question

Diaphragmatic excursion is decreased in:

answer

Emphysema, ascites, on the affected side in pleural effusion and in pneumothorax.

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A high level of dullness or a lack of excursion may indicate?

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Atelectasis or pleural effusion.

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Diaphragmatic excursion normally varies from

answer

about 3 to 5 cm

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The trachea should be midline however it shifts to the unaffected side in _________ and _________? And shifts to the affected side in___________?

answer

- pleural effusion and pneumothorax - atelectasis.

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Tactile fremitus is a vibratory sensation called, which occurs as sound waves from the larynx travel through patent bronchi and lungs to the chest wall. It is decreased in respiratory conditions such as?

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Atelectasis, emphysema, asthma, pleural effusion and pneumothorax. It is increased in pneumonia if the bronchus is patent.

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Normal respiratory rate:

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12-20 breaths per min

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Retraction of intercostal spaces may be seen in?

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Asthma

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Bulging of intercostal spaces may be seen in?

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Pneumothorax

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Thoracic expansion is decreased on the affected side in?

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Atelectasis, pneumonia, pneumothorax and pleural effusion.

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Bilateral chest expansion is decreased in?

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Emphysema

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When percussing the lungs dullness is heard in people with?

answer

Atelectasis, lobar pneumonia and pleural effusion.

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Hyper-resonance is heard in those with?

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Chronic asthma, emphysema and pneumothorax.

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The normal percussion tone over normal lung tissue is?

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Resonance.

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The three different types of normal breath sounds are?

answer

vesicular, bronchovesicular and bronchial

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Bronchial breath sounds: expiration > inspiration Bronchovesicular: inspiration = expiration Can be heard when?

answer

Over lungs filled with fluid or solid tissue.

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Breath sounds are decreased or diminished over?

answer

Atelectasis, emphysema, asthma, pleural effusion and pneumothorax.

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Breath sounds are increased over?

answer

Lobar pneumonia

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When are breath sounds absent?

answer

Over a collapsed lung, surgical removal of lung, pleural effusion and primary bronchus obstruction.

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Crackles: short, discrete, crackling or bubbling sounds, may be noted in?

answer

Pneumonia, bronchitis and congestive heart failure.

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Wheezes: continuous, musical sounds, may be heard in people with?

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bronchitis, emphysema and asthma.

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A friction rub is a loud, dry, creaking sound that indicates?

answer

Pleural inflammation.

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Voice sounds are decreased or absent over areas of?

answer

Atelectasis, asthma, pleural effusion and pneumothorax.

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Voice sounds are increased and clearer over?

answer

lobar pneumonia.

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When testing egophony, the sound becomes louder and changes to 'a' over areas of?

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Consolidation or compression.

question

Crackles

answer

Short, discrete, crackling or bubbling sounds.

question

Wheezes

answer

Continuous, musical sounds.

question

A friction rub

answer

A loud, dry, creaking sound.

question

Vesicular breath sounds

answer

- Soft, low-pitched, gentle sounds - Heard over all areas of the lungs except the major bronchi - Have a 3:1 ratio for inspiration and expiration, respectively

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Bronchovesicular breath sounds

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- Medium pitch and intensity of sounds - Have a 1:1 ratio, with inspiration and expiration being equal in duration - Heard anteriorly over the primary bronchus on each side of the sternum and posteriorly between the scapulae

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Bronchial breath sounds

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- Loud, high-pitched sounds - Gap between inspiration and expiration - Have a 2:3 ratio for inspiration and expiration, respectively - Heard over the manubrium

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"You are teaching a person about a thoracentesis. How would you best describe this procedure? 1. 'You will be asleep when they make the incision.' 2. 'Fluid will be drawn off the area around your lung.' 3. 'It involves lying very still in a large, noisy machine.' 4. 'The doctor will be able to see inside your lung.

answer

2. 'Fluid will be drawn off the area around your lung.' Performed to obtain a specimen of pleural fluid for diagnosis (and used as a procedure to remove pleural fluid or instill medication). A large-bore needle is inserted through the chest wall and into the pleural space. Following the procedure, a chest x-ray is taken to check for a pneumothorax.

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"Which of the following questions should be included when conducting a health history to identify a genetic risk of respiratory disease? 1. 'Tell me how many colds you have each year.' 2. 'Has anyone in your family had a stroke or heart attack?' 3. 'Has lung cancer ever been diagnosed in your family?' 4. 'Do your children have trouble breathing at night?'"

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3. 'Has lung cancer ever been diagnosed in your family?' "A familial history of lung cancer increases the risk of developing lung cancer and small-cell lung cancer has a definite genetic component. In addition, researchers have found that people with lung cancer who never smoked are more likely than smokers to have one of two genetic mutations linked to the disease." (LeMone 1205)

question

While auscultating the person's breath sounds, you note continuous musical sounds. You document these sounds as: 1. murmurs 2. wheezes 3. crackles 4. rales

answer

2. wheezes. "Wheezes (continuous, musical sounds) may be heard in people with bronchitis, emphy- sema and asthma." (LeMone 1211)

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What would you ask the person to do as you auscultate the lungs? 1. 'Hold your breath.' 2. 'Repeat the number 99 several times.' 3. 'Take slow deep breaths through your mouth.' 4. 'Breathe in and out through your nose.'

answer

3. 'Take slow deep breaths through your mouth.' "Auscultate the lungs for breath sounds with the diaphragm of the stethoscope by having the person take slow deep breaths through the mouth. Listen over anterior, posterior and lateral intercostal spaces " (LeMone 1211)

question

"While assessing the person with a left pneumothorax you note decreased diaphragmatic excursion on the left. What would you do next? 1. Notify the doctor immediately. 2. Document the assessment. 3. Repeat the assessment several times. 4. Tell the person to hold their breath."

answer

2. Document the assessment. Diaphragmatic excursion is decreased on the affected side in pleural effusion and in pneumothorax . (LeMone 1210) Therefore this would be "normal" and not necessary to report to the doctor immediately.

question

5 Early signs of Hypoxia:

answer

Tachypnoea Tachycardia PaO2: 50-60mmHg PaCO2: 50-60mmHg Confusion

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7 Late signs of Hypoxia:

answer

Bradypnoea Cyanosis Unresponsive to verbal command Bradycardia PaO2 60mmHg SpO2 <90%

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An appropriate nursing intervention for a patient with pneumonia with the nursing diagnosis of ineffective airway clearance related to thick secretions and fatigue would be to:

answer

Teach patient how to cough effectively to bring secretions to the mouth

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When teaching the use of a metered-dose inhaler, the nurse's instruction should be?

answer

rinse the mouth after using the inhaler to reduce systemic absorption of the drug

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A plan of care for a patient with COPD would include?

answer

Exercise, such as walking

question

List 3 key features or clinical manifestations of asthma:

answer

Dyspnoea Tachypnoea Wheezing Tight chested Shortness of breath Cough

question

You are caring for a patient requiring oxygen therapy. List 5 things you need to check regularly to ensure the amount of presribed oxygen is being administered correctly and there is no damage to the patient's skin from the delivery device.

answer

Flow and % being delivered Connections and tubing Wall outlet or cylinder Patient response and status Skin integrity of nose if using nasal prongs and mucous membranes if using mask

question

On the way down the hallway you walk with one of your patients that has COPD. You notice they are becoming increasingly breathless and the portable saturation monitor drops to 85%. After checking the monitor and the patient's colour to confirm the reading is correct, what change will you make to the patient's care plan?

answer

Minimise periods of exercise - Pace and space activities. Assist with ADL's

question

The most common causative organisms for community-acquired pneumonia are the respiratory viruses:

answer

Streptococcus pneumoniae (also called pneumococcus) and Mycoplasma pneumonia.

question

Often implicated as nosocomial causes of pneumonia:

answer

Staphylococcus aureus and gram-negative bacteria such as Pseudomonas aeruginosa, Klebsiella pneumo- niae and enteric bacilli, including Escherichia coli.

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Pneumonia may develop in four distinct patterns:

answer

lobar pneumonia, bronchopneumonia, interstitial pneumonia and miliary pneumonia

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Consolidation of a large portion of an entire lung lobe is known as:

answer

lobar pneumonia

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A local area of necrosis and pus formation within the lung itself is called:

answer

A lung abscess. The manifestations of lung abscess develop slowly and include weight loss, malaise, night sweats, fever and a productive cough. Sputum is foul smelling and tasting. Rupture of the abscess into a larger airway is evidenced by production of copious amounts of purulent sputum.

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An accumulation of purulent exudate in the pleural cavity is:

answer

Empyema

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Nasal prongs can deliver:

answer

24-45% oxygen concentrations with flow rates of 2 to 6 L/min

question

A simple face mask delivers:

answer

40-60% oxygen concentrations with flow rates of 5 to 8 L/min

question

non-rebreather mask can deliver:

answer

Up to 100% oxygen, the highest concentration possible without mechanical ventilation.

question

An arterial oxygen level (PaO2) of less than 50 to 60 mmHg and an arterial carbon dioxide level (PaCO2) of greater than 50 mmHg are generally accepted as indicators of:

answer

Respiratory failure. May however be normal values in someone with COPD.

question

What is the most common cause of respiratory failure?

answer

COPD

Nursing care of people with altered respiratory function – Flashcards

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