Med-Surg Exam 3 Nurs 121

Front 1

What is the Purpose of Chest Physiotherapy? (P.416)

Back 1

- Consists of Postural Drainage, Percussion, and Vibration
- For Patients with Weak Cough and Risk for Retaining Secretions
- Patients with COPD, Cystic Fibrosis, Bronchiectasis

Front 2

What is the Purpose of Purse Lip Breathing? (P.413)

Back 2

- Promotes CO2 Excretion; Used when Patient Feels Short of Breath
- Helps Keep Airway Open During Diaphragmatic Breathing
- Inhale Slowly by Nose On the Count of Two
- Exhale Slowly by Pursed Lips to the Count of Four

Front 3

Signs and Symptoms of a Tension Pneumothorax? (P.460)

Back 3

- In a Closed Pneumothorax, Tension Builds Up in the Pleural Space
- This Tension Puts Pressure on Heart and Vessels
- Results in Reduced Cardiac Output

- Symptoms of Shock
- Dyspnea, Chest Pain, and Tachypnea
- Breath Sounds Absent or Diminished on Affected Side

Front 4

Differentiate Between the Different Respiratory Patterns and Lung Sounds. Give Examples of Respiratory Related Respiratory Conditions: Cheyne-Stokes, Kussmaul’s, Eupnea, Hyperventilation, Hypoventilation, Wheezing, Stridor, Crackles, Pleural Friction Rub

Back 4

- Cheyne-Stokes (P.331) – Shallow – Deep – Apnea Breathing Cycle.
- Kussmaul’s (P.658) – Body’s Attempt to Reduce Acidosis by Deepening Respirations.
Expired Air has Fruity Odor, Caused by Diabetic Ketoacidosis, Type I.
- Eupnea – Normal Relaxed Breathing.
- Hyperventilation (P.59) – Caused by Anxiety when a Person Takes Rapid Deep Breaths.
Serum pH Level is Increased.
- Hypoventilation (P.58) – Inadequate Breathing that Results in Inadequate Oxygenation.
Build-Up of Carbon Dioxide Leads to Respiratory Acidosis.
- Wheezing – High Pitch Whistling Sound Produced by Air Flowing Through Narrow Breathing Tube
Common in Asthma and COPD.
- Stridor – High Pitch Vibratory Noise Caused by Airway Obstruction, and Turbulent Airflow
- Crackles – Abnormal Breath Sounds Caused by Excessive Fluid in the Airways
- Pleural Friction Rub - Occurs when Thickened, Roughened Pleural Surfaces Rub Together

Front 5

What Does Oxygen Saturation Value Measure? (P.411)

Back 5

- Also Called Pulse Oximetry, O2 Sat, and SaO2
- Method of Monitoring Hemoglobin that is Saturated with Oxygen

Front 6

What is the Purpose of Fowler’s Position in a Dyspneic Patient? (P.49, Found. P.1131)

Back 6

- Head of Bed Elevated 45 to 60 degrees
- Promotes Cardiac & Respiratory Function by Dropping Abdominal Organs

Front 7

What is the Rationale for Placing Someone with Respiratory Condition on their Non-Affected Lung Side to Improve Oxygenation? (P.413)

Back 7

- Gravity Causes Greater Blood Flow to the Dependent “Good” Lung, Increasing Oxygenation

Front 8

Oxygen Flow Devices (P.413)
Know the Average % Delivered of
Ø Non-Rebreather (Should Vents be Opened or Closed, Should Bag be Inflated?)
Ø Nasal Cannula

Back 8

Ø Non-Rebreather:
- Vents Allow Expiration but Closed During Inspiration
– Side Vents Closed to Limit Mixing Room Air with O2
- Ensure that Reservoir is Never Allowed to Collapse to Less than Half Full

Ø Nasal Cannula
– O2 Delivered at Rate of 1 to 6 L/minute

Front 9

Teaching Instructions for Patients using an MDI Corticosteriod and Adrenergic Bronchodilator? (P.415)

Back 9

- Metered Dose Inhaler – Method to Administer Topical Mediators to Lungs Minimizing Side-Effects
- Do Not Overuse Inhalers with Extra Puffs (May Cause Bronchoconstriction or Death)

Front 10

What is the Purpose of Incentive Spirometry? (P.415)

Back 10

- Encourages Deep Breathing in Risk of Collapse or Atelectasis
- Commonly Used in Post-Operative Patients, 10 times/hr when Awake

Front 11

What are Key Assessment Areas for Someone with a Chest Tube. Consider the Equipment too? (P.417-418)

Back 11

- Respiratory Rate, Shortness of Breath
- Auscultate for Lung Sounds
- Observe Dressing is Intact
- Palpate Around Insertion for Crepitus
- Too Many To List, Refer to Book

Front 12

What is the Indication/Rationale for Cough and Deep Breathing? (P.412)

Back 12

- Effective Coughing Can Keep Airways Clear of Secretions
- Take 2 to 3 Breaths Using Diaphragm
- After 3rd Breath, Hold Breath, then Cough Forcefully

Front 13

Explain to a Patient what to Expect During and After a Bronchoscopy? (P.413)

Back 13

- Uses a Flexible Telescope to Examine Larynx, Trachea, & Bronchial Tree
- Can be Used to Remove Obstruction, Foregin Body, or Thick Secretions
- Patient is NPO 6 to 8 hrs Before Procedure
- After Procedure, NPO Until Gag Reflex Return

Front 14

What are Treatment Options for Someone with Lung Cancer? (P.463)
Ø Are some Considered Palliative Only?

Back 14

- Treatments are Stage Based
- Non-Small Cell Lung Cancer - Surgical Removal of Tumor
- Lobectomy (Removal of Lobe or Entire Lung) – More Advanced Cases
- Surgery Contraindicated in Metastasized to Distant Areas
- Combination of Chemo, Radiation, and Surgery Used as Adjuvant Treatments

Front 15

Explain Pleural Effusion and Treatment to a Patient? (P.447)

Back 15

- Excess Fluid Collects in Pleural Space
- Fluid Normally Enters Capillary Space and then Reabsorbed by Lymphatic System
- Pathological Condition Can Cause Excess Fluid Build-Up or Poor Reabsorption
- Effusion Can be Transudative or Exudative

- Therapeutic Thoracentesis – X-Ray is Used to Determine Location of Fluid
- Needle is Inserted to Drain Fluid

Front 16

What is the Best Way to Monitor the Progress of a Patient with Asthma? (P.453)

Back 16

- Monitor Peak Expiratory Flow Rate
- From a Fully Inflated Lung, Amount of Air Pt. Can Blow into Peak Flow Meter
- Treatment is Initiated when Level Falls Below Set Point

Front 17

Why are Corticosteriods Used in Patients with COPD? (P.450, 452)

Back 17

- Potent Anti-Inflammatory Agent

Front 18

At what Flow Rate Should a Patient with COPD Receive Oxygen? Why? (P.450)

Back 18

- 1 to 2 Liters
- Prevent Suppression of Hypoxic Drive

Front 19

What Narcotic Medication Helps Reduce Dyspnea in a Patient with End Stage COPD? How? (P.452)

Back 19

- Codeine, PO
- Dextromethorphan (DM) as in Robitussin DM (No it does not stand for Doctor Mom)

Front 20

What are the Nursing Interventions for a Patient with Cystic Fibrosis, with Nursing Diagnosis of Ineffective Airway Clearance? (P.446, 456)

Back 20

- Turn Patient Every q2h or Ambulate by Self
- Administer Ordered Expectorants
- If Patient is Unable to Cough, Suction per Orders
- Obtain Order for Chest Physiotherapy or Flutter Valve

Front 21

Common Respiratory Changes Associated with Aging? (P.406)

Back 21

- Lung Tissue Deteriorates; Alveoli are Lost as Walls Detriorate
- This Results in Decreased Ventilation & Lung Capacity
- Cilia of the Mucosa Deteriorate; Alveolar Macrophages Not as Efficient

Front 22

How Best to Assess for Cyanosis in a Dark Skinned Individual? (P.408)

Back 22

- Assess Color of Skin, Lips, Mucous Membrane, and Nailbeds

Front 23

What is the Term Used to Describe Blood Tinged Sputum? (P.443)

Back 23

- Hemoptysis

Front 24

What are the Major Risk Factors for Pulmonary Embolism? (P.457)

Back 24

- Most Originate in the Deep Veins of Lower Extremeties
- Surgical Procedure Under General Anesthesia, Heart Failures, Fracture
- Fractures of Lower Extremities, Obesity

Front 25

What is the Common Pharmacological Treatment for Pulmonary Embolism? (P.458)

Back 25

- Heparin is Given Continuously via Continuous IV Infusion

Front 26

When is the Chest Tube Normally Removed from a Patient Recovering from a Pneumothorax? (P.???)

Back 26

- UNABLE TO FIND ANSWER
- When Pneumothorax has Resolved (P.418)????

Front 27

Define Hemothorax? (P.460)

Back 27

- Refers to the Presence of Blood in the Pleural Space

Front 28

Give Rationale for Positioning a Nosebleed Patient Sitting Up and Leaning Slightly Forward? (P.428)

Back 28

- To Avoid Aspirating or Swallowing Blood

Front 29

What is the Purpose of Epinephrine Application in Epistaxis? (P.428)

Back 29

- Constrict Vessels & Slow Bleeding

Front 30

Most Common Complication of Influenza? (P.434)

Back 30

- Pneumonia
- Assess Fever, Shortness of Breath, Crackles of Wheeze

Front 31

What is the Purpose of a Ventilation Perfusion Scan? On Exam if no Blood Supply is found what Condition is Implicated? (P.411)

Back 31

- Also Called a Lung Scan
- Radioactive Substance Injected via IV and Scan is Done to View Blood Flow to Lungs
- If an Area has no Blood Supply a Pulmonary Embolism is Suspected
- Another Radioactive Substance is Inhaled and Shows how well O2 is Distributed in Lungs
- Chronic Lung Disease may Cause Poor Ventilation and Perfusion

Front 32

What Common Condition is Treated with NIPPV? (P425)

Back 32

- Patients with Severe Respiratory Disease
- Sleep Apnea, or Neuromuscular Disease (Amyotropic Lateral Sclerosis)

Front 33

Describe the Pathophysiology and Etiology, S/S, and Treatment of Asthma and Emphysema? (P.449-452)

Back 33

Asthma:
- Inherited, Allergens, Air Pollution

- “Attacks” Last from minute to days. Chest Tightness, Dyspnea, and Difficulty Moving Air In & Out
- Monitor PEFR

Emphysema:

- Hyperinflated Lungs, Barrel Chesting
- Shortness of Breath, Activity Intolerance

- Stop Smoking
- Oxygen 1-2L
- Pneumococcal Vaccination

Front 34

What Conditions/Factors Place Someone at Risk for Atelectasis? (P.448)

Back 34

- Post Surgical Patients who do NOT Cough and Deep Breathe
- Anything that Causes Hypoventilation

Front 35

Describe Cor-Pulmonae and it’s Relationship to Chronic Lung Disease? (P.328)

Back 35

- Right Ventricle Fails Due to Increased Pulmonary Pressure