Nursing Management of Respiratory/Pulmonary Disorders

Question 1

Name 3 acute pulmonary conditions

Answer 1

ARDS, PE and acute infections such as penumonias, SARS, Avian influenza and TB

Question 2

Acute exacerbation of chronic conditions are:

Answer 2

Respiratory failure, status asthmaticus and acute infections

Question 3

This diagnostic test looks at the lungs if a sputum sample can’t be obtained

Answer 3

bronchoscopy

Question 4

The subjective assessment for respiratory nursing care include:

Answer 4

SOB, pain and dyspnea

Question 5

What are some symptom characteristics of respiratory disorders?

Answer 5

Time, duration, frequency, risk factors in hx, effect of symptoms on ADLs, relationships, employment, coping

Question 6

What are the outcomes of impaired gas exchange?

Answer 6

ABGs, SaO2, color, RR, LOC, behavior

Question 7

Inadequate airway will result in

Answer 7

Stridor, noisy, retractions, flaring nares, labored with use of accessory muscles

Question 8

Tachypnea, apnea, cheyne-stokes and RR are all indicative of

Answer 8

ineffective breathing patterns

Question 9

Name some nursing interventions for a pt with respiratory disorder

Answer 9

Assess, monitor and report, position upright and elevated, maintain O2, assess effectiveness, TCDB, ICS, collaborate with RT, evaluate meds, relieve pain, suction PRN

Question 10

What are some procedures to follow for bronchial and oral hygiene?

Answer 10

Turn and reposition Q1-2 hrs, support out of bed activities, encourage ambulation, coughing and deep breathing, chest percussion, vibration, postural drainage to promote pulmonary cure, avoid glycerine swabs or mouthwash for ulcers, bacterial or fungal growth and infections

Question 11

Hazards and complications of oxygen therapy include?

Answer 11

combustion, oxygen induced hypoventilation, toxicity, absorption atelactasis, drying of mucous membranes and infection

Question 12

Lungs can only tolerate and use _____% of O2

Answer 12

21%

Question 13

Causes release of free O2 radicals which leads to alveolar/capillary membrane damage

Answer 13

Hyperoxia

Question 14

Nasal cannula, simple face mask, partial rebreather mask and non rebreather mask are all what kind of oxygen delivery systems?

Answer 14

Low flow

Question 15

What is the goal of oxygen management?

Answer 15

> 60mmHg PaO2, > 90% SaO2

Question 16

High flow oxygen delivery system include

Answer 16

venturi, trach collar, and T piece

Question 17

Oropharyngeal, nasopharyngeal, endotracheal and trachesostomy are all what kind of airways?

Answer 17

Artificial

Question 18

BiPAP (Bi-level positive airway pressure) and CPAP (continuous positive airway pressure) are what kind of management?

Answer 18

Non-invasive

Question 19

Noninvasive positive pressure ventilation technique uses + pressure to keep alveoli open and improve gas exchange w/o airway intubation. T/F

Answer 19

TRUE

Question 20

BiPAP improves what kind of volume? How?

Answer 20

Tidal volume; BiPAP cycling machine delivers a set inspiratory positive airway pressure each time the client begins to inspire. At exhalation, it delivers a lower set end-expiratory pressure

Question 21

CPAP delivers a set of positive pressure airway to open up the collapsed alveoli. T/F

Answer 21

TRUE

Question 22

Clients who benefit from this type of non-invasive ventilation are those with atelactasis after surgery or cardiac induced PE

Answer 22

CPAP

Question 23

What is a mechanical ventilator?

Answer 23

It is an invasive machine that generates a controlled flow of gas into a patient’s airways. Oxygen and air are received from cylinders or wall outlets, the gas is pressure reduced and blended according to the prescribed inspired oxygen tension

Question 24

Nursing management of the mechanically ventilated patient includes assessment and documentation. Name them.

Answer 24

Verify position of ETT in reference to lip/teeth w/ securing device change and position changes, assess skin condition around ETT/oral mucosa, verify ventilator settings q shift and monitor pt for tolerance of ventilator support

Question 25

What would you assess and document for a pt on a mechanical ventilator?

Answer 25

Breath sounds, RR and pattern, SpO2, peak inspiratory pressure, exhaled tidal volume/min. volume, amount/consistency of secretions, response to suctioning/ventilator changes/activity, anxiety and rest/activity balance

Question 26

Sedation to optimize pt comfort, communication via pen/paper/board, keeping pt’s family informed of progress and an oral airway are all interventions for the mechanically ventilated patient. T/F

Answer 26

TRUE

Question 27

What is a tracheotomy?

Answer 27

It is the surgical incision into the trachea for the purpose of establishing an airway and may be permanent or temporary

Question 28

Complications of a tracheotomy include:

Answer 28

misplacement, bleeding, hemorrhage, laryngeal nerve damage, pneumothorax, pneumomediastinum, cardiac arrest, stomal infections, stenosis, fistulas, subcutaneous emphysema

Question 29

What are the primary care issues for a tracheostomy pt?

Answer 29

Prevention of tissue damage, air warming and humidification

Question 30

This procedure maintains a patent airway and promotes gas exchange, removes secretions to promote coughing and can be done through the nose or mouth

Answer 30

Suctioning

Question 31

Suctioning can cause

Answer 31

Hypoxia, tissue trauma, infection, vagal stimulation and bronchospasm, cardiac dysrhythmias from hypoxia caused by suctioning

Question 32

If you cause vagal stimulation or bronchospasm for a pt while suctioning, what would you do?

Answer 32

Stop suctioning immediately and oxygenate client manually with 100% oxygen/may require a bronchodilator

Question 33

The purpose of this is to remove air or fluid that has entered the lung pleural space by surgical intervention, can function w/ or w/o suction allowing fluid to move upward w/ inhalation and downward on exhalation.

Answer 33

Chest tube

Question 34

What kind of precaution do you take on a pt w/ TB?

Answer 34

Air and droplet precaution

Question 35

Which patient population would you retest delayed hypersensitivity test on?

Answer 35

HIV patients starting on highly active antiretroviral therapy (HAART)

Question 36

Management of TB includes:

Answer 36

respiratory precautions and drug treatment (INH)