MS Ch.50 Respiratory Problems

Question 1

CHEST X RAY FILM (RADIO GRAPH)

Description?

Preprocedure?

Postprocedue?

Saftey Alert for this procedure?

Answer 1

Description: Provides information regarding the anatomical location and appearance of the lungs.

Preprocedure: a. Remove all jewelry and other metal objects from the chest area. b. Assess the client’s ability to inhale and hold his or her breath.

Postprocedure: Help the client get dressed.

Saftey alert: Question women regarding pregnancy or the possibility of pregnancy before performing radiography studies

Question 2

SPUTUM SPECIMEN

Description?

Preprocedure?

Key Point?

Postprocedure?

Saftey Alert for Sputum Specimen?

Answer 2

Description: Specimen obtained by expectoration or tracheal suctioning to assist in the identification of organisms or abnormal cells.

Preprocedure:

• Determine the specific purpose of collection
• Obtain an early morning sterile specimen by suctioning or expectoration after a respiratory treatment if a treatment is prescribed.
• Instruct the client to rinse the mouth with water before collection.
• Obtain 15 mL of sputum.
• Instruct the client to take several deep breaths and then cough deeply to obtain sputum.

Key Point: Collect the specimen before the client begins antibiotic therapy. If already started on antibiotic therapy, ensure the laboratory can utilize an antimicrobial removal device when analyzing the specimen.

Postprocedure: If a culture of sputum is prescribed, transport the specimen to the laboratory immediately. Assist the client with mouth care.

Question 3

Laryngoscopy & Bronchoscopy

Description?

Preprocedure?

Postprocedule?

Key Points?

Answer 3

Description: Direct visual examination of the larynx, trachea, and bronchi with a fiberoptic bronchoscope.

Preprocedurfe:

a. Maintain NPO (nothing by mouth) status as prescribed.
b. Assess the results of coagulation studies.
c. Remove dentures and eyeglasses.
d. Establish an intravenous (IV) access as necessary and administer medication for sedation as prescribed.
e. Have emergency resuscitation supplies readily available.

Postprocedure:

a. Maintain the client in a semi-Fowler’s position.
b. Assess for the return of the gag reflex.
c. Maintain NPO status until the gag reflex returns.
d. Monitor for bloody sputum.
e. Monitor respiratory status, particularly if sedation has been administered.
f. Monitor for complications, such as bronchospasm or bronchial perforation, indicated by facial or neck crepitus, dysrhythmias, hemorrhage, hypoxemia, and pneumothorax.
g. Notify the primary health care provider (PHCP) if signs of complications occur.

Key Points: Maintain NPO status until the gag reflex returns. & Notify the primary health care provider (PHCP) if signs of complications occur.

Question 4

ENDOBRONCHIAL ULTRASOUND (EBUS)

What is it?

What are the tissue sample used for?

Post procedure?

Answer 4

What: Tissue samples are obtained from central lung masses and lymph nodes, using a bronchoscope with the help of ultrasound guidance.

Used for: Tissue samples are used for diagnosing and staging lung cancer, detecting infections, and identifying inflammatory diseases that affect the lungs, such as sarcoidosis.

Post: the client is monitored for signs of bleeding and respiratory distress.

Question 5

Pulmonary Angiography

Description?

Preprocedure?

Postprocedure?

Answer 5

Description: A fluoroscopic procedure in which a catheter is inserted through the antecubital or femoral vein into the pulmonary artery or 1 of its branches

• Involves an injection of iodine or radiopaque contrast material

Pre:

a. Assess for allergies to iodine, seafood, or other radiopaque dyes.
b. Maintain NPO status as prescribed.
c. Assess results of coagulation studies.
d. Establish an IV access.
e. Administer sedation as prescribed.
f. Instruct the client to lie still during the procedure.

g. Instruct the client that he or she may feel an urge to cough, flushing, nausea, or a salty taste following injection of the dye. (key)

h.Have emergency resuscitation equipment available.

Post Procedure:

Avoid taking blood pressures for 24 hours in the extremity used for the injection.

b. Monitor peripheral neurovascular status of the affected extremity.
c. Assess insertion site for bleeding.
d. Monitor for reaction to the dye.

Question 6

THORACENTESIS

Description?

Answer 6

Removal of fluid or air from the pleural space via transthoracic aspiration.

Question 7

THORACENTESIS

Preprocedure?

Answer 7

a. Prepare the client for ultrasound or chest radiograph, if prescribed, before the procedure.
b. Assess results of coagulation studies.
c. Note that the client is positioned sitting upright, with the arms and shoulders supported by a table at the bedside during the procedure (Fig. 50-1).

d. If the client cannot sit up, the client is placed lying in bed toward the unaffected side, with the head of the bed elevated.

e. Instruct the client not to cough, breathe deeply, or move during the procedure.

Question 8

THORACENTESIS

Postprocedure?

Answer 8

a. Monitor respiratory status.
b. Apply a pressure dressing, and assess the puncture site for bleeding and crepitus.

c. Monitor for signs of pneumothorax, air embolism, and pulmonary edema.

Question 9

PULMONARY FUNCTION TEST

Description?

Answer 9

Tests used to evaluate lung mechanics, gas exchange, and acid–base disturbance through spirometric measurements, lung volumes, and arterial blood gas levels.

Question 10

PULMONARY FUNCTION TEST

Preprocedure?

Answer 10

a. Determine whether an analgesic that may depress the respiratory function is being administered.

b. Consult with the PHCP regarding withholding bronchodilators before testing, or alternatively if the testing will be done prior to and after administration of a bronchodilator.
c. Instruct the client to void before the procedure and to wear loose clothing.
d. Remove dentures.
e. Instruct the client to refrain from smoking or eating a heavy meal for 4 to 6 hours before the test.

Question 11

PULMONARY FUNCTION TESTS

Postprocedure?

Answer 11

The client may resume a normal diet and any bronchodilators and respiratory treatments that were withheld before the procedure.

Question 12

LUNG BIOPSY

Description?

Where is an open lung biopsy performed?

Answer 12

a. A transbronchial biopsy and a transbronchial needle aspiration may be performed to obtain tissue for analysis by culture or cytological examination.
b. An open lung biopsy is performed in the operating room.

Question 13

LUNG BIOPSY

Preprocedure?

Answer 13

a. Maintain NPO status as prescribed.
b. Inform the client that a local anesthetic will be used for a needle biopsy, but a sensation of pressure during needle insertion and aspiration may be felt.
c. Administer analgesics and sedatives as prescribed.

Question 14

LUNG BIOPSY

Postprocedure?

Answer 14

a. Apply a dressing to the biopsy site and monitor for drainage or bleeding.

b. Monitor for signs of respiratory distress, and notify the PHCP if they occur.

c. Monitor for signs of pneumothorax and air emboli, and notify the PHCP if they occur.

d. Prepare the client for chest radiography if prescribed.

Question 15

SPIRAL (HELICAL) COMPUTED TOMOGRAPHY (CT) SCAN

What is it used for?

How is it done?

What is going on?

Answer 15

1. Frequently used test to diagnose pulmonary embolism
2. IV injection of contrast medium is used; if the client cannot have contrast medium, a ventilation-perfusion (V/Q) scan will be done.
3. The scanner rotates around the body, allowing for a 3-dimensional picture of all regions of the lungs.

Question 16

V/Q LUNG SCAN

Description?

Answer 16

a. The perfusion scan evaluates blood flow to the lungs.
b. The ventilation scan determines the patency of the pulmonary airways and detects abnormalities in ventilation.
c. A radionuclide may be injected for the procedure.

Question 17

V/Q Lung Scan

Preprocedure?

Answer 17

a. Assess the client for allergies to dye, iodine, or seafood.
b. Remove jewelry around the chest area.
c. Review breathing methods that may be required during testing.
d. Establish an IV access.
e. Administer sedation if prescribed.
f. Have emergency resuscitation equipment available.

Question 18

V/Q LUNG SCAN

Postprocedure?

Answer 18

a. Monitor the client for reaction to the radionuclide.

b. Instruct the client that the radionuclide clears from the body in about 8 hours.

c. Encourage increased fluid intake to clear the dye from the body if there is no fluid restriction.

Question 19

Computed tomography pulmonary angiography

Description?

Answer 19

a. The scan visualizes the pulmonary arteries and blood flow.
b. Its main use is to diagnose pulmonary embolism and is the preferred method.
c. A contrast dye is injected.

Question 20

Computed tomography pulmonary angiography

Preprocedure?

Answer 20

Similar to the V/Q lung scan; in addition, renal function should be adequate and dosing of the contrast should be done by a pharmacist.

Question 21

Computed tomography pulmonary angiography

post procedure?

Answer 21

Similar to the V/Q lung scan.

Question 22

SKIN TESTS

What is it (kind of injection site)?

Answer 22

A skin test uses an intradermal injection to help diagnose various infectious diseases.

Question 23

SKIN TESTS

What is the books 9 step procedure?

(hint: learn like a skill check-off)

Answer 23

1. Determine hypersensitivity or previous reactions to skin tests.
2. Use a skin site that is free of excessive body hair, dermatitis, and blemishes.
3. Apply the injection at the upper third of the inner surface of the left arm.
4. Circle and mark the injection test site.
5. Document the date, time, and test site.
6. Advise the client not to scratch the test site to prevent infection and possible abscess formation.
7. Instruct the client to avoid washing the test site.
8. Assess the reaction at the injection site 24 to 72 hours after administration of the test antigen.
9. Assess the test site for the amount of induration (hard swelling) in millimeters and for the presence of erythema and vesiculation (small blister-like elevations).

Question 24

ARTERIAL BLOOD GASSES (ABG’S)

Description?

Saftey Point?

Answer 24

Measurement of the dissolved oxygen and carbon dioxide in the arterial blood helps indicate the acid–base state and how well oxygen is being carried to the body.

SAFEY POINT:Avoid suctioning the client before drawing an ABG sample, because the suctioning procedure will deplete the client’s oxygen, resulting in inaccurate ABG results.

Question 25

D- DIMER

What is it?

What does it help diagnose?

What is the normal rnage of the D-Dimer?

Answer 25

1. A blood test that measures clot formation and lysis that results from the degradation of fibrin
2. Helps diagnose (a positive test result) the presence of thrombus in conditions such as deep vein thrombosis, pulmonary embolism, or stroke; it is also used to diagnose disseminated intravascular coagulation (DIC) and to monitor the effectiveness of treatment.
3. The normal D-dimer level is less than 50 ng/mL (less than 3.0 mmol/L); normal fibrinogen is 60 to 100 mg/dL (2.0 to 5.0 g/L).

Question 26

RIB FRACTURE

Description?

Assessment?

Interventions?

Answer 26

Description: Results from direct blunt chest trauma and causes a potential for intrathoracic injury, such as pneumothorax, hemothorax, or pulmonary contusion

• Pain with movement, deep breathing, and coughing results in impaired ventilation and inadequate clearance of secretions.

Assesment: Pain and tenderness at the injury site that increases with inspiration, Shallow respirations, Client splints chest, Fractures noted on chest x-ray.

Interventions: Note that the ribs usually reunite spontaneously, Open reduction and internal fixation of the ribs (rib plating) may be done, Place the client in a Fowler’s position, Administer pain medication as prescribed to maintain adequate ventilatory status, Monitor for increased respiratory distress, Instruct the client to self-splint with the hands, arms, or a pillow., Prepare the client for an intercostal nerve block as prescribed if the pain is severe.

Question 27

FLAIL CHEST

Description?

Assesment?

Interventions?

Answer 27

Description: Occurs from blunt chest trauma associated with accidents, which may result in hemothorax and rib fractures.

• The loose segment of the chest wall becomes paradoxical to the expansion and contraction of the rest of the chest wall.

Assesment: Paradoxical respirations (inward movement of a segment of the thorax during inspiration with outward movement during expiration), Severe pain in the chest, Dyspnea, Cyanosis, Tachycardia, Hypotension, Tachypnea, shallow respirations, Diminished breath sounds. [Notice that the last ones are obvious].

Interventions: Maintain the client in a Fowler’s position, Administer oxygen as prescribed, Monitor for increased respiratory distress, Encourage coughing and deep breathing, Administer pain medication as prescribed, Maintain bed rest and limit activity to reduce oxygen demands, Open reduction and internal fixation of the ribs (rib plating) may be done, Prepare for intubation with mechanical ventilation, with positive end-expiratory pressure (PEEP) for severe flail chest associated with respiratory failure and shock.

Question 28

PULMONARY CONTUSION

Description?

Asssesment?

Interventions?

Answer 28

Description: Characterized by interstitial hemorrhage associated with intra-alveolar hemorrhage, resulting in decreased pulmonary compliance

b. The major complication is acute respiratory distress syndrome.

Respiratory Distress syndrome is a brreathing disorder in babyies caused by immature lungs.

Assesment: Dyspnea. Restlessness, Increased bronchial secretions, Hypoxemia, Hemoptysis, Decreased breath sounds, Crackles and wheezes.

Interventions: Maintain a patent airway and adequate ventilation, Place the client in a Fowler’s position, Administer oxygen as prescribed., Monitor for increased respiratory distress, Maintain bed rest and limit activity to reduce oxygen demands, Prepare for mechanical ventilation with PEEP if required.

Question 29

Pneumothorax

Description?

Spontanious pnemothorax?

Open Pnemothorax?

Tension Pnemothorax?

Assesment?

Interventions?

How should Clients with any respiratory disorder be positioned?

Answer 29

Description: Accumulation of atmospheric air in the pleural space, which results in a rise in intrathoracic pressure and reduced vital capacity, or the greatest amount of air expired from the lungs after taking a deep breath.

b. The loss of negative intrapleural pressure results in collapse of the lung.

Spontanious: occurs with the rupture of a pulmonary bleb, or small air-containing spaces deep in the lung.

Open: occurs when an opening through the chest wall allows the entrance of positive atmospheric air pressure into the pleural space.

Tension: occurs from a blunt chest injury or from mechanical ventilation with PEEP when a buildup of positive pressure occurs in the pleural space.

Assesment: Absent or markedly decreased breath sounds on affected side, Cyanosis, Decreased chest expansion unilaterally, Dyspnea, Hypotension, Sharp chest pain, Subcutaneous emphysema as evidenced by crepitus on palpation, Sucking sound with open chest wound, Tachycardia, Tachypnea, Tracheal deviation to the unaffected side with tension pneumothorax

Interventions: [KNOW ALL!] Diagnosis of pneumothorax is made by chest x-ray, Apply a nonporous dressing over an open chest wound.,Administer oxygen as prescribed, Place the client in a Fowler’s position., Prepare for chest tube placement, which will remain in place until the lung has expanded fully., Monitor the chest tube drainage system, Monitor for subcutaneous emphysema.

All respiratory disorders should be positioned with the head of the bed eleveated.

Question 30

ACUTE RESPIRATORY FAILURE

Description?

When does it happen?

What are some Causes?

What is going on at the aveoli?

Assesment?

Interventions?

Answer 30

Description:

Occurs when: not enough oxegen in blood, or not enough carbon dioxide is removed, and the body compensatory mechanisms cant keep up. Causes: mechanical abnormality of the lungs or chest wall, a defect in the respiratory control center in the brain, or an impairment in the function of the respiratory muscles.

Aveoli: oxygen may reach the alveoli but cannot be absorbed or used properly, resulting in a PaO2 lower than 60 mm Hg, arterial oxygen saturation (SaO2) lower than 90%, or partial pressure of arterial carbon dioxide (PaCo2) greater than 50 mm Hg occurring with acidemia.

Assesment:Dyspnea, Restlessness, Confusion, Tachycardia, Hypertension, Dysrhythmias, Decreased level of consciousness, Alterations in respirations and breath sounds, Headache (less common)

Interventions: [know all] Identify and treat the cause of the respiratory failure, Administer oxygen to maintain the PaO2 level higher than 60 to 70 mm Hg, Place the client in a Fowler’s position, Encourage deep breathing., Administer bronchodilators as prescribed, Prepare the client for mechanical ventilation if supplemental oxygen cannot maintain acceptable PaO2 and PaCo2 levels.