Respiratory Disorders and testing

Question 1

Clubbing

Answer 1

Rounding enlargement of end of finger caused by chronic hypoxia.

Question 2

Orthopneic position

Answer 2

Leans forward with arms supported, indicates resp distress.

Question 3

Barrel chest

Answer 3

Over expansion of chest.

Usually seen in emphysema

Question 4

Hemoglobin value

Answer 4

Measures amt of hemoglobin available to carry oxygen.

Males: 13.5-17.5 g/dL

Females: 11.5-15.5 g/dL

Question 5

Hematocrit value

Answer 5

Measures proportion of rbcs to plasma

Males: 40-52%

Females: 36-48%

Question 6

RBC values

Answer 6

4-5 million/ mm

Question 7

WBC value

Answer 7

Too high may indicate infection.
Too low, immunosuppression.

Normal 5,000- 10,000

Question 8

Platelet count

Answer 8

Indicates ability to stop bleeding.

Normal 150,000- 400,000/ mcl

Question 9

Arterial blood gas norms:
pH:
PaCO2:
PaO2
HCO3

Answer 9

PH: 7.34-7.45

PaCO2: 35-45 mm hg

PaO2: 80-100 mm hg

HCO3: 22-26 mEq/L

Question 10

Acid fast smear

Answer 10

Sputum test for TB

Collected 3 consecutive mornings

Question 11

Theophylline

Answer 11

Bronchodilator, relaxes bronchial smooth muscle
Contraindicated in peptic ulcers and status asthmaticus. Cautiously used with hypertension, cardiac, renal or hepatic disease

Requires theophylline levels: 5-15 mcg/mL
High levels could cause headache N/ V/D.
Very high levels: hypotension, arrhythmia, convulsions, circulatory failure.

Question 12

Alpha1- antitrypsin assay

Answer 12

Genetic marker for emphysema.

caused by inheriting a deficiency in the enzyme alpha1-antitrysin, which can lean to destruction of walls of alveoli.

Question 13

Thoracoscopy

Answer 13

Surgical procedure used to visualize pleural activity and other structures of thoracic cavity.
Diagnose etiology of pleural effusion or inflammation or to stage malignant tumors.

Question 14

Preop and postop nursing care for thoracoscopy.

Answer 14

Preop:
NPO 8 hrs prior
Consent form, review procedure with patient
Start IV

Postop:
Vitals, assess for resp distress.
Monitor chest tube drainage. 
Pain med if needed. 
Encourage Cough and deep breathing.

Question 15

Lung biopsy

Answer 15

Can be done transbrochially through bronchscope

Or through a percutaneous needle biopsy (needle inserted into pleura)

Question 16

Thoracentesis

Answer 16

Pleural fluid removed from pleural space by needle through chest wall.
Can also instill med into pleural space.
Patient positioned upright with elbows and head supported on bedside table.
Cxr done following procedure to rule out pneumothorax.

Question 17

Possible complications of thoracentesis.

Answer 17

Resp distress, tracheal deviation, hypotension, hemoptysis, coughing, tachycardia

Question 18

Bronchodilators

Answer 18

Theophylline- methylxanthine

Ipratropium (atrovent)- parasympatholytic

Albuterol-beta2 agonist

Metaproterenol- beta2 agonist

Used with caution in patients with heart disease or hyperthyroidism

Question 19

Drug interactions with theophylline

Answer 19

Rifampin, cimetidine, oral contraceptives, macrolide antibiotics (erythromycin), quinolone antibiotics (cipro) can all increase effects of theophylline and lead to toxicity.

Question 20

Ipratropium (atrovent)

Answer 20

Anticholinergic Bronchodilator
Used in tx of asthma and COPD.

Contraindicated in glaucoma, BPH, or bladder obstruction.

Administer atrovent 5 min prior to steroid inhaler.
Beta2agonist should be used before atrovent.

Question 21

Albuterol and other beta2 agonists

Answer 21

Dilate bronchi and increase resp rate and depth.

Side effects: tachycardia, hypertension, decreased renal and GI blood flow.

Question 22

Leukotriene modifiers

Answer 22

Decrease inflammation in asthma that is caused by allergic triggers.

Brochodilators

Montelukast (singulair)
Zafirlukast (accolate)
Zileuton( zyflo)

Question 23

Oxygen toxicity

Answer 23

Too high oxygen concentration over 48 hr
Leads to lung tissue damage, atelectasis, pulm edema.
S/sx: dyspnea, restlessness, lethargy, parenthesis, substernal chest discomfort

Question 24

Venturi mask

Answer 24

Most reliable oxygen delivery system.

Dial on Mask regulates precise concentration.

Question 25

Chest tube

Answer 25

Removes fluid, air, blood.
Promotes expansion of lung.

Re-establish normal negative lung pressure in pleural space.

Prevents development of tension pneumothorax.

Question 26

Stridor

Answer 26

A type of wheeze.
Loud musical high pitched.
Heard in tracheal or laryngeal obstruction. Croup

Question 27

Croup- 3 forms of croup

Answer 27

Acute laryngotracheobronchitis (most common)

Acute epiglottitis,

Acute laryngitis

Question 28

Acute laryngotracheobronchitis LTB

Symptoms:

Answer 28

Most common cause of croup
Children less than 5.
Usually starts with URI.
Low grade fever.
Barking cough with inspiratory stridor. 
Increased and labored respirations.
Substernal retractions.
Hypoxia
Can cause resp failure.

Question 29

Acute epiglottitis.

S/sx:

Answer 29

Sore throat then rapidly progresses to extreme resp distress.
Child will lean forward in Tripod Position with mouth open, chin thrust out and tongue protruding.
Drooling
Anxious, very restless
Cyanosis.
Substernal and suprasternal retractions.
Epiglottis will be edematous and red. Only examine throat if intubation equip is available if this is suspected.

Question 30

Acute laryngitis

Answer 30

Encourage fluids and use hunidifier

Question 31

Nursing interventions for croup

Answer 31

Encourage rest
Adequate fluid intake. 
IV fluid for more seriously ill.
Family should help alleviate anxiety.
Any position that promotes ease of breathing.

Question 32

Sleep apnea can cause increase risk of other health problems, such as:

Answer 32

Stroke
MI
Hypertension
Impotency
Weight gain

Symptoms: fatigue, headache, trouble concentrating, sore throat,

Question 33

Cancer of larynx

Answer 33

Most often occurs in Middle age men.
Risk factors: smoking, alcohol
Symptoms: hoarseness, pain, feeling of lump in throat, dyspnea
Diagnosed with laryngoscopy.