Respiratory Assessment, Upper Respiratory Disorders, & Acute (Influenza)

Question 1

Describe Respiratory Cues of inadequate oxygenation.

Answer 1

Early:
- Dyspnea on exertion
- Tachypnea

Late:
- Dyspnea on exertion
- Dyspnea at rest
- Pause for breath between sentences, words
- Use of accessory muscles

Question 2

Describe Cardiovascular Cues of inadequate oxygenation.

Answer 2

Early:
- Dysrhythmias
- Tachycardia
- Hypertension

Late:
- Cool, clammy skin
- Cyanosis
- Hypotension

Question 3

Describe Central Nervous System cues of inadequate oxygenation.

Answer 3

Early:
- Apprehension
- Confusion, lethargy
- Restlessness, irritability

Late:
- Combativeness
- Coma

Question 4

What are some gerontologic differences in the respiratory structures of adult clients?

Answer 4

• Increased anteroposterior diameter
• Decreased chest wall compliance
• Chest wall stiffening, costal cartilage calcification
• Decreased elastic recoil
• Decreased functioning alveoli
• Decreased respiratory muscle strength

Question 5

What are some gerontologic differences in defense mechanisms of adult clients?

Answer 5

• Cell-mediated immunity
• Cough force
• Cilia function

Question 6

What are some sputum studies that can be done on cultures?

Answer 6

• C & S (diagnosis bacteria, select abx, evaluate tx, takes 48-72 hrs)
• Acid-fast bacteria (mycobacterium tuberculosis)
• Cytology (abnormal cells, may indicate cancer)
• Gram stain (+/-; help guide therapy until C&S are complete)

Question 7

Describe a Mantoux test.

Answer 7

• Patient will have positive intradermal TB test w/in 2-10 weeks of TB exposure
• Intradermal injection of tubercle extract made; read in 48 to 72 hrs
• Induration (palpable, raised, hardened) present when positive

Question 8

What does >/ = 5 mm induration mean on a Mantoux test?

Answer 8

TB positive in:

• HIV-infected people
• Recent exposure w/ a person w/ TB disease
• Immunosuppressed persons

Question 9

What does >/= 10 mm induration mean on a Mantoux test?

Answer 9

TB positive in:

• Recent immigrants from a country where TB is common
• Injected drug users
• Residents & employees of high-risk settings
• Mycobacteriology lab personnel
• People w/ clinical conditions (DM, ESRD) that place then at high risk

Question 10

What does >/= 15 mm induration mean on a Mantoux test?

Answer 10

TB positive in:

Any person; no risk factors

Question 11

How is Sinusitis diagnosed?

Answer 11

• Vital signs (temperature)
• Focus on E-N-T, throat, teeth, sinuses, and chest
  ~ Tenderness, firmness, inflammation, or redness
  ~ Light percussion using index finger

Question 12

Sinusitis assessment cues?

Answer 12

• Facial pressure
• Sense of fullness or pain
• Nasal obstruction
• Presence of purulent nasal discharge

Question 13

How do you treat Influenza?

Answer 13

• Prevention w/ vaccination
• Symptom control
  
  • Antipyretics
  • Analgesics
  • Oseltamivir (influenza A and B)
    ~ Start ASAP (2- day window)

Question 14

Influenza nursing indications?

Answer 14

• Initiate isolation precautions
• Administer humidified supplemental oxygen
• Semi to high Fowlers
• Obtain cultures
• Provide adequate fluid and nutritional intake

Question 15

Influenza patient education?

Answer 15

• Disinfect frequently
• Limit contact with others
• Report worsening shortness of breath
• Maintain adequate fluid intake
• Flu vaccine annually