21 Diagnostics pH 7.35 – 7.45 PO2 80 – 100 mm Hg PCO2 35 – 45 mm Hg HCO3 22 – 26 mm Hg
22 Hgb Within Normal Limits The client has a long history of COPD and is currently experiencing an exacerbation of COPD. The following lab work is done this morning: CBC, ABG’s and an electrolyte panel consisting of K+, Na+, Cl, CO2, BUN and FBS. Which lab data requires immediate follow up?Increased PaO2Increased RBC’sIncreased PaCO2Hgb Within Normal Limits
23 A is the answerHypoxemia provides the stimulus for the respiratory drive in clients with COPD. Increased oxygen levels may depress the respiratory drive.Option B and C are expected findingsOption D does not require immediate follow- up.
53 The nurse is preparing to assist with the insertion of a chest tube that will be attached to a closed-chest drainage system without suction. In monitoring the closed-chest drainage system, the nurse would expect to initially assess for:Fluctuation of water in the water-seal chamber during respirations.Constant fluid fluctuations in the drainage-collection chamber.Continuous bubbling in the suction-control chamber.Occasional bubbling in the suction-control chamber.
54 A is the answerFluctuations of water during inspiration and expiration in the water-seal chamber indicates normal functioning.Option B should not be seen in the collection chamber.Options C and D should not be seen because suction has not been applied to the suction-control chamber.
55 The client has a chest tube connected to a closed-chest drainage system attached to suction and is being prepared to transfer to another room on a stretcher. To safely transport the client, it is most important for the nurse to:Clamp the chest tube during the transport.Get a portable suction before transferring the client.Keep the closed-chest drainage system below the level of the chest.Place the closed-chest drainage system next to the client on the stretcher.
56 C is the answerKeeping the closed-chest drainage system below the level of the chest allows for continuous drainage and prevents any back flow pressure.Options A and D should not be done because they will increase pressure in the pleural space.Option B is not the most important.
58 The physician is preparing to remove the client’s chest tube The physician is preparing to remove the client’s chest tube. Just before removing the chest tube, the physician tells the client to take a deep breath and hold it. This intervention is done primarily to:Distract the client during the chest tube removal.Minimize the negative pressure within the pleural space.Decrease the degree of discomfort to the client.Increase the intrathoracic pressure temporarily during removal.
59 D is the answerThis is done to decrease the risk of atmospheric air entering the pleural space during removal.Options A and C are not the primary reasons for this intervention.Option B is not correct since negative pressure is desired within the lung.
60 Severe Acute Respiratory Syndrome (SARS) Viral illness with flu-like symptomsSpread by close personal contact or contact with infectious materialTreatment:Supportive care
61 Acute Respiratory Tract Disorders: Atelectasis Collapse of lung or portion of lungSigns of respiratory distress proportional to amount of lung tissue involvedTreatment:Respiratory therapy, postural drainage and percussion, suctioning, oxygen, bronchoscopy, thoracentesis, thoracotomy and chest tube drainage, and medications
63 Pulmonary EmbolismDevelops when substance (emboli, fat, or amniotic fluid) lodges in branch of pulmonary artery and obstructs flowSymptoms:Abrupt anxiety, restlessness, inspiratory chest pain, dyspnea, cough, and hemoptysis(continued)
64 Pulmonary EmbolismTreatment:Medications and embolectomy
65 Pulmonary Edema Life-threatening condition Symptoms: Rapid shift of fluid from plasma into alveoliSymptoms:Hemoptysis, dyspnea, orthopnea, cyanosis, anxiety, significant airway obstruction, and increased HR and respiratory rate (RR)(continued)
68 MAD DOG Pulmonary Edema Treatment: Oxygen, medications, and ventilationMAD DOG
69 Acute Respiratory Distress Syndrome (ARDS) Life-threatening conditionDyspnea, hypoxemia, and diffuse pulmonary edemaSymptoms:Severe dyspnea, tachypnea, cyanosis, crackles, wheezes, and hemoptysisTreatment is intensive, supportive, and includes many body systems
72 Acute Respiratory Failure Occurs as result of client literally becoming too tired to continue “work” of breathingMechanical ventilatory support required during acute phase
73 Chronic Respiratory Tract Disorders: Asthma Intermittent airway obstruction in response to variety of stimuliSymptoms:Sudden inspiratory and expiratory wheezing, increasing dyspnea, and chest tightnessTreatment:Taking medications and avoiding known allergens
76 Chronic BronchitisInflammation of bronchial tree with hypersecretion of mucusSymptoms:History of recurrent respiratory infections, dyspnea, cyanosis, productive cough, and adventitious breath sounds(continued)
90 Get an order to increase the oxygen. Place in semi-Fowler’s position. The nurse is caring for a client who was admitted with an exacerbation of COPD. The client’s respirations are 28 with dyspnea on exertion. The client is receiving 2L of oxygen per nasal cannula. The morning pulse oximetry is 92%. Which nursing intervention is of priority?Monitor the client.Notify the physician.Get an order to increase the oxygen.Place in semi-Fowler’s position.
91 A is the answerThe client is manifesting signs and symptoms consistent with COPD. Clients with COPD experience some degree of hypoxia.Options B and C are not appropriate at this time.Option D is not the best position for a client with COPD.
92 The client is admitted with an acute exacerbation of COPD The client is admitted with an acute exacerbation of COPD. Which assessment finding is most indicative of a potential complication?Respirations 32, increasingly anxious and restless.Using accessory muscles during respiration.Pulse oximetry 92%, pursed-lip breathing.Expectorating copious amounts of white phlegm.
93 A is the answerIncreasing anxiousness and restlessness are signs indicating hypoxemia.Options B, C and D are expected findings for a client with an exacerbation of COPD.
95 Prioritize the five nursing interventions as you would do them initially: A – Auscultate lung sounds.B – Assess pulse oximeter, O2 and NC.C – Retake the vital signs.D – Check theophylline level.E – Place in high-Fowler’s position.
96 Pneumothorax/Hemothorax Air in pleural spaceHemothoraxBlood in pleural spaceMay be traumatic, spontaneous, or tensionSymptoms determined by severity of injury and amount of lung tissue affected(continued)
98 Pneumothorax/Hemothorax For affected lung to re-expand, air and/or blood must be removed from pleural spaceThoracotomy tube inserted to drain fluid and airAllows lung to re-expandAnalgesics given for pain
100 Prioritize the five nursing interventions as you would do them initially: A – Check the pulse oximetry.B – Assess for fluctuation in the water-seal chamber and bubbling in the suction-control chamber.C – Check for the previous shift’s fluid level marking on the tape.D – Assess chest tube patency and drainage.E – Ask Mr. G to cough and deep breathe.
101 Lung Cancer May originate in lung or result from metastasis Symptoms develop lateMay include cough, dyspnea, hemoptysis, and painTreatment:Surgery, chemotherapy, and radiation
103 Laryngeal Cancer Relatively asymptomatic May include hoarseness, difficulty speaking, difficulty swallowing, and laryngeal painTreatment determined by extent of tumor growth:Surgery, chemotherapy, and radiation
104 Epistaxis Hemorrhage of nares or nostrils May stem from dry nasal mucosa, local irritation, trauma, or hypertensionTreat to maintain airway, stop bleeding, identify cause, and prevent recurrenceTreatment:Firm pressure on nares or nasal packing
105 Infants with Special Needs: Birth to 12 Months Chapter 60Infants with Special Needs: Birth to 12 Months105
106 Laryngotracheobronchitis Viral illness causing welling of upper airwaySymptoms:Stridor, “barking” cough, and hoarsenessTreat to maintain patent airway and improve respiratory effort(continued)
107 Laryngotracheobronchitis Treatment:Cool mist and medicationsE.g., bronchodilators, corticosteroids
108 PneumoniaInflammation of bronchioles and alveoli spaces often preceded by upper respiratory infection (URI)Symptoms:Abrupt onset of fever, flaring nostrils, circumoral cyanosis, chest retractions, cough, and increased pulse and respirations(continued)
109 PneumoniaTreatment:Oxygen, cool mist hydration, respiratory therapy, and medications
110 Respiratory Distress Syndrome (RDS) Most often found in pre-term infantsSymptoms:Tachypnea, retractions, grunting, crackles, pallor, cyanosis, hypothermia, edema, flaccid muscle tone, GI shutdown, jaundice, and acidosis(continued)
111 RDS First 96 hours critical to recovery Treatment: Surfactant and supportive care
112 Cystic Fibrosis Genetic dysfunction of exocrine glands Affects lungs, pancreas, liver, and reproductive organsSymptoms:Meconium ileus, intussusception, problems gaining and maintaining weight, pulmonary problems, and salty taste on skin(continued)
114 Cystic FibrosisTreat pulmonary problems and nutrition
115 Sudden Infant Death Syndrome (SIDS) Also known as crib deathSudden unexpected death of apparently healthy infantNo single cause identifiedProvide empathic support to familyInform family that autopsy must be done
116 Common Problems: 1–18 Years Chapter 61Common Problems: 1–18 Years
117 Respiratory System Upper-respiratory infections Allergic rhinitis TonsillitisAsthmaForeign-body aspiration