.
• If drainage bottle breaks, clamp tube nearest to patient.

Tuberculosis (TB)

• Caused by Mycobacterium tuberculosis (spread by droplets).
• Manifestations: productive cough, hemoptysis, night sweats, low-grade afternoon fever, weight loss.
• Treatment is long term (up to one year).
• Diagnosis: Acid Fast Bacteria sputum test (repeated 3 times).
• Screening: PPD (Mantoux, Tine tests).
• Positive PPD = exposure, not necessarily active disease.
• Specimen collection: often early morning to maximize concentration.

Pneumonia

• Inflammatory process of respiratory bronchioles/alveolar spaces (infection).
• Manifestations: cough (initially dry/painful, then productive with rusty sputum).
• Pneumocystis carinii pneumonia commonly associated with HIV.

Laryngectomy

• Total laryngectomy requires permanent tracheotomy.
• Establish communication method for immediate postoperative period.

Sputum Color

• Pink/frothy sputum: congestive heart failure, pulmonary edema
• Whitish sputum: asthma, chronic bronchitis
• Greenish sputum: acute bronchitis, lung abscess, pneumonia, TB
• Red sputum: bronchogenic carcinoma or TB

Respiratory Medications

Bronchodilators

• Relax smooth muscle, increase respiration (beta-adrenergic effect).
• Examples: Epinephrine, Albuterol.

Anticholinergic Bronchodilators

• Prevent bronchospasm (acetylcholine).
• Examples: Ipratropium Bromide, Atropine (monitor for tachycardia, hypertension).

Methylxanthine Bronchodilators

• Relax smooth muscles of tracheobronchial tree.
• Examples: Aminophylline, Theophylline.
• Side effects (common NCLEX questions): tachycardia, hypotension, arrhythmias, GI distress, tremors, anxiety, headache. Toxic levels: arrhythmias, seizures.

Anti-inflammatory Agents

• Mast cell stabilizers inhibit histamine release.
• Glucocorticoids reduce inflammation and act as bronchodilators.
• Examples: Cromolyn sodium, Glucocorticoids.
• Monitor for steroid side effects (common NCLEX questions).

Anti-tuberculosis Drugs

• Examples: Isoniazid, Rifampin, Pyrazinamide, Ethambutol.
• Rifampin use: urine, saliva, tears, sweat, sputum may turn orange.

This quiz covers essential procedures related to pulmonary function tests, bronchoscopy, sputum collection, thoracentesis, and assessment of arterial blood gases. Test your knowledge on patient care techniques and important nursing interventions for respiratory conditions.