Gas Exchange

Question 1

Asthma:

• Assessment:

Answer 1

Wheezing, cough, difficulty breathing, recurrent chest tightness, breathlessness, increased respirations, tachycardia, pulsus paradoxus, nasal polyps, and use of accessory muscles

Question 2

Asthma: Dx:

Answer 2

PFTs, spirometry measures, CXR, sputum, CBC, ABGs, ECG, radioallergosorbent test (RAST) for IgE

Question 3

Asthma: Meds:

Answer 3

Meds: Inhaled corticosteroids; salmeterol; cromolyn and nedocromil (mast cell stabilizers); zileuton, montelukast, zafirlukast, and methylxanthines (leukotriene modifiers)
• Quick Relief: Albuterol and ipratropium
• Treatment: Avoid triggers, high Fowler’s position, asthma diary, regular PEF monitoring

Question 4

Cystic Fibrosis:

• S/S:

Answer 4

Chronic or recurrent productive cough with sputum, wheezing, dyspnea, recurrent infections, bronchiectasis, infiltrates, scarring on CXR

Question 5

Cystic Fibrosis:

• Dx:

Answer 5

Dx: Quantitative sweat test (above 60 mEq/L), ABGs, PFTs, CT

Question 6

Cystic Fibrosis:

• Complications:

Answer 6

Frequent respiratory infections, lung disease, malnutrition, poor growth, diabetes, infertility, and various health problems

Question 7

Cystic Fibrosis:

• Diet:

Answer 7

Pancreatic enzyme replacement and adequate fluid and dietary intake

Question 8

Cystic Fibrosis:

• Treatment:

Answer 8

Postural drainage, chest PT, percussion and vibration techniques
o PEEP or flutter valve breathing devices, suction, or active cycle (ACTB)
o Oxygen administration

Question 9

Cystic Fibrosis: Meds

Answer 9

Meds:
 Antiinfectives
 Antibiotics for infections
 Tobramycin (TOBI) is an aerosolized antibiotic for CF patient

Question 10

COPD:

• Causes:

Answer 10

Tobacco smoke, air pollution, chemical fumes, and dust

Question 11

COPD: Assessment:

Answer 11

Barrel chest, cyanosis, clubbing, dyspnea on exertion, cough, sputum production, hyperresonant to percussion, wheezes or crackles on auscultation, weight loss, prolonged expiratory phase

Question 12

COPD: Dx:

Answer 12

• Dx: Pulmonary function spirometry, bronchodilator reversibility, screening for alpha1-antitrypsin deficiency, chest x-ray, CT, ECG, CBC, and ABGs

Question 13

COPD: Diet:

Answer 13

Low Na+, low fat, complex carbs, low cholesterol, low alcohol, 6 small meals, 64 ounces of water daily

Question 14

COPD: Treatment:

Answer 14

Reduce or eliminate pulmonary irritants, controlled O2 therapy, annual flu and pneumococcal vaccines, smoking cessation to slow progression

Question 15

COPD: Medications:

Answer 15

Beta-adrenergic agents; anticholinergics; corticosteroids; methylxanthines; and a combination of one or more drugs; expectorants and mucolytics for symptom relief

Question 16

COPD: Complications:

Answer 16

Pneumonia, atelectasis, pneumothorax, and cor pulmonale

Question 17

Pneumonia:

• Causes:

Answer 17

Immobility and infection

Question 18

Pneumonia: S/S:

Answer 18

Fever, chills, sweats, new cough (with or without sputum), pleuritic chest pain, and dyspnea

Question 19

Pneumonia: Dx:

Answer 19

Chest x-ray, CBC, C&S, electrolytes, glucose

Question 20

Pneumonia: Treatment:

Answer 20

Monitor respiratory status and O2 saturation (95% good level)
o Place the patient in semi-fowlers position
o Provide high calorie, high protein diet with small frequent meals
o Encourage fluids up to 3 L/day to thin secretions
o TCDB and IS use
o Antibiotics and antipyretics as prescribed

Question 21

Tuberculosis (TB):

• S/S:

Answer 21

Cough, fever, weight loss, chills, weakness, and night sweats

Question 22

Tuberculosis (TB): Dx:

Answer 22

Mantoux skin test - Read in 48-72 hrs; 5 MM induration is positive
o CXR
o Sputum culture

Question 23

Tuberculosis (TB): Meds:

Answer 23

Isoniazied (INH); rifampin, ethamutol, and pyrazinamide

o No liver failure, cirrhosis, or hepatitis patients

Question 24

Rib fractures S/S

Answer 24

Pain, difficulty breathing, at risk for pneumonia