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Deviated Septum

answer

-A deflection of the normally straight nasal septum. -Although up to 80% of the adult population may have septum that are slightly off center, the diagnosis of deviated septum is generally reserved for those that are severely shifted.

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Nasal Fracture

answer

-Most common facial fracture and the third most common fracture of any bone. -Occurs as a result of blunt trauma, such as occurs with fights, automobile accidents, falls, and sports injuries.

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Rhinoplasty

answer

The surgical reconstruction of the nose, is performed for cosmetic reasons or to improve airway function when trauma or developmental deformities result in nasal obstruction.

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Epistaxis

answer

-Nosebleed -Occurs in a bimodal distribution, with children 2 to 10 years of age and adults over age 50 most affected -Can be caused by low humidity, allergies, upper respiratory tract infections, sinusitis, trauma, foreign bodies, hypertension, chemical irritants such as street drugs, oversees of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, and tumors.

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Tracheostomy

answer

-A surgically created stoma (opening) in the trachea to establish an airway -Used to bypass an upper airway obstruction, facilitate removal of secretions, or permit long-term mechanical ventilation

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Compliance

answer

-Distensibility -A measure of the ease of expansion of the lungs -This is a product of the elasticity of the lungs and the elastic recoil of the chest wall -When compliance is decreased, the lungs are more difficult to inflate -Compliance is increased when there is destruction of alveolar walls and loss of tissue elasticity, as in COPD

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Dyspnea

answer

-Shortness of breath -Neck and shoulder muscles can assist the effort when this occurs

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Elastic Recoil

answer

-The tendency for the lungs to relax after being stretched or expanded

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Fremitus

answer

-The vibration of the chest wall produced by vocalization -Tactile fremitus can be felt by placing the palmar surface of the hands with hyperextended fingers against the patient's chest

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Rhonchi

answer

Coarse rattling respiratory sounds, usually caused by secretions in bronchial airways.

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Tidal Volume (Vt)

answer

Volume of air inhaled and exhaled with each breath. Only a small proportion of total capacity of lungs. *Normal Values: 500mL (in a 150lb man)

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Surfactant

answer

-A lipoprotein that lowers the surface tension in the alveoli -It reduces the amount of pressure needed to inflate the alveoli and makes them less likely to collapse

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Alveoli

answer

-Small sacs that are the primary site of gas exchange in the lungs -Interconnected by pores of Kohn, which allow movement of air from alveolus to alveolus

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Cor Pulmonale

answer

-Hypertrophy of the right side of the heart with or without heart failure, resulting from pulmonary hypertension -Evidenced by edema in the ankles -A late manifestation of COPD, yet not all patients with COPD develop this

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Thoracentesis

answer

The insertion of a large-bore needle through the chest wall into the pleural space to obtain specimens for diagnostic evaluation, remove pleural fluid, or instill medication into the pleural space.

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Atelectasis

answer

-Refers to collapsed, airless alveoli

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Pulmonary Circulation

answer

-Provides the lungs with blood that participates in gas exchange -The pulmonary artery receives deoxygenated blood from the right ventricle of the heart and delivers it to pulmonary capillaries that are directly connected with alveoli -Oxygen-carbon dioxide exchange occurs at this point

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Bronchial Circulation

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-Starts with the bronchial arteries, which arise from the thoracic aorta -Provides oxygen to the bronchi and other pulmonary tissues -Deoxygenated blood returns from the bronchial circulation through the azygos vein into the superior vena cava.

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Intrapleural Space

answer

-Space between the pleural layers that normally contains 20 to 25 mL of fluid -It provides lubrication, allowing the pleural layers to slide over each other during breathing -It increases cohesion between the pleural layers, thereby facilitating expansion of the pleurae and lungs during inspiration

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Pleural Effusion

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-An abnormal accumulation of fluid in the intrapleural space of the lungs -Fluid may accumulate because of blockage of lymphatic drainage or because of an imbalance between intravascular and oncotic fluid pressures, as in heart failure

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Pulmonary Edema

answer

Lung alveoli become filled with serous or serosanguinous fluid caused most commonly by heart failure

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Pneumothorax

answer

Collection of air in the pleural space causing the lung to collapse

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Diaphragm

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-Major muscle of inspiration -During inspiration the diaphragm contracts, increasing intrathoracic volume, and pushing the abdominal contents downward -At the same time the external intercostal muscles and scalene muscles contract, increasing the lateral and AP dimension of the chest

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Ventilation

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-Involves inspiration or inhalation, and expiration, or exhalation -Air moves in and out of the lungs because intrathoracic pressure changes in relation to pressure at the airway opening

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Empyema

answer

-Purulent exudate in a body cavity, especially in the pleural space -It results from a bacterial infection such as TB

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Flail Chest

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Instability of the chest wall, secondary to multiple rib fractures.

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Tension Pneumothorax

answer

Rapid accumulation of air in the pleural space causing high intrapleural pressures with tension on the heart and great vessels.

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Pulmonary Emboli

answer

Thromboembolic occlusion of a pulmonary blood vessel.

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Pulmonary Hypertension

answer

Increased pulmonary pressure resulting from increased pulmonary vascular resistance to blood flow through small arteries and arterioles.

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Thoracotomy

answer

Surgical opening into the thoracic cavity.

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Tuberculosis

answer

-An infectious disease caused by Mycobacterium tuberculosis -Usually involves the lungs, but any organ can be infected -Leading cause of mortality among persons with HIV -Not highly infectious, and transmission usually requires close, frequent, or prolonged exposure

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M. Tuberculosis

answer

-A gram-positive, acid-fast bacillus that is usually spread from person to person via airborne droplets produced by breathing, talking, singing, sneezing, and coughing

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Collaborative care for Pulmonary Tuberculosis:

answer

DIAGNOSTIC: -History and physical examination -Tuberculin skin test (TST) -QuantiFERON-TB test -Chest x-ray -Bacteriologic studies -Sputum smear for acid-fast bacilli (AFB) -Sputum culture COLLABORATIVE THERAPY: -Long-term treatment with antimicrobial drugs -Follow-up bacteriologic studies and chest x-rays

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Nursing Assessment of TB

answer

-Ask the patient about a previous history of TB, chronic illness, or any immunosuppressive medications -Obtain a social and occupational history to determine risk factors for transmission -Assess the patient for productive cough, night sweats, afternoon temperature elevation, weight loss, pleuritic chest pain, and abnormal lung sounds -If the patient has a productive cough, early morning is the ideal time to collect sputum

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A patient with TB has been admitted to the hospital and is placed in an airborne infection isolation room. What should the patient be taught:

answer

-Take all medications for full length of time to prevent multidrug-resistant TB -Wear a standard isolation mask if leaving the airborne infection isolation room -Maintain precautions in airborne infection isolation room by coughing into a paper tissue

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Directly Observed Therapy (DOT)

answer

-Involves providing the antituberculous drugs directly to patients and watching as they swallow the medications -It is the preferred strategy for all patients with TB to ensure adherence and is recommended for all patients at risk for non adherence -Expensive but essential public health measure

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Drug Therapy: TB

answer

-Isoniazid (INH) -Rifampin -Pyrazinamide (PZA) -Ethambutol (Myambutol) -Rifabutin (Mycobutin) -Rifapentine (Priftin) -Streptomycin -Bedaquiline (Sirturo) -Aminoglycosides -Capreomycin (Capastat) -Kanamycin (Kantrex) -Amikacin (Amikin) -Fluoroquinolones -Levofloxacin (Levaquin) -Moxifloxacin (Avelox, Vigamox)

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Classification of TB:

answer

0-No TB exposure; not infected 1-TB exposure, no evidence of infection 2-Latent TB infection, no disease 3-TB clinically active 4-TB, but not clinically active 5-TB suspect

question

Induration

answer

Used to determine if a TB skin test is +/- and is the diameter of the area of skin that is raised.

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Chest examination findings in COPD:

answer

INSPECTION: Barrel chest, cyanosis, tripod position, use of accessory muscles PALPATION: Decreased movement PERCUSSION: Hyperresonant or dull if consolidation AUSCULTATION: Crackles, rhonchi, wheezes, distant breath sounds

question

Chest examination findings in Atelectasis:

answer

INSPECTION: No change unless involves entire segment, lobe PALPATION: If small, no change; If large decreased movement, decreased fremitus PERCUSSION: Dull over affected area AUSCULTATION: Crackles (may disappear with deep breaths); Absent sounds if large

question

Chest examination findings in Pulmonary Edema:

answer

INSPECTION: Tachypnea, labored respirations, cyanosis PALPATION: Decreased movement or normal movement PERCUSSION: Dull or normal depending on amount of fluid AUSCULTATION: Fine or coarse crackles at bases moving upward as condition worsens

question

Chest examination findings in Pleural Effusion:

answer

INSPECTION: Tachypnea, use of accessory muscles PALPATION: Increased movement, increased fremitus above effusion; Absent fremitus over effusion PERCUSSION: Dull AUSCULTATION: Diminished or absent over effusion, egophony over effusion

question

To promote the release of surfactant, the nurse encourages the patient to:

answer

Take deep breaths

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A patient with a respiratory condition asks "How does air get into my lungs?" The nurse bases her answer on her knowledge that air moves into the lungs because of:

answer

Decrease in intrathoracic pressure relative to pressure at the the airway

question

The nurse can best determine adequate arterial oxygenation of the blood by assessing:

answer

Arterial oxygen tension

question

When teaching a patient about the most important respiratory defense mechanism distal to the respiratory bronchioles, which topic would the nurse discuss?

answer

Alveolar macrophages

question

A student nurse asks the RN what can be measured by arterial blood gases (ABGs). The RN tells the student that the ABGs can measure:

answer

-Acid-base balance -Oxygenation status -Acidity of the blood -Bicarbonate (HCO3-) in arterial blood

question

To detect early signs or symptoms of inadequate oxygenation, the nurse would examine the patient for:

answer

Apprehension and restlessness

question

During the respiratory assessment of the older adult, the nurse would expect to find:

answer

-Increased residual volume -Increased anteroposterior (AP) chest diameter

question

When assessing activity-exercise patterns related to respiratory health, the nurse inquires about:

answer

Dyspnea during rest or exercise

question

When auscultating the chest of an older patient in respiratory distress, it is best to:

answer

Begin listening the lung bases

question

Which assessment finding of the respiratory system does the nurse interpret as abnormal?

answer

Bronchial breath sounds in the lower lung fields

question

The nurse is preparing the patient for a diagnostic procedure to remove pleural fluid for analysis. The nurse would prepare the patient for which test?

answer

Thoracentesis

question

When assessing a patient's sleep-rest pattern related to respiratory health, what should the nurse ask the patient about?

answer

-Have trouble falling asleep? -Awaken abruptly during the night? -Need to sleep with the head elevated?

question

What should the nurse inspect when assessing a patient with shortness of breath for evidence of long-standing hypoxemia?

answer

Fingernails and their base Rationale: Clubbing, a sign of long-standing hypoxemia, is evidenced by an increase in the angle between the base of the nail and the fingernail to 180 degrees or more, usually accompanied by an increase in the depth, bulk, and sponginess of the end of the finger.

question

The nurse is caring for a patient with chronic obstructive pulmonary disorder (COPD) and pneumonia who has an order for arterial blood gases to be drawn. What is the minimum length of time the nurse should plan to hold pressure on the puncture site?

answer

5 minutes

question

A patient with a recent history of a dry cough has had a chest x-ray that revealed the presence of nodules. In an effort to determine whether the nodules are malignant or benign, what is the primary care provider likely to order?

answer

Positron Emission Tomography (PET)

question

A patient with recurrent shortness of breath has just had a bronchoscopy. What is a priority nursing action immediately following the procedure?

answer

Monitor the patient for laryngeal edema

question

After assisting at the bedside with a thoracentesis, the nurse should continue to assess the patient for signs and symptoms of what?

answer

Pneumothorax Rationale: Because thoracentesis involves the introduction of a catheter into the pleural space, there is a risk of pneumothorax.

question

The patient had abdominal surgery yesterday. Today the lung sounds in the lower lobes have decreased. The nurse knows this could be due to what occurring?

answer

Atelectasis

question

The patient's arterial blood gas results show the PaO2 at 65 mmHg and the SaO2 at 80%. What early manifestations should the nurse expect to observe in this patient?

answer

Restlessness, tachypnea, tachycardia, and diaphoresis

question

When the patient is experiencing metabolic acidosis secondary to type 1 diabetes mellitus, what physiologic response should the nurse expect to assess in the patient?

answer

Rapid respiratory rate.

question

After swallowing, a 73-year-old patient is coughing and has a wet voice. What changes of aging could be contributing to this abnormality?

answer

Decreased respiratory defense mechanisms

question

The patient is hospitalized with pneumonia. Which diagnostic test should be used to measure the efficiency of gas transfer in the lung and tissue oxygenation?

answer

Arterial Blood Gases

question

The nurse, when auscultating the lower lungs of the patient, hears these breath sounds. How should the nurse document these sounds?

answer

Coarse crackles

question

The patient is calling the clinic with a cough. What assessment should be made first before the nurse advises the patient?

answer

Cough sound, sputum production, pattern.

question

During the assessment in the ED, the nurse is palpating the patient's chest. Which finding is a medical emergency?

answer

Trachea moved to the left

question

The patient with Parkinson's disease has a pulse oximetry reading of 72%, but he is not displaying any other signs of decreased oxygenation. What is most likely contributing to his low SpO2 level?

answer

Motion

question

In assessment of the patient with acute respiratory distress, what should the nurse expect to observe?

answer

-Tripod position -Accessory muscle use

question

Chronic Obstructive Pulmonary Disease (COPD)

answer

-A preventable and treatable disease characterized by persistent airflow limitation that is slowly progressive -Associated with an enhanced chronic inflammatory response of the airways and lungs to noxious particles or gases, primarily caused by cigarette smoking

question

Chronic Bronchitis

answer

-The presence of chronic productive cough for 3 months in each of 2 consecutive years in patient in whom other causes of chronic cough have been excluded

question

Emphysema

answer

-An abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis

question

?1-Antitrypsin (AAT) deficiency

answer

-An autosomal recessive disorder that may affect the lungs or liver -A genetic risk factor for COPD -AAT is a serum protein produced by the liver and normally found in the lungs -Main function of AAT is to protect normal lung tissue from attack by proteases during inflammation related to cigarette smoking and infections

question

COPD ; Aging

answer

-Normal aging results in loss of elastic recoil, stiffening of the chest wall, gas exchange alteration, and decrease in exercise tolerance -As people age, the lungs gradually lose their elastic recoil -Thoracic cage changes results from osteoporosis and calcification of the costal cartilages -Thoracic cage becomes stiff and rigid, and the ribs are less mobile -As one ages, the number of functional alveoli decreases as peripheral airways lose supporting tissues

question

COPD Pathophysiology

answer

-Characterized by chronic inflammation of the airways, lung parenchyma (respiratory bronchioles and alveoli), and pulmonary blood vessels -Pathogenesis of COPD is complex and involves many mechanisms -The defining feature is not fully reversible airflow limitation during forced exhalation; this is caused by loss of elastic recoil and airflow obstruction caused by mucus hyper secretion, mucosal edema, and bronchospasm -Various processes occur such as airflow limitation, air trapping, gas exchange abnormalities and mucus hypersecretion

question

Classification of COPD

answer

-Should be considered in any person with a chronic cough and dyspnea who has smoked cigarettes or been exposed to environmental or occupational pollutants. -Diagnosis is confirmed by spirometry -An FEV1/FVC ratio of less than 70% establishes the diagnosis of COPD, and the severity of obstruction (as indicated by FEV1) determines the stage of COPD. -The management of COPD is based on the patient's symptoms, classification, and exacerbation history.

question

Spirometry

answer

-Require to confirm the diagnosis in individuals suspected of having COPD -Confirms the presence of airflow obstruction and determines the severity of COPD

question

COPD Diagnostics

answer

-History and physical examination -Pulmonary function tests -Chest x-ray -Serum AAT levels -ABGs -Six-minute walk test -COPD Assessment Test (CAT) or modified Medical Research Council (mMRCH) Dyspnea Scale -BODE Index

question

Collaborative Therapy for COPD

answer

-Cessation of cigarette smoking -Treatment of exacerbations -Drug therapies -Airway clearance techniques -Breathing exercises and retraining -Hydration of 3L/day (if not contraindicated) -Patient and caregiver teaching -Influenza immunization yearly -Pneumovax immunization -Long-term O2 (if indicated) -Progressive plan of exercise, especially walking and upper body strengthening -Pulmonary rehabilitation program -Nutritional supplementation if low BMI -Surgery: Lung volume reduction or Lung transplantation

question

O2 Toxicity

answer

-May result from prolonged exposure to a high level of O2 -High concentrations of oxygen can result in a severe inflammatory response because of oxygen radicals and damage to alveolar-capillary membranes resulting in sever pulmonary edema, shunting of blood, and hypoxemia

question

Pursed-lip breathing (PLB)

answer

-Purpose is to prolong exhalation and thereby prevent bronchiolar collapse and air trapping -Patients should be taught to use "just enough" positive pressure with the pursed lips because excessive resistance may increase the work of breathing

question

Diaphragmatic (Abdominal) Breathing

answer

-Focuses on using the diaphragm instead of the accessory muscles of the chest to (1) achieve maximum inhalation and (2) slow the respiratory rate -However, the use of diaphragmatic breathing in patients with COPD may increase the work of breathing and dyspnea

question

COPD Patient Planning

answer

-Prevention of disease progression -Ability to perform ADLs and improved exercise tolerance -Relief from symptoms -No complications related to COPD -Knowledge and ability to implement a long-term treatment regimen -Overall improved quality of life

question

COPD Medications

answer

-Methylxanthines -B2-Adrenergic Agonists -Corticosteroids -Anticholinergic

question

A plan of care for the patient with COPD could include:

answer

-Exercise such as walking -Breathing exercises such as pursed-lip breathing that focus on exhalation

question

The effects of cigarette smoking on the respiratory system include:

answer

Hyperplasia of goblet cells and increased production of mucus

question

A patient with an acute exacerbation of COPD needs to receive precise amounts of oxygen. Which equipment should the nurse prepare to use?

answer

Venturi Mask Rationale: The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern.

question

The nurse is evaluating if a patient understands how to safely determine whether a metered dose inhaler (MDI) is empty. The nurse interprets that the patient understands this important information to prevent medication underdosing when the patient describes which method to check the inhaler?

answer

Keep track of the number of inhalations used.

question

When planning teaching for the patient with COPD, the nurse understands that what causes the manifestations of the disease?

answer

Hyperinflation of alveoli and destruction of alveolar walls.

question

A male patient with COPD becomes dyspneic at rest. His baseline blood gas results are PaO2 70mmHg, PaCO2 52mmHg, and pH 7.34. What updated patient assessment requires the nurse's priority intervention?

answer

Arterial pH 7.26 Rationale: The patient's pH shows acidosis that supports an exacerbation of COPD along with the worsening dyspnea.

question

The nurse evaluates that nursing interventions to promote airway clearance in a patient admitted with COPD are successful based on which finding?

answer

Effective and productive coughing

question

When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care for this patient?

answer

Order a high-calorie, high-protein diet with six small meals a day

question

The nurse teaches pursed lip breathing to a patient who is newly diagnosed with chronic obstructive pulmonary disease (COPD). The nurse reinforces that this technique will assist respiration by which mechanism?

answer

Preventing bronchial collapse and air trapping in the lungs during exhalation.

question

Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)?

answer

Fluid volume excess resulting from for pulmonale

question

A patient has been receiving oxygen per nasal cannula while hospitalized for COPD. The patient asks the nurse whether oxygen use will be needed at home. What is the most appropriate response by the nurse?

answer

"You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia."

question

Before discharge, the nurse discusses activity levels with a 61-year-old patient with chronic obstructive pulmonary disease (COPD) and pneumonia. Which exercise goal is most appropriate once the patient is fully recovered from this episode of illness?

answer

Walk for 20 min/day, keeping the pulse rate less than 130 beats/min

question

The nurse evaluates that a patient is experiencing the expected beneficial effects of ipratropium (Atrovent) after noting which assessment finding?

answer

Increased peak flow reading

question

The nurse is teaching a patient how to self-administer ipratropium (Atrovent) via a metered dose inhaler (MDI). Which instruction given by the nurse is most appropriate to help the patient learn the proper inhalation technique?

answer

"Breathe out slowly before positioning the inhaler."

question

Which statement made by the patient with chronic obstructive pulmonary disease (COPD) indicates a need for further teaching regarding the use of an ipratropium inhaler?

answer

"If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily."

question

When teaching the patient with chronic obstructive pulmonary disease (COPD) about smoking cessation, what information should be included related to the effects of smoking on the lungs and the increased incidence of pulmonary infections?

answer

Decreased alveolar macrophage function.

question

Hemothorax

answer

Blood in the pleural space.

question

How to prepare a patient for a thoracentesis:

answer

-Explain procedure to patient and obtain signed informed consent before procedure, which is usually performed in the patient's room -Position patient upright with elbow on an over-bed table and feet supported -Instruct the patient not to talk or cough, and assist during procedure. -Observe for signs of hypoxia and pneumothorax, and verify breath sounds in all fields after procedure -Encourage deep breaths to expand lungs -Send labeled specimens to laboratory

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