Resp

Question 1

High risk groups for pneumonia

Answer 1

Smokers 
Immobility 
Immunosuppressed
Depressed gag/cough reflex 
Sedated 
Neuromuscular disorders 
Nasogastric intubAtion 
Hospitalized client

Question 2

Nursing assessment of pneumonia

Answer 2

Tachypnea (often shallow resp with use of accessory muscles)
Abrupt onset of fever with shaking and chills
Productive cough
Rapid bounding pulse
Pain and dullness to percussion over affected lung area
Bronchial breath sounds crackles
Arterial blood gas=hypoxia

Older adults may present confused, lethargic, anorexic, tachypnea, tachycardia

Question 3

A major concern with fever is

Answer 3

It can cause dehydration bc of excessive fluids loss due to diaphoresis

Increased fever also increases metabolism and demand for O2

Question 4

Nursing intervention for pneumonia

Answer 4

Assess sputum for color, volume, consistency, and clarity
Assist client to cough
Provide fluids up to 3 L per day
Assess lung sounds before and after coughing
Assess rate, depth, and pattern of resp regularly
Assess skin color, mental status, temperature
Promote rest and conserve energy

Question 5

The best way to assist with a client coughing

Answer 5

Deep breathing every 2 hours (incentive spirometer)
Use humidity to loosen secretions
Suction air way
Chest physiotherapy
Ambulatory
Fluids
Patients should sit in semi fowler or high fowler bc it lessens the pressure on the diaphragm by abdominal organs

Question 6

What are the two early signs of cerebral hypoxia related to pneumonia?

Answer 6

Irritability and restlessness

Question 7

Chronic bronchitis

Answer 7

Chronic sputum with cough production on a daily basis for a minimum of 3 months in each of 2 consecutive years
Chronic hypoxemia, cor pulmonale
Increase in bronchial wall thickness which obstructs air flow
Reduced responsiveness of resp center go hypoxemia stimuli.
Higher incidence in smokers

Question 8

Chronic bronchitis assessment

Answer 8

Generalized cyanosis 
Blue bloaters 
Right sided heart failure 
Distended neck veins
Crackles 
Exploratory wheezes

Question 9

Emphysema

Answer 9

Reduced gas exchange surface area
Increased air trapping
Decreased capillary network
Increased work, increased O2 consumption precipitating factors- smoking, environmental, genetic

Question 10

Emphysema assessment

Answer 10

Pink puffers 
Barrel chest 
Pursed lip breathers 
Distant, quiet breath sounds 
Wheezes

Question 11

Asthma

Answer 11

Narrowing or closure of the airway due to variety of stimulants
Precipitating factors- mucosal edema, beta blockers, infection, allergic reaction, emotional stress, exercise, environmental, reflux esophagitis

Question 12

Asthma assessment

Answer 12

Dyspnea, wheezing, chest tightness
Assess precipitating factors
Medication history

Question 13

Chronic bronchitis nursing interventions

Answer 13

Lowest FiO2 possible to prevent CO2 retention
Monitor for s/s of fluid overload
Teach purse lip breathing and diaphragmatic breathing and tripod position
Administer bronchodilators and anti inflammatory agents

Question 14

Emphysema interventions

Answer 14

Same as chronic bronchitis

Question 15

Asthma interventions

Answer 15

Administer bronchodilators
Administer fluids and humidification
Education about what caused attack
Ventilatory patterns

Question 16

The primary cause of COPD in US is

Answer 16

Tobacco smoke

Question 17

Tripod position

Answer 17

In bed: sit with arms resting on over bed table

In chair: lean forward with elbows resting on knees

Question 18

Suctioning (tracheal)

Answer 18

Suction when adventitious breath sounds are heard, when secretions are present at endotracheal tube, and when gurgling sounds are noted
Aseptic/sterile technique
Wear mask and goggles
Advance catheter until resistance is met
Apply suction only when withdrawing (gently rotate when withdrawing)
Oxygenate 100% 1-2 mins before

Question 19

Ventilator setting maintenance

Answer 19

Verify that alarms are on
Maintain settings and check often to ensure they are set as prescribed
Verify functioning of ventilator every 4 hours

Question 20

Nasal cannula

Answer 20

Low O2 flow

Good for COPD patients

Question 21

Simple face mask

Answer 21

Low flow but effectively delivers high O2 concentrations.

Can’t deliver

Question 22

Non rebreather mask

Answer 22

Low flow, but delivers high O2 concentrations (60-90% O2)

Question 23

Partial rebreather mask

Answer 23

Low O2 flow reservoir bag attached. Can deliver high O2 concentrations

Question 24

Venturi mask

Answer 24

High flow system can deliver exact O2 concentration

Question 25

Proper use of inhaler

Answer 25

Exhale completely
Grip mouth piece in mouth
Use bronchodilator before steroid inhaler
Wait 1 min between puffs
After steroid inhaler client must perform oral care to prevent final infections

Question 26

Pneumonia

Answer 26

Inflammation of the lower resp Tract

Infection can be through aspiration, inhalation, or hematogeneous spread

Can be bacterial, viral, fungal (rare), or chemical

Can be community or nosocomial (hospital) squired