Breath Easy?
Ayan has a nose bleed. What actions can you do to help her?
Sit upright, lean forward, apply direct lateral pressure to the sides of nose
It is winter in Minnesota and your 80 yo elderly neighbor socializes regularly with a local retirement group and at her church. She does not want to give up seeing people just because she MIGHT get sick and asks you what she can do prevent getting ill? You give her 3 suggestions that include:
Vaccinations (flu and pneumococcal)
Handwashing
Respiratory etiquette (coughing into sleeve); wearing a mask and social distancing
Hazel has smoked 1/2 pack of cigarettes per day for the past 30 years. How many pack years has she smoked?
What does FeV1 indicate? Why is it used?
Pulmonary Function Test: First second of Forced Expiratory Volume. Used for pulmonary disease (asthma and COPD) to determine how much lung volume can be blown out. (helps determine air "trapping")
Ethel's O2 sat is 86%, but I cannot increase her oxygen above 2L NC because she has COPD. T/F ; Why or Why not?
False.
Acceptable O2 saturation for COPD should is 88-91%
Your patient, Stanley, is post op for a tonsillectomy and frustrated because they have to keep swallowing.
What will you say/do?
Frequent swallowing could indicate a posterior bleeding. Place patient in semi-fowlers, try to visualize with penlight. Contact PROVIDER
Abdu, a 35 yo male, comes to your ED with c/o fatigue, fever, he also states his chest is tight when he breathes and he is coughing up thick green mucus. What do you suspect?
Anticipate actions and treatment and in what order?
Possible PNA. V/S to include pulse ox. to ensure hemodynamically stable. Auscultate lungs. CXR, sputum Cx for C&S and antibiotics.
Possible EKG to r/o cardiac w/ c/o chest "tightness"
Grace's father was a heavy smoker and she is worried about second hand exposure. Name three possible warning signs she should look for?
Persistent cough or change in cough
Dyspnea
Hemoptysis or blood tinged sputum
Chest, shoulder or arm pain or chest tightness
Hoarseness/voice change
Recurring pleural effusion, pna, or bronchitis
Tanya is taking Rifampin.
List 3 things that are important for her know?
*Medication is used for TB. *Do not stop taking it as it could cause TB to become resistant. *It can make skin and/or urine reddish/orange tinged. *Use alternate form of contraception b/c it can decrease effectiveness of oral contraception. *Do not drink--WATCH for s/ of liver toxicity. *Follow up with provider to make sure clear.
What precautions are needed for caring for a hospitalized patient with confirmed TB
Negative pressure airflow room, N-95 mask (fitted respirator mask), Gown, gloves
Jake, an 18 yo c/o sinus pressure and fatigue for 5 days that has not improved. He states "I have a sinus infection" and is requesting antibiotics.
His v/s include: T: 99.5F, BP 118/78, HR 98, RR 20, Pulse ox 98%
You suspect _________. How will you respond?
Suspect Rhinosinusitis.
At 5 days with low grade T it is likely viral and antibiotics would not be indicated
What is pulmonary fibrosis?
Who is at risk?
What do you anticipate?
Progressive restrictive lung disease that happens after lung injury causing fibrosis and scarring. Usually older people who are exposed to inhalation irritants
Life expectancy is < 5 years
Decreased FVC. antifibrotic meds and steroids. Only cure is lung transplant.
Your patient will undergo radiation for laryngeal cancer. What should you teach your patient?
Lotion/sunscreen, avoid hot/cold, loose fitted clothing, mild soaps, do not shave.
voice may become hoarse, consider communication.
COPD patients should limit food intake because it is too difficult to eat and breath and they will just drop their O2 saturation making it more difficult to breath. T/F? why or why not?
False. COPD patients have an increased metabolic need and require increased calories, protein, and dietary supplements.
LaVerne's mantoux was (+). Now what?
a + mantoux indicates exposure to TB, but does not indicate the disease is present. Further testing may include an AFB sputum and a CXR.
Jake is diagnosed with acute viral rhinosinusitis.
Name 3 things he can do for symptom relief:
Rest
Hydrate
Intranasal Saline lavage
Decongestants/Antihistamines
Humidified air &/or Warm compresses
What is Cystic Fibrosis?
Who is at risk?
What do you anticipate
Genetic Disease that affects multiple organs. Diagnosed as child (in utero)
Positive Sweat Chloride Test, thick tenacious sputum, recurrent resp infections. Need daily CPT. Non pulmonary: GERD, ooul stool, steatorrhea, malnourishment, vitamin deficiencies, Diabetes, osteoporosis as grow to adult
Jamal came in with status asthmaticus and was treated with duoneb via nebulizer, IV steroids and an antihistamine. He is no longer wheezing so treatment was a success!
T/F why or why not?
False. Need to assess v/s and patient's clinical response. A patient in status asthmaticus and no longer wheezing is sign of severe distress and an emergency!
What is the purpose of Montelukast
It is a leukotriene blocker medication that is used to decrease the inflammation in asthma patients.
Joe is 45 y.o male who is suspected having Obstructive sleep apnea. List at least 3 possible manifestations that would support this diagnosis.
Obese
loud snoring--short neck, large uvula, enlarge tonsils
Irritable
Headaches/difficulty concentrating
A child weighs 33 lb 12 oz.
What is the weight in kg? Round to the nearest tenth (one decimal place)
15.3
A medication order states, infuse 0.9% Normal Saline (NS) 400 mL IV bolus over 30 minutes. The IV pump must be set to _______mL/hr?
800
A medication order states, administer levetiracetam 10 mg/kg/dose PO to a child who weighs 52 lb.
The oral solution is available as 100mg/ml.
How many mL should the nurse administer?
(round to the nearest 10th)
2.4
A medication order states
Ciproflaxin 300mg IVPB q 12h
The pharmacy sends Ciproflaxin 300mg in a 100ml NS to infuse over 2 hours.
The IV pump must be set at _____ml/hr
50
A medication order for Heparin states:
Administer 16 units/kg/hr. The patient weighs 70 kg. The Heparin bag label states
Heparin 25,000 units/250ml 0.9% Sodium Chloride
The infusion pump should be set for a ____ml/hr.
(Round to nearest whole number)
11