Med surg Respiratory exam 2

What is the risk of self treating persistent hoarseness at home?

Persistent hoarseness may indicate laryngeal cancer, delayed care can miss serious conditions.

What is the purpose of elevating the head in URI management?

Elevating the head promotes drainage and helps prevent aspiration.

What is the role of hemoglobin in oxygen transport?

About 97 percent of oxygen binds to hemoglobin as oxyhemoglobin for transport to tissues.

What is the normal range for PaCO2 in ABG's

The normal PaCO2 is 35-45 mmhg

When should a client with URI symptoms contact their provider?

If symptoms worsen, do not improve, or new symptoms like SOB develop.

What is the function of a humidifier in URI care

A humidifier adds moisture to air, preventing mucous membrane dryness and irritation.

What are common clinical manifestations of hypoxia?

Confusion, tachypnea, tachycardia, dyspnea, fatigue, cyanosis, changes in BP.

What is medicamentosa and how is it caused?

Medicamentosa is rebound congestion, it is caused by overuse of nasal or inhaled decongestants.

Why are abx not given for most URI's?

Most URI's are viral, abx are ineffective and can promote resistance if misused.

What is the effect of neuromuscular disorders on lung compliance?

They cause respiratory muscle weakness, decreasing compliance and increasing WOB.

How does age affect the respiratory system?

Older adults have decreased chest wall compliance, weaker muscles, and higher risk of infection.

What is the primary function of the upper airway?

The upper airway warms and fiters inspired air before it reaches the lower respiratory tract.

How does airway resistance impact ventilation?

Increased airway resistance (asthma, edema, obstruction) make ventilation more difficult.

What is the main purpose of handwashing in URI prevention?

Handwashing prevents transmission of viruses and other microbes.

How does decreased lung compliance affect WOB?

Decreased lung compliance increases the work of breathing making it harder to expand the lungs.

Which ABG value best measures oxygenation?

PaO2 (80-100mmhg) best measures oxygenation in arterial blood gasses.

What is the main teaching point for antibiotic use in bacterial infections?

Take the full prescribed course. Do not stop early or share with others to prevent resistance.

What is the primary nursing goal for a client with laryngitis?

Maintain airway, prevent aspiration, pain management, maintain hydration, enable communication.

Why is rest important in managing URI's?

Rest supports recovery and prevents spreading infection to others.

What is the main difference in hypoxia and hypoxia?

Hypoxia is low oxygen in the blood ; hypoxia is decreased oxygenation in the tissues and organs.

Why is hydration important in managing URI's?

Hydration thins secretions, making them easier to clear and keeps mucous membranes moist.

List two complications of URI's?

Airway obstruction, sepsis, OM, aspiration, brain abscess, pneumonia.

What is the purpose of thoracentesis and how is the patient positioned?

To remove pleural fluid or obtain specimens, the patient sits upright, leans forward with arms on table.

How does atelectasis affect gas exchange?

Collapsed alveoli impair ventilation and gas exchange, leading to hypoxia and possible hypoxemia.

What is empyema and its usual cause.

Empyema is thick, purulent fluid in the pleural space, usually from bacterial pneumonia or lung abscess.

Differentiate community acquired pneumonia, healthcare acquired and hospital acquired pneumonia.

Community: outside healthcare

Healthcare acquired: non hospital but healthcare contact

Hospital acquired: >48 hr after admission

When is a TB patient no longer considered contagious?

After three consecutive negative morning sputum cultures while on abx therapy.

Who is at increased risk of developing TB?

Healthcare workers, close contacts, immunocompromised, elderly, homeless, incarcerated, substance users, travelers to endemic areas, those who are HIV positive.

What is the next step after a positive PPD skin test?

Obtain CXR to assess for active disease.

Name five risk factors for pneumonia.

COPD, immunocompromised, elderly, aspiration risk, mechanical ventilation, immobility, smoking, diabetes, heart failure.

What are potential complications after thoracentesis?

Pneumothorax, infection, bleeding, severe pain, dyspnea, changes in VS.

What is the primary goal of treating established atelectasis?

Improve ventilation and assist with secretion mgmt, including turning and suctioning.

List non-pharmacological nursing interventions for pneumonia.

Positioning, deep breathing, secretion removal, supplemental O2, rest, hydration (2-3L/day), nutrition.

What are classic symptoms of active pulmonary TB?

Cough >3 weeks, hemoptysis, pleuritic pain, fever, NIGHT SWEATS, chills, anorexia, weight loss, fatigue.

What education should be given to TB pt's regarding contacts?

Close contacts should be tested for TB exposure , even if asymptomatic.

What are nursing interventions to prevent atelectasis post-op?

Smoking cessation, incentive spirometer, early ambulation, deep breathing, pain control.

What is the difference between latent and active pulmonary TB?

Latent: bacilli present but inactive, no sx's

Active: bacilli active, sx's present, contagious

What is ventilator associated pneumonia (VAP)?

Pneumonia developing >48hrs after intubation and mechanical ventilation.

What are key adverse effects of isoniazid, rifampin, and ethambutol?

Isoniazid: hepatotoxicity

Rifampin: red-orange body fluids

Ethambutol: ocular toxicity (vision changes)

What are classic clinical manifestations of pneumonia?

Fever, chills, pleuritic chest pain, productive cough, crackles/wheezes, dyspnea, low O2 sat, possible confusion in elderly.

How is TB exposure screened and what does a positive PPD mean?

PPD/mantoux skin test: positive means exposure, not necessarily active disease.

TB can also be tested through Quantiferon blood test.

What is atelectasis and its most common cause?

Atelectasis is the closure or collapse of alveoli, most commonly seen acutely after surgery.

Why is it important to obtain cultures before starting abx for pneumonia?

Cultures identify the causative agent: abx can alter results, affecting tx accuracy.

Describe the pathophysiology of pneumonia.

Inflammation (from infection or aspiration) causes edema and mucous in alveoli, impairing oxygenation and ventilation.

List key sx's of acute atelectasis.

Increasing dyspnea, cough, increased sputum, tachypnea, tachycardia, pleuritic pain, central cyanosis.

What are the nursing priorities for a patient with rib fractures?

Maintain airway, provide oxygenation, and control pain to prevent pulmonary complications.

What are the hallmark assessment findings in pneumothorax?

Diminished or absent breath sounds and asymmetrical chest wall movement on the affected side.

What is the purpose of a chest tube and closed drainage system?

To reestablish negative pressure, allow lung reexpansion, and drain air or fluid from pleural space.

How does a low pressure ventilator alarm indicate?

Low exhaled volume, often due to tubing disconnection, cuff leak, or tube displacement.

How can nurses prevent ventilator associated pneumonia?

Meticulous oral care every 2 hours, elevate HOB at least 30 degrees.

What are early clinical signs of acute respiratory failure?

Restlessness, headache, fatigue, SOB, tachycardia, elevated BP.

Name three risk factors for acute respiratory failure.

Chronic respiratory disorders (COPD), neuromuscular disorders (Guilin Barre) and hypovolemic shock.

What does continuous bubbling in the water seal chamber indicate?

An air leak in the chest tube system.

Why is prone positioning used in ARDS?

It redistributes blood flow, improves oxygenation, and minimizes V/Q mismatch.

What is ARDS and how does it differ from acute respiratory failure?

ARDS is a severe inflammatory syndrome causing diffuse alveolar damage and pulmonary edema: it is a cause, not a synonym, of acute respiratory failure.

What should you do if a chest tube becomes disconnected?

Insert the tube end into sterile water to establish a water seal until reconnected.

Why should you not milk or strip chest tube tubing?

It can change intrapleural pressure and cause harm: only clamp if disconnected.

What is the primary goal in managing acute respiratory failure?

Identify and treat the underlying cause while maintaining airway, breathing, and circulation (ABC's).

What is the recommended ET tube cuff pressure?

Maintain btwn 20 and 30 mmhg to prevent air leaks and tracheal injury.

What are late clinical signs of acute respiratory failure?

Confusion, lethargy, cyanosis, diaphoresis, respiratory arrest, and increased WOB.

What defines acute respiratory failure?

Sudden, life threatening deterioration of lung gas exchange causing hypoxemia, hypercapnia, and acidosis.

What is 'tidaling' in a chest tube water seal chamber?

Normal movement of fluid level with breathing; absence may indicate obstruction or lung reexpansion

What is the main risk of a tension pneumothorax?

Mediastinal shift compresses heart and vessels, impairing breathing and cardiac output.

What is PEEP and its purpose in mechanical ventilation?

Positive end expiratory pressure: keeps alveoli open during exhalation to improve gas exchange and prevent atelectasis.

What is the difference between atelectasis and pneumothorax?

Atelectasis is alveolar collapse: pneumothorax is collapse of the entire lung d/t pleural breach.

Why is mobility important for intubated patients?

Prevents complications like clotting and immobility related issues (atelectasis). Some can ambulate with assistance.

Why is early recognition of respiratory failure important to nurses?

It allows prompt intervention and prioritization of care to prevent deterioration.

What is the leading cause of ARDS?

Sepsis is the most common cause of ARDS.

What is the purpose of an ET tube cuff?

To form a seal btwn the tube and tracheal wall, preventing air leaks, ensuring adequate ventilation and to keep tube in place.

What is paradoxical chest movement and when is it seen?

Opposite movement of a chest segment during breathing, seen in flail chest with multiple rib fractures.

What is a tension pneumothorax?

A medical emergency, air trapped in pleural space causes mediastinal shift: tx with needle decompression.

How do you monitor chest tube drainage?

Mark drainage level every shift, do not empty the chamber, replace if full.

What ABG findings indicate acute respiratory failure?

Low PaO2 (hypoxemia), high PaCO2 (hypercapnia), and respiratory acidosis.

What does a high pressure ventilator alarm indicate?

Ventilator is working too hard, often d/t secretions, kinks, coughing, or bronchospasm.

What is the hallmark of ARDS regarding oxygen therapy?

Severe hypoxemia and that does NOT improve with 100% supplemental O2.

What is the primary risk factor for lung cancer?

Cigarette smoking is the number one risk factor for lung cancer.

What is a thoracoscopy and its risk?

A thoracoscopy is a minimally invasive procedure to view the chest cavity: risk includes pneumothorax.

Why is client education important for anticoagulant therapy?

Teach about regular lab monitoring, bleeding precautions, and dietary considerations (ex: warfarin and vitamin K)

What labs monitor for heparin and warfarin therapy?

Heparin: PTT

WARFARIN: INR

Why is lung cancer often a fatal dx?

Most lung cancers have metastasized at dx, making them harder to treat.

What is a broncos copy and its purpose?

A bronchoscopy is an invasive procedure using a scope to visualize the airways and obtain tissue samples.

What is the leading cause of cancer deaths in the US?

Lung cancer

What is the purpose of a DDimer test in PE?

DDimer detects clotting activity but is nonspecific: it helps rule out PE if negative.

What is a pneumonectomy?

The surgical removal of an entire lung

What are major risk factors for PE?

Immobility, surgery, obesity, smoking, OCP's, and advanced age.

What is a key clinical manifestation of lung cancer?

A cough that changes character (frequency, duration, or sputum) is a primary sign.

What is an expected finding after bronchoscopy?

A small amount of blood tinged sputum is expected in the first 24 hrs post procedure.

What are common tx for lung cancer?

Surgery, chemo, radiation, immunotherapy and palliative care.

How is lung cancer generally categorized?

Small cell or non- small cell: with non small cell being more common.

Why must a pt be NPO before bronchoscopy?

To prevent aspiration

Why is metformin held before CT angiography?

To prevent kidney injury when contrast dye is used

What is the difference btwn palliative and hospice care?

Palliative care focuses on symptom relief and quality of life: hospice is and of life care.

What is the initial tx of PE?

Anticoagulation, usually starting with heparin and transitioning to warfarin.

What is an IVC filter and its purpose?

An IVC filter is placed in the inferior vena cava to catch clots and prevent PE in high risk pts.

What is required for a definitive lung cancer dx?

A biopsy

What are key prevention strategies for VTE/PE?

Encourage mobility, compression stockings, avoid prolonged immobility, smoking cessation.

What is the gold standard for PE dx?

CT angiography

What are the classic sx's of PE?

Chest pain, dyspnea, tachypnea, tachycardia, sometimes hemoptysis

What is a PE?

Blockage of the pulmonary artery usually from a DVT that has embolized

What is the most accurate test for diagnosing asthma?

Pulmonary function tests (PFT)