Respiratory

Question 1

What are expected symptoms for a client admitted for heart failure-related fluid overload?

Answer 1

Dyspnea, orthopnea (laboured breathing in supine position), and paroxysmal noctural dyspnea (waking suddenly with difficulty breathing)
Rales or crackles

Question 2

What are risks associated with suctioning?

Answer 2

Hypoxemia, microatelectasis, cardiac dysrhythmias

Question 3

What is done to minimze both the amount of oxygen removed and mucosal trauma when suctioning?

Answer 3

Suction is only applied when removing, not inserting, the catheter into the artificial airway

Question 4

What types of aerosols can be useful for thinning out secretions in patients with mechanical ventilators?

Answer 4

Sterile NS aerosols

Acetylcysteine (Mucomyst) aerosol

Question 5

Aerosol therapy may induce ________ in certain individuals and can be relieved by the use of a __________.

Answer 5

bronchospasm

bronchodilator

Question 6

What is the purpose of morphine administration in patients on a mechanical ventilator?

Answer 6

Promote breathing syncrhony, reduce anxiety and promote comfort

Question 7

What is recommended prior to suctioning to reduce risks of hypoxemia, microatelectasis and cardiac dysrhythmias?

Answer 7

Preoxygenation with 100% oxygen for 30 seconds prior to suctioning

Question 8

Suctioning time should be limited to how long?

Answer 8

10-15 seconds

Question 9

Describe peak expiratory flow measurements.

Answer 9

1. Before each use, slide the indicator on the numbered scale on the flow meter to 0 (or the lowest value), and stand or sit as upright as possible
2. Inhale deeply, place the mouthpiece in the mouth, and close the lips tightly around the mouthpiece to form a seal
3. Exhale as quickly and completely as possible and note the reading on the numbered scale.
4. Repeat the procedure 2 more times, with a 5-10 second rest period between exhalations.
5. Record the highest reading in the peak flow log.

Question 10

Oxygen delivery apparatus used in a medical emergency

What should the liter flow be?

Answer 10

Non-rebreather mask

15L/min

Question 11

Device recommended in post-op clients to prevent atelectasis assocaited with incisional pain

Answer 11

Incetive spirometry

Question 12

What are guidelines prior to use of incentive spirometry?

Answer 12

Adequate pain medication administration

5-10 breaths per session every hour while awake

Question 13

What are the instructions for using an incentive spirometer?

Answer 13

1. Assume a sitting or high Fowler position (promotes lung expansion), and exhale normally
2. While holding the device at an even level, seal the lips tightly on the mouthpiece to prevent leakage of air around it
3. Inhale deeply through the mouth until the piston is elevated to the predetermined tidal volum.
4. Hold the breath for at least 2-3 seconds as this maintains maximual inhalation
5. Exhale slowly to prevent hyperventilation
6. Breathe normally for several breaths before repeating the process
7. Cough at the end of the session to help with secretion expectoration

Question 14

Patients with CF are at great risk for these two conditions.

Answer 14

recurrent lung infections

pneumothorax

Question 15

What signs and symptoms may indicate pneumothorax in a patient with CF?
What may be the only early sign?

Answer 15

sudden, worsening dyspnea, tachypnea, tachycardia, sudden drop in SpO2

Sudden drop in SpO2 may be the only early sign

Question 16

Why do CF patients suffer from constpiation?

Why do they suffer from malnutrition?

Answer 16

reduced salt and water secretion in intestines

lack of enzyme secretion in GI tract

Question 17

Describe the steps for tracheostomy suctioning.

Answer 17

1. Place the client in semi-Fowler’s position, if not contraindicated to promote lung expansion and oxygenation
2. Preoxygenate with 100% oxygen to prevent hypoxemia and microatelectasis; alternatively, have the patient take 3-4 deep breaths
3. Insert the catheter gently the length of the airway without applying suction to prevent mucosal tissue damage.
4. Withdraw the catheter slightly if resistance is felt at the carina (bronchi bifurcation)
5. Apply intermittent suction while rotating the suction catheter during withdrawal to prevent mucosal tissue damage. Limit suction time to 5-10 seconds with each suction pass to prevent mucosal tissue damage and limit hypoxia

Question 18

How is TB transmitted?

What precautions are used?

Answer 18

Airborne

N95 respirator, negative pressure isolation room with HEPA filter

gloves, gowns, google and face shield as needed

Question 19

How is chicken pox spread?

How about shingles?

Answer 19

Airborne if lesions are uncrusted

Shingles is only spread by airborne routes in disseminated disease or immunocompromised clients

Question 20

What is done in the event of accidental dislodgement of a tracheostomy?

Answer 20

If the tracheostomy is mature (> 7 days), the nurse should attempt to open the airway by inserting curved hemostat to maintain stoma patency and insert a new tracheostomy tube with an obturator

if the stoma is immature, or the nurse cannot get a tube in, the nurse may need to place an occlusive dressing over the stoma and bag-valve mask to ventilate the lungs

Question 21

What are interventions to facilitate airway clearance for pneumonia?

Answer 21

Hydration - 2-3L/day
Huff coughing
pain management
Chest PT
Fowlers position or side lying with good lung in dependent position

Question 22

Pursed lip breathing is helpful for these patients.

Answer 22

COPD patients

Question 23

What signs and symptoms are expected in patients with pneumonia?

Answer 23

Lung crackles (fine or coarse)
Increased vocal/tactile fremitus
Bronchial breath sounds in peripheral lung fields

Unequal chest expansion (on palpation)
Dullness (on percussion)

Fever, chills, productive cough, dyspnea, pleuritic chest pain

Question 24

When would hyperresonance be heard?

Answer 24

Pneumothorax (air in pleural space) or in asthma/emphysema (over-inflated lung)

Question 25

Which condition would lead to tracheal deviation?

Answer 25

Tension pneumothorax