Respiratory Tract Disorders

Question 1

Atelectasis

Answer 1

-sx: insidious, increasing dyspnea, cough, sputum production
-acute: tachycardia, tachypnea, pleural pain, central cyanosis
-chronic: similar to acute, pulmonary infections

Question 2

assessment and diagnosis

Answer 2

-increase work of breathing or hypoxemia
-decreased breath sounds and crackles
-chest xray suggest atelectasis before sx show
-pulse ox show low hemoglobin with O2

Question 3

Nursing interventions of pneumonia

Answer 3

-frequent turning (supine to upright)
-early mobilization
-expand lungs and manage secretions
-incentive spirometer
-deep breathing
-respiratory treatments/inhaler

Question 4

Management of pneumonia

Answer 4

-first line: frequent turning, early ambulation, lung volume expansion, cough

-if not responding to first line: Peep, CPAP, bronchoscopy

-CPT (chest physiotherapy)

-thoracentesis to relive compression

-ICOUGH

Question 5

ICOUGH

Answer 5

-incentive spirometry
-cough and deep breathe
-oral care
-understanding edu
-get out of bed at least 3/day
-head of bed elevation

Question 6

Pneumonia risk factors

Answer 6

-cystic fibrosis
-HF
-penicillin resist: >65, alcoholism, beta lactam, immunosuppressive, comorbid, day care

-enteric gram negative bac: long term care, cardiopulmonary dx, comorbid, recent antibiotic

-psuedonomas aeruginosa: structural lung dx, corticosteroids, broad spectrum antibiotic, malnutrition

Question 7

Manifestations of pneumonia

Answer 7

-streptococcal: suddenly onset of chills, fever, pleuritic chest pain, tachypnea, respiratory distress

-viral, mycoplasma, legionella: relative bradycardia

-resp infect, HA, low grade fever, myalgia, rash, pharyngitis

-orthopnea, crackles, increased tactile fremitus, purple to sputum

Question 8

Bronchoscopy

Answer 8

-pre op: formed consent, conscious sedation/general, NPO, IV access, VS

-intra op: help position, VS

-post op: supplemental O2, monitor airway and gag, check with xray

Question 9

Thoracentesis

Answer 9

-risk for pneumothorax
-increase anxiety
-ultrasound to guide needle
-report s/s infection and pneumothorax

Question 10

Pneumonia prevention

Answer 10

-vaccination: all adults over 65 or over 19 with conditions that weaken the immune system (COPD, asthma, DM, CF, HIV, AIDS, RA

-TCDB, reposition, oral hygiene, HOB elevated, s/s, decrease smoking and alcohol, monitor RR, early ambulation, nutrition

Question 11

Medicinal management of pneumonia

Answer 11

-admin of appropriate antibiotic as determined by results of C&S

-supportive treatment: fluids, oxygen for hypoxia, antipyretics, antitussives, decongestant, antihistamine

Question 12

S. Pneumonia complications

Answer 12

-shock
-pleural effusion
-superinfections
-pericarditis
-otitis media

Question 13

H influenzae complications

Answer 13

-lung access
-pleural effusion
-meningitis
-arthritis
-pericarditis
-epiglotitis

Question 14

Pneumonia interventions

Answer 14

-improved airway patency (TCDB, humidifier, incentive spirometry)

-increased activity

-maintenance of proper fluid volume (being hydrated and break secretions)
-maintain nutrition: multiple frequent small meals

-understand of treatment protocol and prevent

-absence of complications

Question 15

Covid 19

Answer 15

-Manifestations: fever, nonproductive cough, sore throat, fatigue, myalgia, nasal congestion, nausea, vomit, diarrhea, anosmia, ageusia

-isolate until: 72hrs fever free w/o med, pt report improve, 5 days elapsed since first noted clinical manifestation

-hospital management: precautions, DVT, prophylaxis, isolation room, laboratory testing

Question 16

Aspirations manifestations and risks

Answer 16

-manifestations: tachycardia, dyspnea, central cyanosis, hypertension, hypotension, death

-risk factors: seizure, decrease LOC, stroke, cardiac arrest, brain injury, swallow disorder, flat body position

Question 17

Nursing interventions for aspiration

Answer 17

-keep HOB elevated >30
-avoid stimulation of gag with suctioning
-check for placement before tube feeding
-thickened fluids for swallowing problems
-swallow eval before initiating oral feeding for recently extubated

Question 18

Pulmonary tuberculosis manifestations and risks

Answer 18

-manifestations: low grade fever, cough, hemotysis, night sweats, fatigue, weight loss

-risks: immunocomp, sub abuse, w/o health care, immigration, overcrowded housing, HC worker

Question 19

Management of TB

Answer 19

-drug resist is primary concern
-patient compliance

Question 20

Interventions for TB

Answer 20

-monitor adverse effects
-report to HCP: fatigue, N/V, numb and ting, fever, anorexia, depression, jaundice
-monitor therapeutic: decrease in sx, lack of response from therapy

Question 21

Pleurisy

Answer 21

-inflammation of both layers of pleurae
-key characteristic: pleuritic pain
-pleural friction can be heard
-chest xray, sputum analysis, thoracentesis
-treat underlying cause, provide analgesia, teaching to splint

Question 22

Pleural effusion

Answer 22

-fluid collection in space
-fever, crackles, pleuritic pain, dyspnea
-decreased or absent breath sounds; decreased fremitus; dull, flat sound on percussion
-support medial regimen and provide education

Question 23

Empyema

Answer 23

-accumulation of thick, purulent fluid in pleural space
-s/s similar to acute resp infect or pneumonia
-decreased or absent breath sounds
-drain and admin antibiotic for 4-6 wk
-psychosocial support and lung expanding breathing exercise

Question 24

Acute respiratory failure s/s and manifestations

Answer 24

-early: restlessness, tachycardia, hypertension, fatigue, HA

-later: confusion, lethargy, central cyanosis, diaphoresis, resp arrest

-manifestation: use of accessory muscles, decreased breath sounds

Question 25

Management of ARF

Answer 25

-intubation, mechanical ventilation
-nutritional support, eternal feedings
-reduce anxiety
-provide communication
-prevent complications (turning, ROM, mouth care, skin care)

Question 26

Endotracheal intubation

Answer 26

-Auscultate for breath sounds for placement
-head of bed elevated 30-45
-intubation no longer than 14-21days (after tracheostomy)

Question 27

Tracheotomy

Answer 27

-Auscultate lung sounds, change collar, clean site
-humidity, suction, skin integrity, infection, hydration, sterile

Question 28

Management of tracheostomy

Answer 28

-maintain patency by suction
-semi Fowler
-admin analgesic and sedative
-provide way to communicate
-edu about daily care and prevent emergency