VN 36 TEST 3 respiratory

Question 1

1. Rifampin Kill, hurt, know (K,H,K) [pharm flashcard 61, pharm S.G 3)

Answer 1

(Treatment of TB)
 Body fluids may turn red/orange (tears, urine & sweat) - NORMAL
 Do not wear contacts, wear glasses
 Use non hormonal back up birth control
 AE: liver toxicity can develop into hepatitis (report signs of jaundice)
 No alcohol during therapy

Question 2

2. Chest tube nursing considerations (PP slide 29)

Answer 2

 Drain fluid, blood or air
 RE-establish a negative pressure
 Facilitate lung expansion
 Monitor VS
 Monitor Chest tube placement
 Provide rest periods
 Assess for abdominal distention
 Monitor drainage: 70ml/within 3hrs
 Assess for continual bubbling (is it on?)

Question 3

3. Post op sinus surgery nursing considerations (PP slide 4)

Answer 3

 Observe for repeated swallowing: hemorrhage
 Optic nerve function assessment
 Temperature every 4hrs, pain over involved sinus
 Administer analgesics as indicated: ice compresses
 Nasal packing & dressing under nares (“moustache” or drop pad”)

Question 4

4. Trach suctioning nursing considerations (PP slide 12)

Answer 4

 Risk for ineffective airway clearance : VS, breath sounds, assess skin color, LOC, mental status, airway patency
 Risk for infection: Monitor stoma, provide routine trach care, position
 Risk for ineffective management of therapeutic regimen

Question 5

5. ABGs

Answer 5

Acidosis Neutral Alkalosis
PH: 7.35-7.45
PCo2: 45-35
HCo3: 22-26
PaO2: 80- 100

Question 6

6. Emphysema client education(PG.266)

Answer 6

 Drink extra fluids as indicated, unless fluids are restricted.
 Eat a well-balanced diet.
 Success of treatment depends on strict adherence to the treatment regimen.
 Perform breathing exercises as prescribed.
 Avoid respiratory irritants and people with respiratory infections.
 Avoid dry-heated areas that can aggravate symptoms.
 Take medication exactly as prescribed. Observe the time intervals between medications.
 Take frequent rests during the day. Space activities to prevent fatigue and shortness of breath.
 Contact the primary provider if adverse drug effects occur, drugs fail to relieve symptoms, new symptoms appear, symptoms become more severe, or signs or symptoms of respiratory infection develop.
 Humidify inspired air during the winter months.
 Maintain close medical supervision.
 Do not skip doses or take more than what is prescribed.

Question 7

6. Emphysema manifestations & Nursing management (PP slide 21)

Answer 7

 Dyspnea especially- exertional dyspnea, breathlessness at rest
 Chronic productive cough, pursed-lip breathing
 Expiration difficult, carbon dioxide narcosis
 Use of accessory muscles; barrel – chested *
 Clubbing of the fingers
 Shallow respirations

Management:
 Monitor: O2 and PaCO2 levels, breathing exercises- pursed lip, nutrition

Question 8

7. Asthma manifestations (PP slide 24)

Answer 8

 SOB
 Expiratory wheezing
 Coughing
 Production of thick sputum
 Prolonged expiration

Question 9

8. Pleural effusion manifestations (PP slide 31, PG.257)

Answer 9

 Will hear decreased breath sounds (caused by trauma)
 Fever
 Pain

Question 10

9. Thoracentesis nursing actions (PG.234 box 19-3)

Answer 10

 Explain procedure & educate client will still receive local anesthesia but will still experience pressure like pain when needle pierces & fluid is withdrawn
 Assist client to position (sitting w/arms & head on padded table or in side lying position on unaffected side
 Instruct client to not move during procedure including no coughing or deep breathing
 Provide comfort & maintain asepsis
 Monitor VS during procedure (including pulse oximetry)
 During removal of fluid monitor for respiratory distress, dyspnea, tachypnea or hypotension
 Apply small sterile pressure dressing to the side after the procedure.
 Position client on unaffected side, and instruct them to stay in this position for at least 1hr & to remain on bed rest for several hrs
 Check that chest X-ray is done after procedure
 Record amount, color & other characteristics of fluid removed
 Monitor signs:
-increased respiratory rate, asymmetry in respiratory movement
-syncope/vertigo
-chest tightness
-uncontrolled cough or blood tinged/frothy mucus cough or both
-tachycardia & hypoxemia

Question 11

10. COPD nursing interventions (PP slide 20)

Answer 11

 Vaccination against complicating illnesses (influenza & pneumonia)
 Bronchodilators
 Raising Head of bed
 Humidifiers in dry settings
 Can lead to right sided heart failure
 Increase water intake to thin secretions
 High protein diet
 Cough every 2hrs to clear secretions

Question 12

11. Nosebleed nursing interactions (PP slide 32)

Answer 12

 Tilt head forward
 Apply pressure & ice pack
 If unable to stop can insert tampon
 Cauterization if needed

Question 13

12. Salmeterol K,H,K

Answer 13

(Treatment of asthma/COPD)
 Not rescue med
 Never used alone
 Tachycardia
 Headaches
 Tremors
 Restlessness (don’t take at night)

Question 14

13. Pulmonary embolism manifestations and nursing actions (PP slide 27)

Answer 14

Manifestations:
 Immediate onset: pain
 Tachycardia & dyspnea
 Fever
 Cough
 Blood streaked sputum
 Cyanosis
 Irregular HR
 Wheezing
 FOID
Nursing Actions:
 Prevention of DVT to prevent PE
 PRIORITY always O2

Question 15

14. Cystic Fibrosis client education (PP slide 26)

Answer 15

 Engage in daily aerobic exercise

Question 16

15. Pyrazinamide K,H,K (Pg.262)

Answer 16

(First line of treatment for primary active pulmonary TB)
 Initial Phase: 2mos, continuing phase 4-7mos
 AE: N/V, epigastric distress, myalgia, rash, peripheral neuropathy
 Take on empty stomach
 Hepatotoxic at routine doses (monitor liver enzymes frequently)

Question 17

16. Pneumonia nursing interventions (PP slide 16)

Answer 17

 Respiratory assessment: Lung Sounds, pulse oximetry, ABG’S
 Cough & sputum assessments (position – semi fowlers, raise HOB)
 Pneumococcal vaccine

Question 18

17. Fractured ribs nursing interventions (PP slide 32)

Answer 18

 Airway management
 Emergency treatment
 Pain management
 Incentive spirometer
 Splinting devices like pillows w/deep breathing & coughing (want to maintain expansion so no devices that constrict)

Question 19

18. Trach care/cleaning (clinical skills book pg.861)

Answer 19

 Gather supplies & put on gloves
 Remove oxygen source if necessary
 Dip cotton tipped applicator or gauze sponge in cup or basin w/sterile saline & clean stoma under faceplate.
 Use each applicator or sponge only once, moving from stoma site outward
 Pat skin gently dry 4x4 gauze sponge
 Slide non cotton 4x4 dressing under the faceplate
 Change the trach collar
 Make sure to always hold faceplate when inserting the tabs of the collar
 Check the fit of the trach collar (should be able to fit one finger between the neck & collar), also make sure client can flex neck comfortably
 Reapply oxygen source if necessary
 Reassess the patients respiratory status (RR, respiration effort, oxygen sat & lung sounds)

Question 20

19. Isoniazid (INH) K,H,K

Answer 20

(Treatment of TB)
 AE: hepatoxicity (jaundice of the skin & eyes, dark urine, vomiting, fatigue)
 Peripheral neuropathy (numbness & tingling of the extremities)
 Contraindications: clients w/severe liver damage, hepatic & renal impairment
 Remember INH interferes w/absorption of B6, client may need to take supplements 25-50mg (neuropathy numbness, hepatoxicity)
 NO ALCOHOL

Question 21

20. Lung Cancer early manifestations (PP slide 31)

Answer 21

 Chronic cough
 Dyspnea
 Hemoptysis
 Shoulder or chest pain
 Intermittent temperature
 Reoccurring respiratory infections

Question 22

20. Lung Cancer late manifestations (PP slide 31)

Answer 22

 Bone pain
 Chest pain
 Dysphagia
 Blurred vision
 Weight loss
 Pleural effusion (will hear decreased breath sounds)

Question 23

21. Tracheostomy suctioning (Funds flashcard)

Answer 23

 Turn on suction to regular or ordered setting & verify tubing is attached & within arm’s reach
 Open suction catheter kit & don sterile gloves
 Moisten catheter by dipping the tip into sterile water
 Prepare non-dominant hand to control the suction by placing thumb near the suction hole but not over it yet!
 Insert catheter into trachea & thread gently down until you meet resistance, now pull back slightly
 Place thumb over suction hole for 10 secs max & wait 1-2 mins between (patient cant breath during these 10 secs)
 Slowly remove while suctioning, working inner to outer & twirling around the edges to remove mucous buildup
 Administer oxygen to patient to reoxygenate
 Dip tip of catheter into sterile water & apply thumb over suction hole to wash out the catheter of mucous
 Repeat suction of trach until mucous is cleared, dispose catheter
 Monitor oxygenation status (if this was helpful oxygenation should improve)