Nur 182 Unit 2

Question 1

Nursing intervention for effective respiration

Answer 1

Incentive spirometer, coughing, turn-cough-and deep breaths, and breathing exercises.

Question 2

Incentive spirometer

Answer 2

frequently ordered after surgery, most common doctor order * if patient recently undergone abdominal or chest surgery, place a pillow or folded blanket over a chest or abdominal incision for splinting* if patient become light headed , stop and take a few normal breaths benefits - reduce atelectasis resulting in pneumonia, cardiac output is not decreased, patient does not swallow air, inspired volume is assured, minimal patient discomfort, cheap lightweight, provide visual reinforcement. Procedure - volume setting, number of times and time intervals, sitting position. Instruction - inhale deeply, hold 5 sec then exhale - repeat 5-10x per hr. 1 min rest if need and coughing is. Purpose - assist patient to breath slowly and deeply and to sustain maximal inspiration, maximize lung inflation and prevent or reduce atelectasis ( incomplete expansion or collapse of a part of lung ). Optimal gas exchange and secretion can be cleared and expectorated. Increase Lungs volume in inflation of Alveoli and facilitate venous return.

Question 3

Coughing

Answer 3

With patient in semi Fowler position (30 degree), have the patient take a few deep diaphragmatic breaths. After the third breath, instruct to cough twice from the same breath - this is called a two stage cough. The first cough raises secretions; second facilitates expectoration. With post op patient , pain decrease if a pillow is used to splint the abdominal incision and the hip are flexed. Coughing early in the morning after rising remove secretion that may have accumulated during the night. Coughing before meals improve the Taste of food and oxygenation. At bedtime coughing remove any build up of secretion and improve sleep patterns. Patient who is unable to cough voluntarily, manual stimulation over the trachea and prolong exhalation can be helpful. If neither of these methods is useful mechanical endotracheal suction with a catheter may be necessary. For an assisted cough Firm pressure is placed on the abdomen below the diaphragm and rhythm with exhalation, similar to the Heimlich maneuver but with less force, is used to substitute for the weekend or paralyzed abdominal muscle.

Question 4

Turn - cough - and deep breathe ( TCDB)

Answer 4

Most common method of maintaining effective breathing patterns and promoting efficient gas exchange. Used most often. Turning help to mobilize secretion.

Question 5

Breathing exercises

Answer 5

Pursed lip breathing - deep breath through nose and slowly exhale with lip partly closed. By forcing through narrowing opening, pressure bronchial is increase causing them to remain open and therefore expel more air. This allow bronchial tubes to widen and allows stale air to be expelled. Repeat 2 min. Deep diaphragmatic breathing - surgical patient and those on bed rest longer than 2 days are taught deep breathing exercises. Full breath through nose, exhale slowly through month. 10 deep breath better than 50 shallow breaths

Question 6

Exercises to increase force of exhalation

Answer 6

1. Lying flat on back with knee flexed, inhale through nose and balloon abdomen as far as possible. This exercises increase aeration to lungs and help client to synchronize abdominal muscle and diaphragm with breathing. 2. Have patient sit up on side of bed and inhale deeply. As they exhale, have them press a book firmly against the abdomen. This help elevate the diaphragm, improve aeration of lungs, and encourage coughing. 3. Have client lie flat on back. Each time they exhale they should raise their head and shoulder. With each inhalation they should drop back to flat position. Strengthen abdominal muscle. 4. Have client lie flat on back with hands at side and each time they exhale they raise their leg, alternately, as vertically as possible. Leg lower with inhalation. Help strengthen abdomen.

Question 7

Exercises to increase expirations volume

Answer 7

1. Feather blowing exercises- attempt to blow feather away from them. 2. Candle 🔥 blowing exercises. 3. Inflating paper bag. 4. Blow bottles. 5. Inflating balloon

Question 8

Diaphragmatic breathing

Answer 8

You reduce respiratory rate, increase alveolar ventilation, and sometimes help expel as much aid as possible during expirations. One hand on stomach and one on chest. Breath in slowly protruding abdomen as far out as possible then breath out through pursed lips whole contracting the abdominal muscles, with one hand pressing inward and upward on the abdomen. Repeat for 1min follow by 2mjn rest

Question 9

Cough

Answer 9

A cough is a cleaning mechanism of the body. It is a mean of helping to keep the airway clear of secretions and other debris.

Question 10

Productive cough

Answer 10

A cough that produce respiratory secretion. If the cough produce sputum, the patient is said to be congested with a productive cough. To be effective takeoff should have enough muscle contraction to force air to be expelled and to propel a liquid or a solid on its way out of the respiratory tract. Coughing is most effective when the patient is sitting up right now with feet flat on the floor.

Question 11

Nonproductive cough

Answer 11

A cough that is dry. If a cough is dry, the patient is said to be congested with a nonproductive cough. A patient who is coughing and does not have any congestion or secretion produced is said to be noncongested with a nonproductive cough.

Question 12

Guideline nursing for effective coughing

Answer 12

1. Place the patient in a semi Fowler position, learning forward. 2. Provide a pillow or folded bath blanket to use in splinting the incision. 3. Ask the patient to: Inhale and exhale deeply and slowly through the nose three times. Take a deep breath and hold it for three seconds. Hack out for three short breaths. With mouth open take a quick breath. Cough deeply once or twice. Take another deep breath. Repeat the exercise every two hours while awake.

Question 13

Involuntary coughing

Answer 13

Respiratory tract infection and irritation. Many times respiratory infection leads to the production of respiratory secretions. The secretion can trigger the cough mechanism.

Question 14

Expectorant

Answer 14

Drug that Facilitate the removal Of respiratory tract secretion by reducing the viscosity of the secretions.

Question 15

Cough suppressant

Answer 15

Codeine - can become addictive. Dextromethorphan - non additive

Question 16

Lozenges

Answer 16

Relieve my own non-productive cough in people without congestion. Control cough my local anesthetic affect of the benzocaine.

Question 17

Ipratropium bromide (atrovent)

Answer 17

And maintenance therapy of Reversible airway obstruction due to COPD including chronic bronchitis and emphysema. Route includes inhalation intra-nasal. Side effects include dizziness headaches nervousness Blurry vision sore throat(nasal only) nasal dryness bronchospasm cough hypotension palpation G.I. irritation nausea rash allergic reaction. Onset of action is too slow for patient in acute distress.

Question 18

Albuterol sulfate (proventil)

Answer 18

A bronchodilator used to treat or prevent bronchospasm in people with reverse obstructive airway disease. Also use to prevent exercise-induced bronchospasm. Side effects include headaches dizziness insomnia cough sore throat runny or stuffy nose nausea vomiting dry mouth muscle pain and diarrhea. Assess long sounds calls and blood pressure before administration and during peak of medication no amount color and characteristic of sputum produce. PO,inhal,

Question 19

Salmeterol (setavent)

Answer 19

Therapy for the treatment of asthma and the prevention of bronchospasm and patient who are currently taking but are in adequately controlled on a long-term asthma controlled medication( corticosteroid). Prevention of exercise-induced bronchospasm. Maintenance treatment to prevent bronchospasm and COPD including chronic bronchitis and emphysema. Side effects include headaches nervousness palpation tachycardia abdominal pain diarrhea nausea muscle cramp trembling bronchospasm and cough. Route include inhalation.

Question 20

Tertutaline sulfate

Answer 20

Management of reversible airway disease due to asthma or COPD inhalation and subcut use for short term control and oral agent for long-term control. Management of preterm labor - don’t use inject in pregnant. PO subcut and iv. Side effects includes nervousness restlessness tremor headaches insomnia pulmonary edema Angina hypertensionMyocardial ischemia tachycardia nausea and vomiting hyperglycemia and hypokalemia. You

Question 21

Guifenesin (robitussin, mucinex, mytussin)

Answer 21

Call associated with viral Upper respiratory tract infection. Reduce viscosity of tenacious creation by increasing respiratory tract fluids. Expectorants of mucus. PO. Side effects include dizziness headaches nausea diarrhea stomach pain and vomiting rash and urticaria.

Question 22

Zafirlukast (accolate)

Answer 22

Bronco dilator. PO. Side effects include headaches dizziness nausea and vomiting. Not used to treat acute attack do not give with meal.

Question 23

Montelukast(singulair)

Answer 23

Also inhibits leukotriene Release as well as inflammatory response reaction. PO. Should not be given before bedtime.

Question 24

Theophylline (aminophylline)

Answer 24

Bronchodilator. PO IV rectally. Side effects include nausea vomiting tachycardia diuresis irritability vertigo convulsion nervousness. Monitor vital signs. Force fluids as a clinical status allow. Monitor serum level especially if the patient does not respond to the drug or if severe affects develop.

Question 25

Corticosteroids

Answer 25

Reduce inflammation. PO IV inhalation intranasal. Side effects include fluid retention hypertension mood swing weight gain hyperglycemia insomnia gastritis. Reduce sodium intake. Make the patient and family aware of potential for labile emotion.Weigh Daily in the morning. Monitor blood sugar and blood pressure.

Question 26

Respiratory rate

Answer 26

Infant(birth to 1) 30 to 50 breaths per minute. Early childhood (1-5) 20-40 breaths per minute. Late childhood(6-12) 18 to 26 breaths per minute. Age adult(65+) 16 to 24 breaths per minute.

Question 27

Respiratory pattern

Answer 27

Infant birth to one year old Abdominal breathing irregular in rate and depth. Early childhood 1-5Abdominal breathing irregular. Late childhood thoracic breathing regular. Age adults thoracic breathing regular.

Question 28

Chest wall

Answer 28

Infant thin little muscle ribs and sternum easily seen.Early childhood same as infants but with more subcutaneous fat. Ly childhood further subcutaneous fat deposit structure less prominent. Aged adult thin structure prominent

Question 29

Breath sounds

Answer 29

In fact loud harsh crackles at end of deep inspiration. Early childhood loud harsh expiration longer than inspiration. Late childhood clear inspiration is longer than expiration. Age adults clear.

Question 30

Shape of thorax

Answer 30

Infant round. Early childhood elliptical. Late childhood elliptical. Aged adult Barrel shaped or elliptical.

Question 31

Older adults

Answer 31

Decrease gas exchange and increased work of breathing. Decrease elastic recoil of the long. Expiration require use of accessory muscles. If you were functional capillaries and more fibrous tissue in Alveoli. Decreased skeletal muscle strength in thorax. Reduction in vital capacityAn increase in residual value. Decrease ventilation and In effective cough. Less air exchange more secretion remains in Lung.Dryer mucous membrane. Altered pain sensation. Different norms or body temperature fever may be a typical. Greater risk for aspiration due to slow her gastric motility. Impaired mobility and in activity effects of medication. Decreased cardiac output and an ability to respond to stress. Reduction in the Elasticity of the heart issues. Heart muscle become less effective working harder to comp the same amount of blood through the body. Progressive Arterial sclerosis. Capillary walls taken lightly. Leading to a slower rate of exchange of gases nutrients and waste.

Question 32

Nasal cannula

Answer 32

1-2 /23-30. 3-5/30-40. 6/42 cops 88-92 usually 2-3. Low flow

Question 33

Simple mask

Answer 33

6-8/40-60. Support patient if claustrophobia is concern. Low flow. Equipped with a reservoir bag for the collection of the first part of the patient exhale air.The air in the reservoir is mixed with 100% oxygen for the next installation. This mass permits the conservation of oxygen an additional advantage is that the patient can inhale room air through the opening in the mass if oxygen supply is briefly interrupted.

Question 34

Partial rebreather mask

Answer 34

8-11/50-75. Set flow rate so that the mask remains 3/4 full during inspiration. Low flow

Question 35

Nonrebreather

Answer 35

12-15/80-100. Maintain flow rate so that the reservoir that claps only slightly during inspiration. Low flow. Deliver the highest concentration of Oxygen via a mass to a spontaneous Ly breathing patient. Similar to partial rebreather mask except for two one-way valve Prevent the patient from rebreathing exhale air.

Question 36

Venturi mask

Answer 36

4-10/ 24-40. High flow. Requires careful monitoring to verify fi02 flow rate order. Deliver the most precise concentration of oxygen.

Question 37

Hypoxic drive

Answer 37

Form of respiratory drive in which the body uses oxygen chemo receptor instead of carbon dioxide receptor to regulate the respiratory cycle.