You are on page 1of 8

Med Surg Chapters 30 & 31

1. What is the route of the air flow to the lungs?


Air flows from the higher to the lower pressure areas and into the lungs through a system of
channels that begins with the oral cavity (mouth) and the nasal cavity (nose). The air flow then
continues through the trachea (the windpipe) and into the bronchi which are two large tubes,
one for each lung. Finally, stemming from the main bronchi are smaller bronchi and tiny
bronchioles, then to the alveoli.

2. What are the nursing considerations when collecting a sputum specimen?


Collect the specimen early in the morning before breakfast. Provide a sterile container. Instruct
the patient to 1. Brush teeth and rinse mouth; 2. Cough deeply and expectorate directly into the
container; 3. Immediately cap the container; and 4. Inform the nurse that the specimen is ready.

3. What happens when secretions pool in lungs or there is a stasis of respiratory secretions?

4. What are your nursing assessment, precautions, and interventions and pre and post
bronchoscopy?
Pre: obtain a written consent, NPO for 6-8 hrs or as specified have pt remove dentures and
provide oral hygiene, document loose teeth. Ask pt not to smoke. Administer sedatives and
anticholinergics as ordered.
Post: npo until gag reflex returns. Semi fowlers position. Monitor v/s, gross hemoptysis, swelling
of the face and neck, stridor, decreased or asymmetric chest movement, diminished lung
sounds, dyspnea. Report any abnormal findings.

5. What is orthopnea, dyspnea, tachypnea, bradypnea, kussmuls and cheyne stokes


respirations?
Orthopnea- difficullty breathing while lying down
Dyspnea- difficulty breathing
Tachypnea- rapid respiratory rate
Bradypnea- slow respiratory rate
Kussmuls- rapid deep breathing. (Faster than 20 breaths per min, hyper ventilation)
Cheyne stokes- breath progressively gets deeper them become more shallow, followed by a
period of apnea.
6. What are your nursing interventions for each of the above respiratory dysfunction?

7. What are the types of questions you would ask the respiratory patient during your
functional assessment?
Describe the patient’s occupational history, including any exposure to pathogens or to
substances that might irritate or harm the respiratory tract. Document exposure to any
fumes, toxins, coal dust, silica, or saw-dust. Ask the patient to describe a typical day and to
give particular attention to any limitations imposed by the respiratory disorder. Ask about the
usual diet and fluid intake. A smoking history is important and reported in pack years.

8. What are crackles, rales, wheezes, rhonci, pleural friction rub, diminished and absent
breath sounds? What do they sound like, describe? (combined with 9 & 10)
9. What disruption in the normal respiratory structure causes the abnormal sounds?
10.What are the s/s? (pg 514 and internet) PLEASE REVIEW ON YOUR OWN ALSO!!!
CRACKLES Also called rales ( two types- fine and coarse)
FINE CRACKLES
SOUNDS: Sounds like a few strands of hair rubbed between the thumb and forefinger next to

Page 1
Med Surg Chapters 30 & 31
the ear.
CAUSE: Due to accumulation in the alveoli and DOESN'T clear with coughing.
COARSE CRACKLES
SOUNDS: Sounds like a velcro fastner being seperated.
CAUSE: Due to secretions accumulating in the larger airways and usually DOES clear with
coughing.
S/S OF CRACKLES: Associated with many cardiac and pulmonary disorders (I KNOW these are
not S/S BUT Ms Benjamin told me to just know what diseases are associated with the sounds
rather than S/S)
WHEEZES
SOUNDS: Is a high pitched sound
CAUSE: Due to air passing through a narrowed passage way.
S/S: Associated with asthma or COPD.
PLEURAL FRICTION RUB
SOUNDS: Is a grating, scratchy noise similar to a creaking shoe.
CAUSE: Ocurs because the pleural layers are inflamed and have lost their lubrication.
S/S: Associated with pneumonia, pulmonary embolism, and pleurisy.
RONCHI
SOUNDS: Is a dry, rattling sound
CAUSE: By partial bronchial obstruction, owing to secretions, mucosal swelling, or tumor
tissue pressing on the passage.
S/S: Associated with COPD and severe bronchitis.
DIMINISHED BREATH SOUNDS
SOUND: Normal lung sounds that are decreased or harder to hear.
CAUSE: Due to poor inspiratory effort or impending plueral effusion.
S/S: Associated with COPD, pnemonia or fluid in the lungs.
ABSENT BREATH SOUNDS
SOUNDS: Absent
CAUSE: All of the above (per Ms Benjamin)
S/S: All of the above (per Ms Benjamin)

11.What is a ventilation Perfusion Scan? What is the primary purpose of the scan? (pg 516
and 517)
A lung scan or ventilation perfusion scan is used to assess lung ventilation and lung perfusion.
Its chief purpose is to detect pulmonary embolism or some other obstruction. The pt is given
a radioactive substance either by inhalation (to evaluate ventilation) or by IV (to evaluate
perfusion). Ventilation images are compared with pictures taken during equal amount of
radioactivity on both the ventilation and the perfusion pictures. Any areas indicating good
ventilation but poor perfusion suggests the presence of a pulmonary embolus or obstruction.

12.What is TB? What are the test preformed to confirm dx? How is skin testing done and
when are results read? (pg 517)
TB is a common and in some cases deadly infectious disease caused by various strains of
mycobacteria,, usually Mycobacterium tuberculosis in humans. Tuberculosis usually attacks
the lungs but can also affect other parts of the body. It is spread through the air when people
who have an active TB infection cough, sneeze, or otherwise transmit their saliva through the
air. Most infections in humans result in an asymptomatic, latent infection, and about one in
ten latent infections eventually progresses to active disease.
There are many test to confirm TB but the book focuses on the skin test. The skin test
determines past or present exposer to TB. The pt is injected intradermally on the anterior
forearm with an extract of TB and see if they react to it. Pt is checked in 48-72 hours. NO
MORE NO LESS!! If pt is reactive they are told to get a chest xray which then will show a

Page 2
Med Surg Chapters 30 & 31
positve result or a false positive.

13.What is a flutter mucus device? When is it used? (LOOKED all over the book, couldn't find
it and then was told by Ms Bejamin to google it!)
Portable and easy to use, the flutter mucus device promotes removal of harmful secretions
from the airway of patients with mucus-producing respiratory conditions. Three mechanisms
of action help promote secretion removal: positive expiratory pressure (PEP), which helps
hold airways open; airway oscillation, which helps vibrate mucus away from airway walls; and
intermittent flow acceleration, which helps push mucus upward for expectoration.
The device is shaped like a pipe and has a hardened plastic mouthpiece at one end, a
perforated plastic cover at the other end and a stainless steel ball resting in a plastic circular
cone on the inside. It is designed for patients with chronic obstructive pulmonary disease
(COPD) such as asthma, bronchitis, cystic fibrosis, atelectasis or other conditions producing
retained secretions. *When is it used? Couldn't find that one!! SORRY!!!!!

14.What is SCLC and NSCLC? Lung cancer- SCLC small cell lung carcinoma, NSCLC non-small
cell lung carcinoma

15.What is CPAP? What would you teach the patient about the machine and its function?
CPAP- Continuous Positive Airway Pressure. Used by people with sleep apnea, maintains
positive pressure in the airway during sleep, thereby avoiding periods of apnea. Nursing care
of patients on mechanical ventilation requires special training, but key aspects of care include
the following:
• Monitor settings to ensure they are set as prescribed.
• Be sure high and low pressure alarm settings are turned on.
• Have a manual resuscitator and oxygen source readily available.
• Do not allow water to accumulate in the tubing.
• Monitor the patient’s vital signs and breath sounds; suction as necessary.
• Establish an alternate method of communication because the patient cannot speak
while intubated.

16.What is the allen test? The allen test should be done before each radial arterial puncture
to ensure adequate collateral circulation. Because an arterial puncture may injure the radial
artery, the adequacy of blood supply to the area by other arteries must be determined. A
puncture is not done on an artery if the other blood supply is not adequate.

17.What is respiratory acidosis? Alkalosis? What is the associated pH? (combined with 18)
18.What the lab values associated with the imbalance in blood gases? Normal blood pH: 7.35-
7.45
Respiratory acidosis- occurs when the respiratory system fails to eliminate the appropriate
amount of carbon dioxide, carbon dioxide is retained, with a resultant accumulation of
carbonic acid and a decrease in blood pH. (High CO2 & Low blood pH)
Respiratory alkalosis- occurs when low carbon dioxide, resulting in a rise in pH. Most common
cause is hyperventilation. (Low CO2 & High blood pH)

19.What is the purpose of the chest tube? What are the three chambers? Chest tubes are

Page 3
Med Surg Chapters 30 & 31
inserted to drain air or fluid from the pleural space of the lungs. This permits reexpansion of a
collapsed lung in the patient with a hemothorax, pneumothorax, or a pleural effusion. Three
chambers: collection chamber, water-seal chamber, and the suction chamber.

20.Learn and memorize the meaning of bubbles in each chamber. What is the significance of
bubbles in the water seal, for instance. Pg 529
When a chest tube is initially connected bubbles are usually seen in the water seal chamber
after a short time the bubbling in this chamber will stop until the lung has reexpanded or the
tubing is occluded. Continuous bottling it in the water seal chamber suggest an air leak. If
suction is prescribed, you will see bubbling in the suction control chamber.

21.How should the nurse manage the care of the tubes? Milking vs. stripping. How should the
tube be the left to allow for proper drainage? Pg 529
Tube connections are taped and inspected frequently for leaks. Extra tubing it is coiled and
placed on bed to prevent kinking.
Milking it is when you squeeze in a release several times in one direction. Stripping is when
you pinch the tubing and move your fingers in one direction squeezing the fluid through the
tubing.
Tubing should be coiled and placed on the bed to prevent kinking. Drainage system should be
on the floor.

22.What class of medication is contraindicated for a hypertensive patient? Pg 532


Decongestants are contraindicated for patients who have severe hypertension or coronary
artery disease.

23.What positions should you implement for the respiratory patient? Postoperatively? Early
onset of chest trauma? pg 630
To improve gas exchange position the patient with the head of the bed elevated 20 to 40
degrees.
In the immediate post operative period, the patient is usually placed on the unaffected side.
After a pneumonectomy avoid lying on the affected side because that may encourage a
mediastinal shift.
pg 543 To facilitate breathing place the client in a semi-fowler's position or on the injured
side.

24.What should you teach your patient about the use of antibiotic therapy. Pg 535
Health Promotion Considerations
* Teach patients the difference between bacterial and viral infections. * Teach patients that
the common cold from a viral cause does not require anti microbial therapy. * Reinforced
health promotion considerations such as frequent handwashing using soap and warm water
for at least 20 seconds. * Instruct to cover mouth and nose when coughing or sneezing. *
Teach patients the importance of adequate nutrition to reduce their susceptibility to
infectious organisms.

Page 4
Med Surg Chapters 30 & 31
25.What is hypoxemia? Hypoxia? Hypercapnia? What are the different signs and symptoms of
the above? (Glossary)
Hypoxemia - Low level of oxygen in the blood. S/S - cyanosis, restlessness, stupor, cheyne-
strokes respiration, apnea, increased blood pressure, tachycardia.
Hypoxia - Low oxygen level; decreased availability of oxygen to body tissues. S/S - unusual
rapid or slow breathing and possible tachycardia pg 513
Hyercapnia - Excess carbon dioxide in the blood. S/S - excessive acidity in the body fluids,
caused by an increase in carbon dioxide in the blood.

26.What is a sucking chest wound? What type of dressings would you employ on a
patient with an open chest wound? pg 543
A sucking chest wound is the air that can be heard or felt moving in and out of the wound.
The type of dressing that you would employ on a patient with an open chest wound is an
airtight dressing taped on three sides. This is called a vented dressing; it permits air to
escape through the chest wound but prevents additional air from entering the chest through
the wound. If you were to completely seal an open chest wound, air could continue to leak
from the lung into the pleural space. With no exit, the leaking air could accumulate in the
pleural space and create a tension pneumothorax.

27.What is Flail Chest wound?What is the management of the patient with severe dyspnea?
pg 545
The term flail chest refers to an injury in which two adjacent ribs on the same side of the
chest are each broken into two or more segments. The affected section of the rib cage is, in a
sense, detached from the rest of the rib cage. This permits it to move independently, so that
the segment moves in with inspiration and moves out with expiration. The pattern of
movement is exactly the opposite of the movement of an intact chest wall. Therefore it is
called paradoxical movements. The management of the patient with severe dyspnea is when
a patient in respiratory distress usually requires intubation and mechanical ventilation.
Radiographs and arterial blood gas tests are often repeated at intervals to monitor
oxygenation and detect additional pulmonary complications such as pneumonia.

28.What is a pulmonary embolus? What nursing interventions/management would you


employ in the care of a patient with thrombus? pg 545-47
An embolus is a foreign substance that is carried through the bloodstream. Emboli are usually
blood clots but may be fat, air, tumors, bone marrow, amniotic fluid, or clumps of bacteria. ??
With nursing interventions/management, you would employ in the care of a patient with
thrombus anticoagulant therapy is the cornerstone of treatment for PE. Intravenous heparin is
usually given to establish and maintain a partial thromboplastin time of 2.0 to 2.5 times the
normal rate. Heparin prevents the development of new thrombin it also prevents the
extension of existing thrombi but does not dissolve them.

29.With spirometry testing what would you teach your patient pre and post procedure? pg
519
A spirometer is an instrument that measures the ventilatory function of the lung. It measures
the volume of air that the lung can hold, the rate of flow of air in and out of the lung, and the
compliance(elasticity) of lung tissue. The test enables the physician to detect impaired
pulmonary function, classify the pulmonary impairment, estimate the severity of the
impairment, monitor the cause of pulmonary disease, evaluate treatment, give information
helpful in planning care, and provide preoperative assessment. The test involves inserting a
Page 5
Med Surg Chapters 30 & 31
mouthpiece, taking as deep breath as possible, and blowing as hard, as fast, and as long as
possible. Patients should be encouraged to continue blowing out until exhalation is complete.
Spirometry measures forced vital capacity and forced expiratory volume. These and other
lung volumes and capacities. People who are to undergo spirometry should be taught what to
expect during the test and how to prepare. The may be anxious about taking a breathing test
if they have respiratory problems, because they may fear increased dyspnea or exhaustion.
They should be advised not to smoke or use bronchodilator medications for 4 to 6 hrs before
testing.

30.What is COPD? What are signs and symptoms of chronic bronchitis? What are the signs
and symptoms of asthma patient? pg 550
Chronic obstructive pulmonary disease(COPD) is the fifth leading cause of death in the United
States. It is characterized as varying combinations of asthma, chronic bronchitis, and
emphysema.
Pg 555 The signs and symptoms of chronic bronchitis include productive cough, exertional
dyspnea, and wheezing.
pg 551 During an asthma attack, the patient may exhibit dyspnea, productive cough, use
accessory muscles of respiration(scalenes and sternocleiodmastiods),audible expiratory
wheezing, tachycardia, and tachypnea.

31.What are the omnious signs and symptoms of severe asthma? During an asthma attack,
the patient may exhibit dyspnea, productive cough, use of accessory muscles of respiration
(scalenes and sternocleidomastoids), audible expiratory wheezing, tachycardia, and
tachypnea. Findings that suggest that respiratory arrest is imminent include drowsiness,
confusion, absence of wheezing, bradycardia, and retractions above the sternum.

32.TB screening. What are the signs and symptoms of TB infection? What is the length of
time for treatment? What would you teach patient about the infectious process and what
would you teach family members about living in close quarters with someone infected with
TB? Which patients are at high risk? pg562-63
The signs and symptoms of tuberculosis may include cough, night sweats, chest pain, and
tightness,fatigue,anorexia,weight loss, and low-grade fever. The cough is often persistent and
productive and may produce bloody sputum(hemoptysis).
Tuberculosis is spread by airborne droplets. Most healthy people are not infected through
brief contact. Those at increased risk for tuberculosis include older adults; economically
disadvantaged and homeless; people who are substance abusers; children younger than 5
years; people who are immunosuppressed; and some racial and ethnic groups. Tuberculin
skin tests are commonly used for screening. People who have been infected mount an
immune response that causes a local reaction when tuberculin, a protein fraction of the
tubercle bacillus, is injected intradermally, The patient is said to have a positive reaction if a
hard area(induration) of 5mm or more develops at the site within 48-72 hrs. A positive
reaction may indicate active or inactive infection. The Tuberculosis Stat Test detects
M.tuberculosis in respiratory secretions within 48hrs. The test does not distinguish between
active and past infections. The patient who is thought to have active tuberculosis is isolated
at first. Practice good hand washing and wear masks(disposable particulate respirators)
during contacts. Gowns are unnecessary unless there is gross contamination of clothing. The
patient may feel rejected and be fearful that others will avoid contact. Encourage expression
of feelings about the diagnosis and the isolation. Instruct visitors in measures to reduce the
risk of infection. Explain to the patient how the infection was transmitted and how to protect
others. The patient should always cover nose and mouth when sneezing and coughing.
Disposable tissues should be used and discarded in a sanitary way. Members of the patient's
Page 6
Med Surg Chapters 30 & 31
household are tested for active disease. Those who have positive skin tests but are
asymptomatic are usually given prophylactic therapy to prevent development of active TB.
One problem with the homeless is that it may be impossible to locate contacts. Emphasize
the importance of the patient completing the full course therapy. Otherwise infection may be
reactivated.
33.Why is a face mask contradicted in COPD patients?
Patients with COPD are at greatest risk for oxygen induced hypoventiliation. They are
insensitive to high carbon dioxide levels in the blood, so that low oxygen levels in the blood
serve as the stimulus for respirations, so high concentrations may raise the blood O2 level so
the patients stimulus to breathe is lost and respiratory depression may result.

34.What is a peak flow meter?


Is a small, hand-held device used to monitor a person's ability to breathe out air and
maximum speed of expiration. It measures the airflow through the bronchi and thus the
degree of obstruction in the airways. The patient uses the meter twice daily to monitor the
level of control. If the level drops below 20% or more patients usual level, notify physician.

Zone Reading Description


80 to 100 percent of the
Green A peak flow reading in the green zone indicates that
usual or normal peak
Zone the asthma is under good control.
flow readings are clear.
50 to 79 percent of the
Yellow Indicates caution. It may mean respiratory airways are
usual or normal peak
Zone narrowing and additional medication may be required.
flow readings
Indicates a medical emergency. Severe airway
Less than 50 percent of
Red narrowing may be occurring and immediate action
the usual or normal
Zone needs to be taken. This would usually involve
peak flow readings
contacting a doctor or hospital.
35.What is Centrilobular and Panlobular emphysema? Pg 554
Emphysema is a degenerative, irreversible disease characterized by enlargement of airway
beyond the terminal bronchioles.

• Centriobular- associated with cigarette smoking. Is the focal enlargement of air spaces around the bronchioles.
The walls of the bronchioles enlarge and breakdown (alveolis remain intact). The elastic recoil diminishes and
airways partially collapse. Pockets of bullae and blebs form. Bullae are located between alveolar spaces and blebs are
in lung parenchyma and ruptured blebs can cause lungs to collapse. As the functional units are destroyed, there is
impairment in the exchange of O2 and CO2. As the lungs become hyperinflated they cause the diaphragm to flatten
and increase the reliance on accessory muscles for breathing. Leads to Right sided heart failure.
• Panobular- affects respiratory bronchioles and alveoli and is caused by a hereditary
deficiency in the enzyme inhibitor of alpha1- antitrypsin. It is the enlargement of all air
spaces. The walls of both breakdown and cause air to be trapped and decreases the surface
area for gas exchange.

36. Differentiate between Pink Puffer and Blue Bloater? What are the differences in signs and
symptoms? Pg 555
Pink Puffer Blue Bloater
n have dyspnea, cyanosis, and peripheral edema
Causes their faces to turn red Bluish coloration in skin and lips

Page 7
Med Surg Chapters 30 & 31
Patients with emphysema Chronic Bronchitis
s/s: dyspnea on exertion s/s: productive cough
patients are often thin exertional dyspenea
barrel chest wheezing

Page 8

You might also like