Respiratory Disorders in Nursing

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Questions and Answers

What is the primary action to take for a newly admitted patient with suspected pneumothorax?

Cover the wound with a 3-sided petroleum gauze tape (correct)

Perform an emergency thoracotomy

Place the patient in a supine position

Administer intravenous fluids immediately

What symptom may indicate postoperative bleeding in a patient who has had a tonsillectomy?

Continuous swallowing and cough (correct)

Improved speech clarity

Increased appetite

Elevated heart rate

What is the recommended suction time when performing suctioning?

5-10 seconds

10-15 seconds (correct)

30-40 seconds

20-30 seconds

Which movement is characteristic of flail chest?

Paradoxical chest movement Signup and view all the answers

What is the proper technique for using a peak flow meter?

Exhale as forcefully and quickly as possible Signup and view all the answers

What is the usual PEEP setting for mechanical ventilation?

5 Signup and view all the answers

Which of the following actions should be avoided in patients recovering from tonsillectomy?

Clearing the throat or blowing the nose Signup and view all the answers

What risk is associated with a high level of PEEP (10-20)?

Rupture of the alveoli Signup and view all the answers

What is a common symptom of atelectasis?

Crackles Signup and view all the answers

What is the primary action a nurse should take in managing carbon monoxide poisoning?

Deliver 100% oxygen via non-rebreather mask Signup and view all the answers

What should a COPD patient do regarding fluid intake during meals?

Avoid drinking fluids during meals Signup and view all the answers

Which sound is primarily associated with bronchitis?

Rhonchi Signup and view all the answers

In patients with COPD exacerbation, what is the most important aspect for the nurse to monitor?

Mental status changes Signup and view all the answers

What is the method of administration for Tiotropium (Spiriva)?

Capsule inhaler Signup and view all the answers

Which of the following medications should be avoided in COPD patients due to its cough-suppressing effects?

Codeine Signup and view all the answers

What is a common symptom of carbon monoxide poisoning?

Dizziness Signup and view all the answers

What is the priority care for a new tracheostomy?

Prevent accidental dislodgement of the tube Signup and view all the answers

How should ties be adjusted for a tracheostomy tube?

One finger should fit between the ties Signup and view all the answers

When should the inner cannula of a tracheostomy tube be changed?

24 hours after insertion Signup and view all the answers

What should be done immediately before deflating the cuff in a tracheostomy patient?

Ask the client to cough and suction Signup and view all the answers

What is a common complication of pneumonia that relates to chest pain?

Pleural friction rub Signup and view all the answers

What should a client be monitored for after returning from a bronchoscopy?

Positive gag reflex Signup and view all the answers

What should be reported when assessing sputum after a bronchoscopy?

Bright red blood mixed with sputum Signup and view all the answers

Which patient condition is indicated for BIPAP therapy?

COPD with hypercapnic respiratory failure Signup and view all the answers

What triggers the high pressure alarm on a ventilator?

Increased resistance to airflow Signup and view all the answers

Which is NOT a possible cause of a high pressure alarm in a ventilator?

Disconnection of oxygen sensing tubing Signup and view all the answers

What is the purpose of assessing lung sounds in relation to endotracheal tube placement?

To check for proper tube placement Signup and view all the answers

What is the anatomical location of the phlebostatic axis?

Fourth intercostal space at the midaxillary line Signup and view all the answers

Which symptom is NOT typically associated with pleural effusion?

Wheezing Signup and view all the answers

Which characteristic is commonly associated with emphysema?

Activity intolerance Signup and view all the answers

What should the nurse do if a mature tracheostomy stoma is dislodged?

Cover with a sterile dressing and bag-valve mask Signup and view all the answers

What is a primary reason for the development of hyperresonance in emphysema?

Air trapped in the alveoli Signup and view all the answers

What is the best indicator of Ventilator Associated Pneumonia?

Positive sputum culture Signup and view all the answers

Which intervention is NOT recommended for facilitating secretions removal in pneumonia?

Complete bed rest Signup and view all the answers

Which age group is at increased risk for pneumonia?

People under 2 years Signup and view all the answers

What symptom is NOT typically associated with Obstructive Sleep Apnea (OSA)?

Frequent urination at night Signup and view all the answers

What is a common cause of Acute Respiratory Distress Syndrome (ARDS)?

Sepsis Signup and view all the answers

What is a primary characteristic of Acute Respiratory Distress Syndrome (ARDS)?

Fluid leaks into the alveoli Signup and view all the answers

What is a common treatment for Obstructive Sleep Apnea?

Continuous Positive Airway Pressure (CPAP) Signup and view all the answers

What is a potential consequence of pneumonia affecting lung function?

Impaired oxygenation and ventilation Signup and view all the answers

What is the priority nursing diagnosis for a patient with ARDS?

Impaired gas exchange Signup and view all the answers

What is the expected drainage amount from a chest tube on the first day post-procedure?

50-500 ml Signup and view all the answers

Which breathing technique involves exhaling through pursed lips?

Pursed lip breathing Signup and view all the answers

Which finding would indicate a potential complication of thoracentesis?

Pneumothorax Signup and view all the answers

What indicates that suction is working properly in the chest tube drainage system?

Gentle continuous bubbling Signup and view all the answers

What should be assessed immediately if drainage from a chest tube stops abruptly?

Breath sounds Signup and view all the answers

When should a patient be instructed to hold their breath during the chest tube removal procedure?

When the chest tube is being pulled out Signup and view all the answers

What type of drainage is expected immediately after chest tube placement?

Sanguineous (bright red) Signup and view all the answers

What is the correct procedure if the drainage tube becomes disconnected from the plastic chamber?

Place the distal part of the tube in sterile saline water Signup and view all the answers

When should a chest tube be removed?

When drainage is less than 200 ml/24hrs and other conditions are met Signup and view all the answers

What is an important strategy to prevent post-operative pneumonia?

Ambulate within 8 hours of surgery Signup and view all the answers

What should you do if the water seal of a chest tube breaks?

Clamp first, cut the tube, and place it in sterile water Signup and view all the answers

During CPR, how often should compressions be paused to check for a pulse?

Every 2 minutes Signup and view all the answers

What is the normal range for arterial blood gas (ABG) pH values in adults?

7.35-7.45 Signup and view all the answers

Which condition is most likely to cause metabolic alkalosis?

Vomiting Signup and view all the answers

What indicates a respiratory disturbance in acid/base imbalance?

Bicarb normal with pH abnormal Signup and view all the answers

What effect does a decrease in pH have on potassium levels?

Potassium levels increase Signup and view all the answers

Which of the following is considered a normal range for HCO3 in arterial blood gas measurements?

22-26 mEq/L Signup and view all the answers

What condition is a contraindication for beta blockers in patients with asthma?

NSAID sensitivity Signup and view all the answers

Which of the following symptoms indicates a severe asthma exacerbation?

Oxygen saturation < 90% Signup and view all the answers

What should a nurse administer for a severe asthma exacerbation?

SABA inhaler (Albuterol) Signup and view all the answers

Which of the following is NOT a side effect of Albuterol?

Hypoglycemia Signup and view all the answers

In a patient with asthma, what should be avoided during treatment?

NSAIDs Signup and view all the answers

Study Notes

Respiratory Disorders and Nursing Considerations

Atelectasis: A common post-operative complication characterized by difficulty breathing, hypoxia, and basal crackles; elderly and post-thoracic or abdominal surgery patients are particularly at risk.
Incentive Spirometer: A device that promotes deep breathing to enhance maximum lung inspiration, encouraging recovery and preventing atelectasis.
Carbon Monoxide Poisoning: Pulse oximetry is unreliable; key nursing intervention includes administering 100% oxygen via a non-rebreather mask. Symptoms may include headache, dizziness, and nausea.
Bronchitis: Inflammation of the upper airway, often following viral infection, associated with low-pitched wheezes (rhonchi) mostly during expiration.
Chronic Obstructive Pulmonary Disease (COPD): Client education focuses on dietary strategies, including small meal portions and oral hygiene; avoid cough suppressants like codeine. Patients should seek medical attention for increased sputum and get flu vaccinations.
COPD Exacerbation: Characterized by worsening symptoms; NIPPV may be prescribed to support gas exchange in hypercapnic patients. Monitoring mental status changes is crucial.
Tiotropium (Spiriva): A long-acting inhalation medication for COPD management taken with a capsule inhaler; capsules should not be swallowed.
Pneumothorax: Priority care includes covering the wound with a 3-sided petroleum gauze tape, which allows air escape without allowing air in; avoid placing in clients with suspected head trauma.

Surgical Procedures

Tonsillectomy: Continuous swallowing may indicate postoperative bleeding; avoid coughing and physical activity during recovery, and instruct to refrain from milk products and harsh oral hygiene.
Suctioning: Initiate suction only during catheter withdrawal, pre-oxygenate with 100% oxygen, and limit suction time to 10-15 seconds.
Flail Chest: Indicated by paradoxical chest movement; risk for respiratory failure due to trauma.

Monitoring and Procedures

Peak Flow Meter: Measures peak expiratory flow rate for asthma patients; should be done after using a bronchodilator.
PEEP: Provides end-of-ventilation pressure; higher levels (10-20) can lead to barotrauma, such as pneumothorax.
Ventilator Alarms: High-pressure alarms indicate obstructed airflow (from kinks, condensation, or mucus). Low-pressure alarms suggest disconnection. Lung sounds should be assessed to ensure tube placement.

Respiratory Conditions and Their Management

Emphysema: Symptoms include activity intolerance, barrel chest, pursed-lip breathing, and tripod positioning in advanced stages.
Phlebostatic Axis: Anatomical point at the fourth intercostal space for accurate hemodynamic measurements.
Pleural Effusion: Fluid accumulation prevents lung expansion; diagnosed by chest x-ray or CT. Symptoms include dyspnea and pleuritic chest pain.
Tracheostomy: Tubes must be secured to prevent dislodgement; emergency procedures involve using a curved hemostat or bag valve mask ventilations if dislodged.

Emergency Procedures and Interventions

BIPAP: Provides positive pressure to help expel CO2, particularly beneficial for COPD patients with hypercapnia.
Cystic Fibrosis Management: Increased salt intake in hot weather, pancreatic enzymes with meals, and encouraging aerobic exercise.
Pleurisy: Characterized by sharp chest pain worsening with inhalation, often a complication of pneumonia.
Bronchoscopy: Used for visualization under sedation; observe for blood-tinged sputum. NPO until gag reflex returns.
Ventilator-Associated Pneumonia (VAP): Symptoms appear within 2-3 days; monitoring for purulent sputum and new pulmonary infiltrates is vital.
Pneumonia Interventions: Includes chest physiotherapy, hydration, and positioning strategies to enhance oxygenation.
Obstructive Sleep Apnea (OSA): Characterized by apneic events; CPAP is effective for treatment; signs include loud snoring and waking gasping for air.

Quick Facts on Nursing Interventions

ARDS: Often caused by pulmonary insults; marked by refractory hypoxia and impaired gas exchange; prone positioning may be helpful.
Thoracentesis: Removal of pleural fluid; monitor for pain and respiratory status; potential complications include pneumothorax and infection.
Chest Tube Management: Requires sterile technique; assess drainage, and position to maintain negative pressure.
Post-Operative Pneumonia Prevention: Strategies include ambulation, deep breathing, pain management, and regular mouth care.

Cardiopulmonary Resuscitation (CPR)

CPR Guidelines: Perform compressions at a rate of 100-120 per minute, with full chest recoil; alternates between compressions and ventilation.

Arterial Blood Gas (ABG) Basics

Normal ABG Values:
- pH: 7.35-7.45
- PaO2: 80-100 mm Hg
- PaCO2: 35-45 mm Hg
- HCO3: 22-26 mEq/L
- SaO2: 95%-99%
Acid/Base Imbalances: Determine if the issue is metabolic or respiratory based on trends in pH and bicarbonate levels.

Specific Conditions and Their Metabolic Effects

Metabolic Alkalosis: Often caused by NG suction, vomiting. Symptoms are related to changes in K levels.
Asthma Considerations: Avoid NSAIDs and beta blockers; severe exacerbations may present with elevated heart rate and respiratory rate.

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Description

This quiz covers critical respiratory disorders relevant to nursing practice, including atelectasis and carbon monoxide poisoning. You'll learn about post-operative complications and nursing interventions such as the use of incentive spirometers. Enhance your understanding of these conditions to provide better patient care.