nursing practice

Question 1

what is the requirement to use a metered dose inhaler ?

Answer 1

need coordination (press and breathe at the same time)
need ensure a tight seal

Question 2

what is the requirement to use spacer mask?

Answer 2

dont need coordination, just breathe normally

Question 3

what is the requirement to use nebulizer?

Answer 3

dont need coordination

but not portable

Question 4

what are the requirement to use dry powder inhaler?

Answer 4

no need coordination

but need forceful suction (not for patient with COPD)

Question 5

what are the requirement for respimat?

Answer 5

need ensure tight seal

Question 6

what are the steps for using metered dose inhaler?

Answer 6

1. shake the bottle
2. prime (spray one or more puffs into the air)
3. exhale fully
4. put inhaler in mouth and press
5. inhale deeply for 2-3 seconds ( to help draw medication into lungs)
6. remove mouth piece and hold breath for 10 sec (to allow medication to reach to alveoli)
7. exhale slowly with pursed lips (keep distal bronchioles open and allowing increased absorption and diffusion of the drug)

Question 7

for quick relief medication like SAMA and SABA , what to do between puffs ?

Answer 7

wait about 15-30 seconds between puffs to allow the bronchodilators to open the air passage for maximum effectiveness

Question 8

for other medications like LAMA and LABA what to do between puffs?

Answer 8

do not need to wait between puffs as it takes about 10-20 min to work

Question 9

what to do when more than one medication is prescribed?

Answer 9

wait 2 mins between each medication

Question 10

what to do when patient is on steroid inhaler?

Answer 10

use bronchodilator first then wait 5 mins before using steroid
this is to allow bronchiole dilator to open the air passage for maximum effectiveness

Question 11

who are metered dose inhaler with spacer recommended for?

Answer 11

children and elderly with coordination difficulties

Question 12

what to do when new spacer is used?

Answer 12

prime it by firing at least 10 puffs

Question 13

what are the steps to use MDI with spacer?

Answer 13

1. press down inhaler and breathe and hold breath for 5-10 sec then breath out slowly (if cannot hold breath can breathe in and out slowly 3-5 times)

Do not press the inhaler more than 1 times each time

Question 14

when do you need to clean a spacer?

Answer 14

clean one a month or when required

static electricity builds up in the spacer and makes medication stick inside and not much will go down the lungs

Question 15

what are the instructions to clean the spacer?

Answer 15

soak the spacer completely in a container of mild warm soapy water
shake out the excess water and allow it to dry

do not scrub or rinse the spacer after removing from soapy water
(detergent is good to reduce static charges)

Question 16

when do you usually replace spacer?

Answer 16

every year

Question 17

what is the flow to set for nebulizer?

Answer 17

at least 6-7 liter per min

Question 18

what are the instruction to give patient using nebulizer ?

Answer 18

instruct the patient to breath normally and take deep inspiration every 4-5 breathes

take about 10 mins

Question 19

what to do when patient is using nebulizer and is hypercapnic or acidotic ?

Answer 19

use nebulizer driven by compressed air to prevent worsening of hypercapnia

Question 20

if oxygen therapy is needed for patient using nebulizer ?

Answer 20

can be administered with nasal cannula

Question 21

what is the recommended suctioning pressure to set for suctioning ?

Answer 21

100-120mmHg

too high pressure will cause excessive trauma without enhancing secretion removal

Question 22

what are the steps for oral insertion of catheter ?

Answer 22

without applying suction gently insert catheter into mouth
advance 3”-4” along side the mouth until reach the pool of secretion or when patient starts to cough

apply suction for no longer than 10 sec each time

withdraw the catheter with continuous motion

repeat procedure up to three times or until gurgling or bubbling sounds stop

allow 30 sec to 1 min between suctioning to allow reoxygenation and ventilation

Question 23

what are the steps for nasal insertion ?

Answer 23

raise the tip of patient of nose with non dorminant hand to straighten the passage way and facilitate insertion

without applying suction gently insert in nose

advance to approximate 5”-6” until you reach a pool of secretion or patient starts to cough

Question 24

what is incentive spirometry used for?

Answer 24

to help expand patient’s lungs by helping them to breathe more deeply and fully

Question 25

what are the steps and instruction for incentive spirometry ?

Answer 25

1. ask patient to sit upright
2. close lips tightly (weak seal will affect readings )
3. inhale slowly as deeply as possible (suck like sucking straw)
4. ask patient to retain the entire volume of air for 5 seconds

Question 26

what will happen when incentive spirometry is used ?

Answer 26

1. piston rise inside the large column (as high as possible)
2. indicator should move upwards (stay between the two arrows)

if not its too fast or slow

Question 27

when should patient do incentive spirometry ?

Answer 27

10 breaths every 1-2 hours while awake
10 breathes 5 times a day
15 breathes every 4 hours

Question 28

how to diagnose patient with copd ?

Answer 28

1. older than 40, current or ex smoker
2. cough regularly
3. cough up phlegm regularly
4. simple chores cause SOB
5. wheeze when exerting yourself
6. have frequent colds that persist longer than other people,

Question 29

what are some physical assessment of patient with copd ?

Answer 29

1. heart and respiration rate increased (compensatory mechanism)
2. o2 saturation 89-92 (impaired gas exchange)
3. anxious pale, hands and feet cold to touch, capillary refill time more than 3 sec (lack of oxygenation)
4. decreased breath sounds and presence of rhonchi (gurgling sounds)
5. fever

Question 30

what is diagnostic spirometry used for?

Answer 30

help diagnose and measure breathing difficulties like SOB, to measure airflow obstruction

Question 31

severity of copd

Answer 31

FEv1/ FVC ratio less than70%

1. mild copd FEV1 at least 80%
2. moderate : FEV1 50-80%
3. severe : FEV1 30-50%
4. very severe : FEV1 less than 30% or less than 50% with severe chronic symptoms

Question 32

what are the non pharmacological treatment of COPD?

Answer 32

1. long term O2 therapy (saturation lower than 88%)
2. surgical treatment
   - lung volume reduction surgery
   - bullectomy (for younger people with potential of good life)
   - bronchoscopic lung volume reduction
   - lung transplant
3. annual vaccination

Question 33

how to check the signs of servere exacerbation of patient with COPD ?

Answer 33

1. marked dyspnea and tachycardia (more than 30 respirations per min)
2. accessory muscles
3. cyanosis
4. confusion
5. sao2 less than 90%

Question 34

what to do when there is persistant hypercapnic ventilary failure for COPD ?

Answer 34

administer non-invasive positive pressure ventilation

Question 35

what is non-invasive ventilation?

Answer 35

delivers intermittent positive airway pressure which gives ventilatory support using face mask
less labored breathing
positive pressure encourages a steady flow of oxygen
allows the lungs to more efficiently transport O2 to the rest of the body and remove excess carbondioxide

Question 36

when to use non -invasive ventilation?

Answer 36

PH less than 7.35 and or Paco2 more than 45

severe dyspnea

Question 37

what are 2 levels of air pressure for non- invasive ventilation?

Answer 37

1. inspiratory positive airway pressure (higher level of pressure assist ventilation by lowering Co2 level)
2. expiratory positive airway pressure (lower level maintains airway patency during expiration which increases oxygen level)

Question 38

what are the lab test to diagnose pneumonia?

Answer 38

1. blood
   - wbc count increase
   - blood culture test are positive for causative organism
   - ABG shows hypoxemia
2. sputum culture
   - have infecting organism
3. xray
   - cloudy