Respiratory Disorders Flashcards
CARE OF THE PATIENT WITH RESPIRATORY DISORDERS
M
ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM
,
External respiration, or breathing, is the exchange of oxygen and carbon dioxide between the lung and the environment.
A)true
B)false
A
_______ respiration, or breathing, is the exchange of oxygen and carbon dioxide between the lung and the environment
External
The respiratory system works with the cardiovascular system to deliver oxygen to the cells, where it provides energy to carry out metabolism.
A)true
B)false
A
Internal respiration is the exchange of oxygen and carbon dioxide at the cellular level
A)true
B)falsE
A
_________ respiration is the exchange of oxygen and carbon dioxide at the cellular level
Internal respiration is the exchange of oxygen and carbon dioxide at the cellular level
UPPER RESPIRATORY TRACT
,
Air enters the respiratory tract through the nose. The air is filtered, moistened, and warmed as it enters the two nasal openings (nares) and travels to the nasal cavity.
A)true
B)false
A
The mucous membrane provides warmth and moisture and secretes 1 L of moisture every day.
A)true
B)false
A
Lateral to the nasal cavities are three scroll-like bones called turbinates or conchae, which cause the air to move over a larger surface area.
A)true
B)false
A
paranasal sinuses. They are called the frontal, maxillary, sphenoid, and ethmoid cavities. These are hollow areas that make the skull lighter and are believed to give resonance to the voice.
A)true
B)false
A
The pharynx, or throat (a tubular structure about 5 inches [13 em] long extending from the base of the skull to the esophagus and situated just in front of the vertebrae), is the passageway for both air and food.
A)true
B)false
A
the distal end of the pharynx are three subdivisions:
(1) nasopharynx (superior portion),
(2) oropharynx (posterior to mouth), and
(3) laryngopharynx (directly superior to larynx) .
A)true
B)false
A
eustachian tubes enter either side of the nasopharynx, connecting it to the middle ear.
A)true
B)false
A
The adenoids (pharyngeal tonsils) are in the nasopharynx, whereas the palatine tonsils are in the oropharynx. A)true B)false
A
larynx, or organ of voice, is supported by nine areas of cartilage and connects the pharynx with the trachea.
A)true
B)false
A
The largest area of cartilage is composed of two fused plates and is called the thyroid cartilage, or Adam’s apple.
A)true
B)false
A
The epiglottis, a large leaf-shaped area of cartilage, protects the larynx when swallowing. It covers the larynx tightly to prevent food from entering the trachea and directs the food to the esophagus
A)true
B)false
A
The larynx contains the vocal cords.
A)true
B)false
A
The trachea, or windpipe, is a tubelike structure that extends approximately 4 1/3 inches (11 cm) to the midchest, where it divides into the right and left bronchi
A)true
B)false
A
The entire structure is lined with mucous membranes and tiny cilia (small, hairlike processes on the outer surfaces of small cells, which produce motion or current in a fluid) that sweep dust or debris upward toward the nasal cavity.
A)trachea
B)lungs
A
Sometimes, because of an airway obstruction, a physician performs a tracheostomy (a surgical opening into the trachea through which an indweLling tube may be inserted). Once this procedure is completed, the individual breathes through the tracheal opening rather than the nose. The opening is below the larynx, so air cannot pass over the vocal cords. The vocal cords cannot vibrate, and speech becomes physiologically impossible.
A)true
B) false
A
tracheostomy, The opening is below the larynx, so air cannot pass over the vocal cords. The vocal cords cannot vibrate, and speech becomes physiologically impossible.
A)true
B)false
A
LOWER RESPIRATORY TRACT
,
Because of this design, foreign objects that are aspirated generally enter the right bronchus.
A)true
B)false
A
The end structures of the bronchial tree are called alveoli
A)true
B)false
A
These saclike structures(alveoli) resemble a bunch of grapes. A single grapelike structure is called an alveolus.
A)true
B)false
A
MECHANICS OF BREATHING
,
lungs occupy almost all the thoracic cavity except the centermost area, the mediastinum, which contains the heart and the great vessels. This cavity, the interpleural space, is enclosed by the sternum, the ribs, and the thoracic vertebrae.
A)true
B)false
A
The lungs receive their blood supply, which comes directly from the heart, through the pulmonary arteries
A)true
B)false
A
The surface of each lung is covered with a thin, moist, serous membrane called the visceral pleura.
A)true
B)false
A
The walls of the thoracic cavity are covered with the same type of membrane called the parietal pleura.
A)true
B)false
A
When too much serous secretion is produced, fluid accumulates in the pleural space; this is called pleural effusion.
A)true
B)false
A
The physician may decide to remove the fluid by performing a thoracentesis-inserting a needlelike instrument into the pleural space and removing the fluid.
A)true
B)false
S
Respiratory Movements and Ranges
,
The normal range of respiration for an adult at rest is 12 to 20 breaths/min. This rate can be affected by many variables, including age, sex, activity, disease, and body temperature.
A)true
B)false
A
The respiratory rate is 40 to 60 breaths/min for a newborn, 22 to 24 breaths/min for an early school-age child, and 20 to 22 breaths/min for a teenager.
A)true
B)false
A
The normal range for women is higher than that for men
A)true
B)false
A
The medulla oblongata and pons of the brain are responsible for the basic rhythm and depth of respiration. The body’s demands can modify the rhythm.
A)true
B)false
A
Chemoreceptors in the carotid and aortic bodies are specialized receptors. When stimulated by increasing levels of blood carbon dioxide, decreasing levels of blood oxygen, or increasing blood acidity, these receptors send nerve impulses to the respiratory centers, which in turn modify respiratory rates.
A)true
B)false
A
Carbon dioxide, which is present in the blood as carbonic acid, is considered the chemical stimulant for regulation of respiration. Therefore the more carbon dioxide in the blood, the more acidic the blood becomes.
A)true
B)false
A
After exhalation the blood becomes more alkaline. The normal pH of the blood is 7.35 to 7.45 a narrow range. Deviation from this range causes the patient to develop either acidosis or alkalosis.
A)true
B)false
A
ASSESSMENT OF THE RESPIRATORY SYSTEM
,
subjective data. During the interview, encourage the patient to describe any symptoms, such as shortness of breath, dyspnea on exertion, or cough.
A)true
B)false
A
Dyspnea, or difficulty breathing, is a subjective experience that only the patient can accurately describe.
A)true
B)false
A
Flaring nostrils indicate the patient is struggling to breathe, which is usually a late sign of respiratory distress
A)true
B)false
A
orthopnea (an abnormal condition in which a person must sit or stand to breathe deeply or comfortably).
A)true
B)false
A
adventitious sounds (abnormal sounds superimposed on breath sounds, including sibilant wheezes [formerly called simply wheezes], sonorous wheezes [formerly called rhonchi], crackles [formerly called rales], and pleural friction rubs. A)true B)false
A
Sibilant wheezes are musical, high-pitched, squeaking or whistling sounds, caused by the rapid movement of air through narrowed bronchioles.
A)true
B)false
A
Sonorous wheezes are low-pitched, loud, coarse, snoring sounds. They are often heard on expiration.
A)true
B)false
A
Crackles are short, discrete, interrupted crackling or bubbling sounds that are most commonly heard during inspiration.
A)true
B)false
A
Pleural friction rubs are low-pitched, grating or creaking lung sounds that occur when inflamed pleural surfaces rub together during respiration.
A)true
B)false
A
hypoxia (oxygen deficiency)
A)true
B)false
A
Adventitious Breath Sounds
,
Crackles (rales) Caused by fluid, mucus, or pus in the small airways and alveol
A)true
B)false
A
Fine crackles Found in diseases affecting bronchioles and alveoli.
A)true
B)false
A
Medium crackles,Associated with diseases of small bronchi.
A)true
B)false
A
Coarse crackles,Associated with diseases of small bronchi.
A)true
B)false
A
Sonorous wheezes (rhonchi),Caused by air moving through narrowed tracheobronchial passages (caused by secretions, tumor, spasm); cough may alter sound if caused by mucus in trachea or large bronchi. A)true B)false
A
Sibilant wheezes (wheezes),Caused by narrowed bronchioles; bilateral wheeze often result of bronchospasm; unilateral, sharply localized wheeze may result from foreign matter or tumor compression. A)true B)false
A
Pleural friction rub,Sound originates outside respiratory tree, usually caused by inflammation; over the lung fields it suggests pleurisy; over the pericardium it suggests pericarditis with a pericardia! friction rub. To distinguish the two, ask the patient to hold the breath briefly. If the rubbing sound persists, it is a pericardia! friction rub because the inflamed pericardia! layers continue rubbing together with each heartbeat; a pleural rub would stop when breathing stops.
A)true
B)false
A
LABORATORY AND DIAGNOSTIC EXAMINATIONS
,
CHEST ROENTGENOGRAM
,
This test gives information on alterations in size and location of the pulmonary structures and blood flow, and it identifies lesions, infiltrates, foreign bodies, or fluid.
A)CHEST ROENTGENOGRAM
B)false
A
chest radiograph also shows whether a disorder involves the lung parenchyma (the tissue of an organ, as distinguished from supporting or cotmective tissue) or the interstitial spaces.
A)true
B)false
A
Chest radiographs can confirm . pneumothorax, pneumonia, pleural effusion, and pulmonary edema
A)true
B)false
A
Any article of clothing containing metal (e.g., .a bra with metal hooks) or jewelry must be removed, since the metal produces a shadow on the film.
A)CHEST ROENTGENOGRAM
B)false
A
Signs and Symptoms of Hypoxia
,
-Apprehension, anxiety, restlessness
• Decreased ability to concentrate
• Disorientation
• Decreased level of consciousness
• Increased fatigue
• Vertigo
• Behavioral changes
• Increased pulse rate; bradycardia as hypoxia advances
• Increased rate and depth of respiration; shallow, slow respirations as hypoxia progresses
• Elevated blood pressure; with continuing oxygen deficiency, decreased blood pressure
• Cardiac dysrhythmias
• Pallor
• Cyanosis (may not be present until hypoxia is severe)
• Clubbing
• Dyspnea
Truw
COMPUTED TOMOGRAPHY
,
Computed tomography (CT) scans of the lungs take pictures of small layers of pulmonary tissue, usually to identify a pulmonary lesion A)true B)false
A
the helical CT can scan the abdomen and chest in less than 30 seconds, the entire study can be performed with one breath-hold
A)true
B)false
A
Pulmonary angiography (pulmonary arteriography) uses a radiographic contrast material injected into the pulmonary arteries to permit visualization of the pulmonary vasculature. A)true B)false
A
Angiography is used to detect pulmonary embolism (PE) and a variety of congenital and acquired lesions of the pulmonary vessels
A)true
B)false
A
If the lung scan is normal, PE is ruled out.
A)true
B)false
A
Ventilation-perfusion (V/Q) scanning is used primarily to check for a PE. An intravenous (IV) radioisotope is given for the perfusion portion of the test, and the pulmonary vasculature is outlined and photographed.
A)true
B)false
A
PULMONARY FUNCTION TESTING
,
PFTs include various procedures to obtain information on lung volume, ventilation, pulmonary spirometry, and gas exchange.
A)true
B)false
A
Lung volume tests refer to the volume of air that can be completely and slowly exhaled after a maximum inhalation (vital capacity).
A)true
B)false
A
Inspiratory capacity is the largest amount of air that can be inhaled in one breath from the resting expiratory level.
A)true
B)false
A
Total lung capacity is calculated to
determine the volume of air in the lung after a maximal inhalation
A)true
B)false
A
MEDIASTINOSCOPY
,
This is performed to gather a sample of lymph nodes for biopsy for tumor diagnosis. Because these lymph nodes receive lymphatic drainage from the lungs, they help diagnose malignant tumors.
A)MEDIASTINOSCOPY
B)false
A
LARYNGOSCOPY
,
Direct laryngoscopy requires local or general anesthesia and exposes the vocal cords with a laryngoscope passed down over the tongue.
A)LARYNGOSCOPY
B)false
A
BRONCHOSCOPY
,a
Bronchoscopy is performed by passing a bronchoscope into the trachea and bronchli
A)BRONCHOSCOPY
B)false
A
local anesthetic agent may be used, but an IV general anesthetic agent is usually given.
A)bronchyscopy
B)false
A
Nursing interventions for patients after bronchoscopy include
(1) keeping the patient on NPO (nothing by mouth) status until gag reflex returns, usually about 2 hours after the procedure;
(2) keeping the patient in a semi-Fowler’s position and turning on either side to facilitate removal of secretions (unless the physician specifies another position);
(3) monitoring the patient for signs of laryngeal edema or laryngospasms, such as stridor or increasing dyspnea; and
(4) if lung tissue biopsy is taken, monitoring sputum for signs of hemorrhage (blood-streaked sputum is expected for a -few days after biopsy).
True
Guidelines for Sputum Specimen Collection
1 . Explain to the patient that the sputum must be brought up from the lungs. Patients who have difficulty producing sputum or who have tenacious sputum may be dehydrated. Encourage fluid intake.
- Collect the sputum specimen before prescribed antibiotics are started.
- Collect specimens before meals to avoid possible emesis from coughing.
- Instruct patient to inhale and exhale deeply three times, then inhale swiftly, cough forcefully, and expectorate into the sterile sputum container. Usually early morning samples are collected on 3 consecutive days.
- If the patient cannot raise sputum spontaneously, a hypertonic saline aerosol mist may help produce a good specimen. Instruct the patient to take several normal breaths of the mist, inhale deeply, cough, and expectorate.
- Instruct patient to rinse mouth with water before expectorating into sterile specimen bottle to decrease sputum contamination.
- Properly label and send to the laboratory without delay.
- Sputum samples can also be obtained indirectly, such as with nasotracheal suctioning with a catheter or transtracheal aspiration. Take care to ensure that the suction catheters remain sterile. A physician’s order must be obtained for endotracheal suctioning.
True
LUNG BIOPSY
,
Lung biopsy may be done transbronchially or as an open-lung biopsy. The purpose is to obtain tissue, cells, or secretions for evaluation.
A)LUNG BIOPSY
B)false
A
THORACENTESIS
,
Thoracentesis is the surgical perforation of the chest wall and pleural space with a needle for the aspiration of fluid for diagnostic or therapeutic purposes or for the removal of a specimen for biopsy.
A)true
B)false
A
Nursing interventions for the patient undergoing thoracentesis include explaining the procedure and obtaining a written consent. Try to relieve the patient’s anxiety. The procedure is usually carried out in the patient’s room. The patient sits on the edge of the bed with the head and arms resting on a pillow placed on an overbed table. If the patient cannot sit up, turn him or her to the unaffected side with the head of the bed elevated 30 degrees.
A)true
B)false
A
Nursing interventions for the patient with thoracentesis, Monitor vital signs, general appearance, and respiratory status throughout the procedure. Usually no more than 1300 mL of pleural fluid should be removed within a 30-minute period because of the risk of intravascular fluid shift with resultant pulmonary edema.
A)true
B)false
A
After thoracentesis, position the patient on the unaffected side. Label the specimen and send it immediately to the laboratory per physician’s orders.
A)true
B)false
A
ARTERIAL BLOOD GASES
,
Arterial blood gas (ABC) testing yields definitive information on the patient’s respiratory status and metabolic balance. The procedure is performed at the bedside. A heparinized syringe and needle are used to withdraw 3 to 5 mL of arterial blood, usually from the radial artery. Other possible sites include femoral or brachial arteries. After the sample is obtained, place direct pressure on the puncture site for a minimum of 5 minutes to prevent hematoma formation and blood loss.
A)ARTERIAL BLOOD GASES
B)false
A
If the patient is taking anticoagulants, maintain pressure for 20 minutes or longer until bleeding stops. Place the capped syringe in a basin of crushed ice and water to preserve the gas and pH levels of the specimen. Send the properly labeled specimen to the laboratory immediately.
A)ARTERIAL BLOOD GASES
B)false
A
PULSE OXIMETRY
,
Pulse oximetry is a noninvasive method of providing continuous monitoring of Sao2 (saturation of oxygen) for assessment of gas exchange.
A)true
B)false
A
An Sao2 of 90% to 100% is needed to adequately replenish oxygen in plasma.
A)true
B)false
A
An Sao2 of less than 70% is considered life threatening.
A)true
B)false
A
DISORDERS OF THE UPPER AIRWAY
,
EPISTAXIS
,
The underlying cause of epistaxis (bleeding from the nose) is congestion of the nasal membranes, leading to capillary rupture. This condition is frequently caused by injury and occurs more frequently in men.
A)True
B)false
A
Other causes include local irritation of nasal mucosa, such as dryness, chronic infection, trauma (e.g., injury, vigorous nose blowing, or nose picking), topical corticosteroid use, nasal spray abuse, or street drug use.
A)epistaxis
B)false
A
Bleeding may also be prolonged of a patient with a nose bleed, if the patient takes aspirin or nonsteroidal antiinflammatory drugs (NSAIDs).
A)true
B)False
A
Exsanguination (loss of blood to the point at which life can no longer be sustained) .
A)true
B)false
A
Assess the patient’s blood pressure, temperature, pulse, respirations, and any evidence of hypovolemic shock. Severe bleeding results in a drop in blood pressure,
which may cause the bleeding to stop. Hypotension is a late sign of shock.
A)objective data for patient with epistaxis
B)false
A
A hemoglobin and hematocrit determination will aid in establishing an estimate of the blood loss.
A)true for epistaxis
B)false
A
Nursing interventions for a patient with epistaxis include keeping the patient quiet.
- Place the patient in a sitting position, leaning forward, or in a reclining position with head and shoulders elevated.
- Apply direct pressure by pinching the entire soft lower portion of the nose for 10 to 15 minutes.
- Apply ice compresses to the nose and have the patient suck on ice.
- Partially insert a small gauze pad into the bleeding nostril, and apply digital pressure if bleeding continues.
- Monitor for signs and symptoms of hypovolemic shock.
True
Nursing diagnoses and interventions for the patient with epistaxis include but are not limited to the following:
,
Ineffective tissue perfusion, cerebral and/or cardiopulmonary, related to blood loss. A nursing intervention would be? Select all that apply
A)Assess vital signs and level of consciousness every 15 minutes and report any changes.
B)Document estimated blood loss.
C)give alcohol
A B
Risk for aspiration, related to bleeding, a nursing intervention would be?select all that apply
A)Elevate head of bed; place patient in Fowler’s position with the head forward; encourage patient to let the blood drain from the nose.
B)Pinch nostrils; have the patient breathe through the mouth; apply ice compresses over the nose (however, the primary benefit of the application of ice is that it requires the patient to remain still); assist patient in clearing secretions.
C)Maintain airway patency.
D)Instruct patient to expectorate any blood or clots rather than swallow them, which could cause nausea and vomiting.
A B C D
To prevent recurrent hemorrhage, warn the patient not to blow the nose vigorously and to avoid dryness of the nose.
A)true for patient with epistaxis
B)false a
A
Encourage the patient to use a vaporizer and saline or nasal lubricants to keep nasal mucous membranes moist.
A)for patient with epistaxis
B)false
A
Advise the patient to avoid using aspirin-containing products or NSAIDs, and teach him or her to sneeze with the mouth open.
A)true for patient with epistaxis
B)false
A
DEVIATED SEPTUM AND NASAL POLYPS
,
Common conditions that cause nasal obstruction include nasal polyps or a deviated septum caused by congenital abnormality or, more likely, injury.
A)true
B)false
A
Nasal polyps are tissue growths on the nasal tissues that are frequently caused by prolonged sinus inflammation; allergies are often the underlying cause.
A)true
B)false
A
A septum that deviates from the midline can obstruct airway passages
A)true
B)false
A
stertorous (characterized by a harsh snoring sound)
A)true
B)false
A
Sinus radiographic studies depict the presence of shadowy sinuses when nasal polyps are present.
A)true
B)false
A
A shift of the nasal septum is evident with a septal defect
A)true
B)false
A
Nasoseptoplasty is the operation of choice to reconstruct, align, and straighten the deviated nasal septum.
A)true
B)false
A
nasal polypectomy is performed to remove the polyps. Actions include nasal packing to control bleeding for 24 hours, and then maintaining nasal mucosa hydration with nasal irrigation of saline or application of a light layer of petroleum jelly to the external nares to prevent drying
A)true
B)false
A
Medications include (1) corticosteroids (prednisone), which cause polyps to decrease or disappear; and (2) antihistamines for allergy signs and symptoms, to decrease congestion in both septal deviations and polyps. A)true B)false
A
Nursing diagnoses and interventions for the patient with deviated septum or nasal polyps include but are not limited to the following:
,
Ineffective airway clearance, related to nasal exudates. A nursing intervention would be? Select all that apply
A)Document patient’s ability to clear secretions, and note respiratory status.
B)Elevate head of bed, and apply ice compresses to the nose to decrease edema, discoloration, discomfort, and bleeding.
C)Change nasal drip pad as needed, documenting color, consistency, and amount of exudates.
A B C
Risk for injury, related to trauma to bleeding site associated with vigorous nose blowing. A nursing intervention would be?select all that apply.
A)Assess and report exudates (as stated above).
B)Instruct patient against blowing nose in immediate postoperative period, since this could increase bleeding, edema, and ecchymosis.
A B
Remind the patient to avoid nose blowing, vigorous coughing, or Valsalva’s maneuver (holding the breath and bearing down as if straining during a bowel movement) for 2 days postoperatively. Remind the patient that facial ecchymosis and edema may persist for several days after surgery.
A)true
B)false
A
ANTIGEN-ANTIBODY ALLERGIC RHINITIS AND ALLERGIC CONJUNCTIVITIS (HAY FEVER)
,
atopic allergic conditions that result from antigenantibody reactions in the nasal membranes, nasopharnasopharynx, and conjunctiva from inhaled or contact allergens. Many infants, children, and adults have these seasonal or perennial conditions, which often result in absences from school and work.
A)ANTIGEN-ANTIBODY ALLERGIC RHINITIS AND ALLERGIC CONJUNCTIVITIS (HAY FEVER)
B)false
A
During the antigen-antibody reaction of rhinitis and conjunctivitis, ciliary action slows; mucosal gland secretion increases; leukocyte (eosinophil) infiltration occurs; and, because of increased capillary permeability and vasodilation, local tissue edema results.
A)true
B)false
A
Common allergens are tree, grass, and weed pollens; mold spores; fungi; house dusts; mites; and animal dander.
A)ANTIGEN-ANTIBODY ALLERGIC RHINITIS AND ALLERGIC CONJUNCTIVITIS (HAY FEVER)
B)false
A
The initial complaints of seasonal rhinitis and conjunctivitis include severe sneezing, congestion, pruritus, and lacrimation (watery eyes).
A)true
B)false
A
Cough, epistaxis, and headache may also occur. With ANTIGEN-ANTIBODY ALLERGIC RHINITIS AND ALLERGIC CONJUNCTIVITIS (HAY FEVER)
A)true
B)false
A
More chronic signs and symptoms include headache, severe nasal congestion, postnasal drip, and cough. If these are not treated, . chronic sufferers eventually develop secondary infections, such as otitis media, bronchitis, sinusitis, and pneumonia.
A)ANTIGEN-ANTIBODY ALLERGIC RHINITIS AND ALLERGIC CONJUNCTIVITIS (HAY FEVER)
B)false
A
In allergic rhinitis, on physical examination the mucosa of the turbines is usually pale because of venous engorgement, which is in contrast to the erythema of viral rhinitis.
A)true
B)false
A
Perennial use of antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists such as zafirlukast (Accolate) or montelukast (Singulair) is recommended.
A)ANTIGEN-ANTIBODY ALLERGIC RHINITIS AND ALLERGIC CONJUNCTIVITIS (HAY FEVER)
B)false
A
Lodoxamide (Alomide) four times a day is the recommended treatment for mild to moderately severe allergic conjunctivitis
A)true
B)false
A
Pressure headaches may require opioid analgesics until signs and symptoms are relieved.
A)true
B)false
A
Hot packs over facial sinuses offer relief if headache is related to sinus congestion.
A)true
B)false
A
OBSTRUCTIVE SLEEP APNEA
,
Obstructive sleep apnea (OSA) is characterized by partial or complete upper airway obstruction during sleep, causing apnea and hypopnea
A)true
B)false
A
Apnea is the cessation of spontaneous respirations;
A)true
B)false
A
hypopnea is abnormally shallow and slow respirations
A)true
B)false
A
Airflow obstruction occurs when the tongue and the soft palate fall backward and partially or completely obstruct the pharynx.
A)true
B)false
A
During the apneic period, the patient experiences severe hypoxemia (decreased Pao2) and hypercapnia (increased Paco2). These changes are ventilatory stimulants and cause the patient to partially awaken.
A)true
B)false
A
Apnea and arousal cycles occur repeatedly, as many as 200 to 400 times during 6 to 8 hours of sleep.
A)true
B)false
A
Clinical manifestations of sleep apnea include frequent awakening at night, insomnia, excessive daytime sleepiness, and witnessed apneic episodes
A)true
B)false
A
Other symptoms include morning headaches (from hypercapnia, which causes vasodilation of cerebral blood vessels), personality changes, and irritability
A)OBSTRUCTIVE SLEEP APNEA
B)false
A
Risk factors for OSA include the following:
A)Male gender: About twice as many men as women have OSA.
B)incidence increases with age over 65 years, probably because of weight gain and loss of pharyngeal muscle strength.
C)Nasal conditions: Nasal allergies, polyps, or septal deviation decrease the diameter of the pharynx
D)Receding chin: A person with a receding chin may not have enough room in the pharynx for the tongue, thus contributing to obstruction.
E)Pharyngeal structural abnormalities: A person with OSA may have enlarged tonsils, an elongated uvula, an especially long tongue, or a soft palate that rests on the base of the tongue. Any of these structural abnormalities can impinge on the airway
A B C D E
Diagnosis of sleep apnea is made during sleep with the use of polysomnography. Electrodes are placed on the patient’s scalp, mandibular area, and lateral area of the eyelids.
A)true
B)false
A
Instruct the patient to avoid sedatives and alcoholic beverages for 3 to 4 hours before sleep. Referral to a weight loss program may help, since excessive weight exacerbates symptoms.
A)OBSTRUCTIVE SLEEP APNEA
B)false
A
Symptoms resolve in half of the patients with OSA who use an oral appliance during sleep that brings the mandible and tongue forward to enlarge the airway space, thereby preventing airway occlusion.
A)true
B)false
A
In patients with more severe symptoms, nasal continuous positive airway pressure (nCPAP) may be used
A)OBSTRUCTIVE SLEEP APNEA
B)false
A
The blower is adjusted to maintain sufficient positive pressure (5 to 15 em H20) in the airway during inspiration and expiration to prevent airway collapse.
A)true OSA
B)false
A
A technologically more sophisticated therapy, bilevel positive airway pressure (BiPAP), capable of delivering higher pressure during inspiration (when the airway is most likely to be occluded) and lower pressure during expiration, may be helpful and is better tolerated.
A)true, OSA
B)false
A
Although nCPAP is highly effective, compliance is poor even if symptoms of sleep apnea are relieved.
A)true
B)false
A
The most common procedures are uvulopalatoplasty, pharyngoplasty (UPP, UPPP, or UP3) and genioglossal advancement and hyoid myotomy (GAHM)
A)true
B)false
A
UPPER AIRWAY OBSTRUCTION
,
Upper airway obstruction is precipitated by a recent respiratory event, such as trallffiatic injury to the airway or surrounding tissues
A)true
B)false
A
Common airway obstructions include choking on food; dentures; aspiration of vomitus or secretions; and, the most common airway obstruction in an unconscious person, the tongue.
A)true
B)false
A
Altered physiology includes any condition that could produce airway obstruction, such as laryngeal spasm caused by tetany resulting from hypocalcemia. Another cause may be laryngeal edema caused by injury.
A)UPPER AIRWAY OBSTRUCTION
B)false
A
objective data includes prompt assessment for the classic sign of choking in which the patient places a hand over throat. Also monitor for signs of hypoxia (an inadequate, reduced tension of cellular oxygen; see Box 9-1), cyanosis (slightly bluish, -grayish, slatelike, or dark pmple discoloration of the skin resulting from excessive amounts of deoxygenated hemoglobin in the blood), stertorous respirations, and wheezing or stridor (harsh, high-pitched sollllds during respiration, caused by obstruction).
A)UPPER AIRWAY OBSTRUCTION
B)false
A
As hypoxia progresses, the respiratory centers in the brain (medulla oblongata and pons) are depressed, resulting in bradycardia and shallow, slow respirations.
A)UPPER AIRWAY OBSTRUCTION
B)false
A
The most immediate nursing intervention is opening the airway and restoring patency. This may be accomplished by properly repositioning the patient’s head and neck, or it may require further maneuvers.
A)UPPER AIRWAY OBSTRUCTION
B)false
A
The head-tilt/ chin-Lift tedmique recommended by the American Heart Association minimizes further damage in the presence of a suspected cervical neck fracture. With a foreign body. airway obstruction, the Heimlich maneuver is used.
A)UPPER AIRWAY OBSTRUCTION
B)false
A
Nursing diagnoses and interventions for the patient with an airway obstruction include but are not limited to the following:
,
Ineffective airway clearance, related to obstruction in airway. A nursing intervention would be. Select the all that apply
A) Reestablish and maintain secure airway.
B)Administer oxygen as ordered.
C)Suction as needed and assess patient’s ability to mobilize secretions.
D)Monitor vital signs and breath sounds closely.
A B C D
Risk for aspiration, related to partial airway obstruction. Nursing intervention would be.
A)Monitor respiratory rate, rhythm, and effort.
B)Assess patient’s ability to swallow secretions by elevating the head of the bed.
C)Assess and document breath sounds
D)Facilitate optimal airway and functional swallowing by elevating head of bed.
E)Note amount, color, and characteristics of secretions
F)Suction as needed.
A B C D E F
CANCER OF THE LARYNX
,
The incidence appears to be correlated to prolonged tobacco use (cigarettes, pipes, cigars, chewing tobacco, smokeless tobacco) and heavy alcohol use, chronic laryngitis, vocal abuse, and family history.
A)CANCER OF THE LARYNX
B)false
A
Because of the increase in the number of women who are heavy smokers, their incidence of carcinoma of the larynx is increasing
A)true
B)false
A
Progressive or persistent hoarseness is an early sign. Any person who is hoarse longer than 2 weeks should seek medical treatment.
A)CANCER OF THE LARYNX
B)false
A
Signs of metastasis to other areas include pain in the larynx radiating to the ear, difficulty swallowing (dysphagia), a feeling of a lump in the throat, and enlarged cervical lymph nodes.
A)CANCER OF THE LARYNX
B)false
A
Complaints of referred pain to the ear (otalgia) and difficulty breathing (dyspnea) or swallowing should be noted.
A)CANCER OF THE LARYNX
B)false
A
objective data includes examining sputum for blood (hemoptysis, or blood expectorated from the respiratory tract)
A)CANCER OF THE LARYNX
B)false
A
Visual examination of the larynx with direct laryngoscopy, with a fiberoptic scope, is done to determine the presence of laryngeal cancer.
A)true
B)false
A
partial laryngectomy is done to remove the diseased vocal cord and possibly a portion of thyroid cartilage. This requires placement of a temporary tracheostomy, which is closed when the edema has decreased.
A)true
B)false
A
Because the patient can no longer breathe through the nose, the sense of smell is lost.
A)true
B)false
A
The voice is also absent once the larynx is removed.
A)true
B)false
A
Because of neck and facial disfigurement and loss of voice, a thorough psychosocial assessment and resultant interventions are beneficial
A)true
B)false
A
Encourage communication through writing and facial and hand gestures.
A)CANCER OF THE LARYNX
B)false
A
Many cities have a Lost Chord Club or a New Voice Club, whose members are willing to visit hospitalized patients.
A)CANCER OF THE LARYNX
B)false
A
A speech therapist should meet with the patient after a total laryngectomy to discuss voice restoration options, including a voice prosthesis, esophageal speech, and an electrolarynx.
A)true
B)false
A
Nursing diagnoses and interventions for the patient with a tracheostomy include but are not limited to the following:
,
Ineffective airway clearance, related to secretions or obstruction. A nursing interventions be.
A)Provide tracheostomy care according to protocol; ensure the availability of emergency equipment (oxygen and tracheostomy tray). B)Offer small, frequent feedings, and give liquid or pureed food as tolerated to avoid choking.
C)Suction secretions as needed.
D)Teach patient stoma protection.
E)Assess respiratory rate and characteristics every 1 to 2 hours.
F)Auscultate lung sounds, monitor Sao2 every 4 hours
G)Elevate head of bed 30 degrees or higher.
H)Turn patient and encourage coughing and deep breathing every 2 to 4 hours.
I)Auscultate lung sounds.
J)Provide constant humidity.
K)Suction tracheostomy tube as needed, using aseptic technique; instruct patient to inhale as catheter is advanced.
L)Clean inner cannula of tracheostomy tube every 2 to 4 hours and as needed, using a solution of normal saline and hydrogen peroxide.
M)Suction trachea as needed.
ALL THE ABOVE
Impaired communication, verbal, related to removal of larynx, nursing intervention would be.
A)Provide patient with implements for communication, including pencil, paper, Magic slate; picture books, or electronic voice device. B)Keep call signal by patient’s hand at all times.
C)If possible, ask patient questions that require only a yes or no response to avoid fatigue and frustration.
D)Refer patient to local support groups and the local chapter of the American Cancer Society.
F)Assist with speech rehabilitation.
G)Review instructions about esophageal and electroesophageal speech.
H)Reinforce need for regular follow-up with speech pathologist and surgeon after discharge.
All the above
Explain techniques of airway maintenance, such as oxygen usage, deep breathing, and coughing.
A)true
B)false
A
ACUTE RHINITIS
,
Acute rhinitis (or acute coryza), known as the common cold, is an inflammatory condition of the mucous membranes of the nose and accessory sinuses. It is typically characterized by edema of the nasal mucous membrane. A)true B)false
A
Signs and symptoms usually are evident within 24 to 48 hours after exposure
A)acute rhinitis
B)false
A
Sinus congestion causes increased sinus drainage, leading to postnasal drip. The postnasal drip causes throat irritation, headache, and earache.
A)true
B)false
A
Most people with colds contaminate their hands when coughing or sneezing, thus contaminating everything they touch. Others become infected when touching the telephone, computer, or anything else that has been touched by the person with a cold.
A)true
B)false
A acute rhinitis
Subjective data include the patient’s complaints of sore throat, dyspnea, and congestion of varying duration.
A)acute rhinitis
B)false
A
Nursing interventions are aimed at promoting comfort. Such measures include encouraging fluids and applying warm, moist packs to sinuses.
A)acute rhinitis
B)false
A
Nursing diagnoses and interventions for the patient with acute rhinitis include but are not limited to the following:
,
Ineffective airway clearance, related to nasal exudates, a nursing intervention would be?select all that apply
A)Encourage fluids to liquefy secretions and aid in their expectoration.
B)Use vaporizer to moisten mucous membranes and prevent further irritation.
A B
Health-seeking behaviors: illness prevention, related to preventing exacerbation or spread of infection, a nursing intervention would be? Select all that apply.
A)Remind patient and family of health maintenance behaviors to decrease risk of illness, such as adequate fluid and nutritional management and sufficient rest.
B)Teach importance of hygiene measures to decrease spread of infection.
A B
Instruct the patient to limit exposure to others during the first 48 hours and to check the temperature every 4 hours.
A)acute rhinitis
B)false
A
ACUTE FOLLICULAR TONSILLITIS
,
Acute follicular tonsillitis can be an acute inflammation of the tonsils. It is the result of an airborne or foodborne bacterial infection, often streptococci.
A)true
B)false
A
It appears to be most common in school-age children. Signs and symptoms of tonsillitis include sore throat, fever, chills, and anorexia. The tonsils become enlarged and often contain purulent exudate.
A)Acute follicular tonsillitis
B)false
A
subjective data includes monitoring the severity of throat pain and the possibility of referred pain to the ears. Note headache or joint pain.
A)Acute follicular tonsillitis
B)false
A
Collection of objective data includes a visual examination that shows increased throat secretions and enlarged, erythematous tonsils
A)Acute follicular tonsillitis
B)false
A
Throat cultures identify the causative microorganism, most commonly 13-hemolytic streptococci.
A)Acute follicular tonsillitis
B)false
A
An elective tonsillectomy and adenoidectomy (T&A), where the tonsils and adenoids are surgically excised, is performed in people who have recurrent attacks of tonsillitis
A)true
B)false
A
Medications used in tonsillitis include analgesics and antipyretics (e.g., acetaminophen) and antibiotic .agents (e.g., penicillin). Warm saline gargles are also beneficial.
A)true
B)false
A
One of the primary nursing goals for acute tonsillitis is to provide meticulous oral care, which promotes comfort and assists in combating infection.
A)true
B)false
A
Postoperative care for tonsillectomy includes maintaining IV fluids until the nausea subsides, at which time the patient may begin drinking ice cold clear liquids.
A)true
B)false
A
The diet is advanced to custard and ice cream and then to a normal diet as soon as possible. Apply an ice collar to the neck for comfort and to reduce bleeding by vasoconstriction.
A)after tonsils are removed
B)false
A
Nursing diagnoses and interventions for the patient with acute follicular tonsillitis include but are not limited to the following:
,
Pain, related to inflammation and irritation of the pharynx, a nursing intervention would be? Select all that apply
A)Assess degree of pain and need for analgesics.
B)Document effectiveness of medication, and offer analgesic as ordered.
C)Maintain bed rest, and promote rest.
D)Offer warm saline gargles, ice chips, and ice collar as needed.
A B C D
Risk for deficient flujd volume, related to inability to maintain usual oral intake because of painful swallowing, a nursing intervention would be? Select all that apply
A)Assess hydration status by noting mucous membranes, skin turgor, and urinary output.
B)Encourage Popsicles, ice chjps, and increased oral intake; cold liquids, sherbet, and ice cream are best tolerated; carbonated drinks may be taken if patient tolerates; avoid offering citrus juices because they may burn the throat.
A B
Risk for aspiration, related to postoperative bleeding, a nursing intervention would be? Select all that apply.
A)Maintain patent airway; keep patient lying on side as much as possible to prevent aspiration.
B)Observe for vomiting of dark brown fluid; patient may have “swallowed” blood during surgery.
C)Watch for frequent swallowing, which may indicate bleeding; check frequently with flashlight to see if blood is trickling down posterior pharynx.
A B C
Tell the patient to avoid attempting to clear the throat immediately after surgery (may initiate bleeding) and to avoid coughing, sneezing, or vigorous nose blowing for 1 to 2 weeks
A)true after tonsils are removed
B)false
A
Most surgeons no longer prescribe aspirin for pain after tonsillectomy, since it increases the tendency to bleed; acetaminophen or another aspirin substitute is usually ordered
A)true
B)false
A
Analgesics are usually given orally in liquid form. Remind the patient to avoid overexertion, and make certain that the patient and the family know how to reach the physician in case of increased pain, fever, or bleeding.
A)true after tonsils are removed
B)false
A
LARYNGITIS
,
Laryngeal inflammation is a common disorder that can be either chronic or acute. Acute laryngitis may cause severe respiratory distress in children younger than 5 years of age because the relatively small larynx is subject to spasm when irritated or infected and readily becomes partially or totally obstructed
A)LARYNGITIS
B)rhinitis
A
Acute laryngitis often accompanies viral or bacterial infections. Other causes include excessive use of the voice or inhalation of irritating fumes.
A)true
B)false
A
Chronic laryngitis is usually associated with inflammation of laryngeal mucosa or edematous vocal cords.
A)true
B)false
A
Subjective data include the patient reporting progressive hoarseness and a cough that may be productive or may be dry and nonproductive. Attempt to identify any precipitating factors such as excessive voice use or exposure to inhaled irritants
A)laryngitis
B)rhinitis
A
Collection of objective data includes evaluating the patient’s voice quality and the characteristics (color, consistency, and amount) of sputum produced.
A)laryngitis
B)rhinitis
A
Laryngoscopy reveals abnormalities (edema, drainage) of vocal cords and erythematous laryngeal mucosa.
A)true
B)false
A
General interventions include use of warm or cool mist inhalation via vaporizer. Encourage the patient to rest the voice by limiting verbal communication.
A)laryngitis
B)rhinitis
A
Nursing diagnoses and interventions for the patient with laryngitis include but are not limited to the following:
,
Pain, related to pharyngeal irritation, a nursing intervention would be?select all that apply
A)Assess level of pain, and offer medications to promote comfort.
B)Use steam inhalation as ordered.
C)Instruct patient on the importance of resting the voice.
A B C
Impaired communication, verbal, related to edematous vocal cord, a nursing intervention would be? Select all that apply
A)Instruct patient on the importance of resting the voice.
B)Provide other means for communication (written word, gestures).
C)Anticipate patient’s needs whenever possible.
A B C
PHARYNGITIS
,
Pharyngitis is usually viral but can be caused by 13-hemolytic streptococci, staphylococci, or other bacteria. There is increased evidence of gonococcal pharyngitis caused by the gram-negative diplococcus Neisseria gonorrhoeae.
A)true
B)false
A
A severe form of acute pharyngitis often is referred to as strep throat because the streptococcus organism is commonly the cause. This . disorder is contagious for 2 or 3 days after the onset of signs and symptoms.
A)true
B)false
A
Pharyngitis manifests itself clinically by a dry cough, tender tonsils, and enlarged cervical lymph glands.
A)true
B)false
A
Subjective data include any reported pharyngeal discomfort, fever, or difficulty swallowing.
A)Pharyngitis
B)rhinitis
A
Collection of objective data includes palpating for enlarged, edematous glands and associated tenderness and noting elevated temperature.
A)Pharyngitis
B)rhinitis
A
Two throat swabs are obtained so a culture can be performed if the rapid strep screen test is negative
A)pharyngitis
B)rhinitis
A
Commonly ordered medications include antibiotics, such as penicillin or erythromycin, to (1) treat severe infections; or (2) prevent superimposed infections, particularly in people who have a history of rheumatic fever or bacterial endocarditis.
A)pharyngitis
B)rhinitis
A
Nursing diagnoses and interventions for the patient with pharyngitis include but are not Limited to the following:
,
Impaired oral mucous membrane, related to edema, a nursing intervention would be?select all that apply
A)Provide warm saline gargles to promote comfort.
B)Assess level of pain and provide meclications as ordered.
C)Encourage oral intake of fluids.
D)Offer frequent oral care.
A B C F
Deficient fluid volume, risk for, related to decreased oral intake as a result of painful swallowing, a nursing intervention would be?select all that apply
A)Observe and record patient’s hydration status.
B)Monitor 1&0 and patient’s temperature.
C)Maintain IV therapy if indicated.
A B C
SINUSITIS
,
Sinusitis can be chronic or acute, involving any sinus area, such as maxillary or frontal. This infection can be either viral or bacterial in origin and often is a complication of pneumonia or nasal polyps. The underlying pathophysiology begins with an upper respiratory tract infection that leads to a sinus infection.
A)SINUSITIS
B) pharyngitis
A
The patient with sinusitis often complains of a constant, severe headache with pain and tenderness in the particular sinus region, and often has purulent exudate.
A)true
B)false
A
Subjective data include patient reporting decreased appetite or nausea. The patient may also complain of generalized malaise, headache, diminished sense of smell, and pain in the sinus region when bending forward
A)sinusitis
B)rhinitis
A
Purulent nasal secretions, elevated temperature, facial congestion, and eyelid edema are often noted
A)objective data for sinusitis
B)false
A
Sinus radiographic studies are frequently done to depict cloudy or fluid-filled sinus cavities.
A)sinusitis
B)false
A
A common surgical procedure to relieve chronic maxillary sinusitis, the Caldwell-Luc operation, is a radical antrum operation involving the creation of an incision under the lip to remove diseased mucosal and bone tissue.
A)true
B)false
A
Steam inhalation and warm, moist packs facilitate drainage and promote comfort
A)sinusitis
B)false
A
