Diagnostics
What type of test is used to show the size of the heart, lungs, and mediastinum. It also can show fluid accumulation? What kind of things might we use for this test?
Chest Xray
R/O pneumonia
ARDS
COPD
Pleural effusions etc
PH: 7.6
PaCO2: 22
HCO3: 30
diagnostics and interventions?
Respiratory alkalosis with partial compensation.
- breathe into a paper bag or rebreather
- provide emotional support
- monitor electrolytes
What type of test do we do to help visualize the blood flow in the lungs and is typically the gold standard for diagnosing PE
Pulmonary angiogram
Your patient had a TB test placed on Monday. It's Wednesday and you are determining if it is positive or negative? What would indicate a positive TB test? What would be the next step?
Induartion more than 10mm or redness and swelling. Next step is to get a chest x ray
this delivery device is 10-15 L only
NON rebreather
What kind of test do we use to collect a sample of sputum from a patient? What are 2 nursing considerations and when would we use this?
Sputum culture
- 1st thing in the morning is best
- Always do before starting abx
- need at least 15 mL
can use on ANY type of productive cough to test for bacteria
Ph 7.39
PaCO2: 60
HCO3: 25
Interpretation and interventions?
Respiratory acidosis with no compensation
- encourage deep breathing and coughing
- high fowlers or semi flowers
- O2 if not hyper oxygenated or COPD
- suction as needed
What is pulmonary artery hypertension?
A. complication caused by RS heart failure which causes pulmonary edema.
B. A complication caused by COPD that causes the artery to be stenosed leading to RS HF
C. A complication caused by car pulmonate that causes the pulmonary artery to become inflamed leading to RS HF
B.
What test is used to primarily detect the early growths consistent with lung cancer or to help find pulmonary embolisms if present? What are 2 things you should assess before having your patient complete this test?
Spiral CT
Kidney function
Allergy to contrast
This delivery device is 1-6 LPM
Nasal Cannula
Your patient undergoes a bronchoscopy in their room due to signs and symptoms of hemoptysis and constant coughing for the past 3 weeks. After the branch, what is the most important assessment to make before allowing anything by mouth?
Gaga reflex needs to return
Ph: 7.32
PaCO2: 24
HCO3: 13
PaO2: 87
Interpretation and interventions?
metabolic acidosis with partial compensation and normal oxygenation
- monitor ABGs
- Initiate seizure precautions
- Prepare buffer or base IV solution for admin
What signs and symptoms are you likely to notice in a patient with pulmonary artery hypertension? name at least 3-5
RS HF signs and symptoms
1. Peripheral edema
2. JVD
3. Weight gain
4. Dyspnea
5. delayed capillary refill
What is the best exam to diagnose lung cancer. Explain the process.
Lung biopsy.
CT guided needle biopsy that take a small tissue sample of the patient to diagnose cancer.
This delivery device is at least 6-10 LPM
Simple Mask
What test can be used to determine if there is the presence of a clot somewhere in the body but not necessarily helpful for confirming or identifying where?
D dimer (detective d dimer)
Ph: 7.50
PaCo2: 38
HCO3: 25
PaO2: 92
Interventions and interpretation
Metabolic alkalosis with no compensation
- monitor ABGs
- treat the underlying causes
- monitor for respiratory distress
What is the goal and #1 treatment intervention for PAH?
Vasodilator the pulmonary artery with sildenafil or. remodeling infusions to keep the artery patent
What is a pulmonary function test?
Used in COPD to determine the breathing capacity person with COPD. It looks at values like FEV1 (forced expiratory volume) FVC (forced vital capacity) and FEV1/ FVC Ratio: low ration indicate impairment
what mask is used for titrating off a ventilator of COPD exacerbations
What type of test is performed to determine the chemical makeup of the blood to assess for pulmonary compliance? Who can perform this test?
ABG
RT
You have a patient diagnosed with an asthma exacerbation who is sitting in the ED. Current VS: HR:118 RR: 30 BP: 130/87 O2: 92%. RT comes and does an ABG. What do you expect the ABG to read and what kind of interventions might you interpret?
I expect the ABG to show Respiratory alkalosis with hypoxemia. I would want tor breach into a bag or a rebreather, provide O2 and provide emotional support and to monitor electrolytes.
What are some other support therapies for PAH. SATA
A. O2 therapy to maintain sat above 84% B. 5L fluid restriction
C. 2 g r=sodium restriction
D. metoprolol
E. Atorvastatin.
A, C
What test is used to repair a pleural effusion? Please discuss 3 things you are responsible for.....
1. Pre op
2. During
3. Post Op
Pre OP:
1. get signed consent
2. assess labs to look for bleeding
3. educate on what to expect (pressure, continue to take deep breaths the whole time)
4. Baseline Vitals
DURING:
- Monitor VS (any change in VS, BP, rate or rhythm)
- coaching the patient with education
POST PROCEDURE
1. check for crepitus (should be at site but not move)
2. monitor for a pneumonia, PE, or pulmonary edema
3. Follow up VS
4. Apply pressure to site
Explain the difference between a non rebreather and a simple mask?
Nonrebreather is 100% FIO2 so that you are breathing in 100% oxygen where as a simple mask needs to be above 6 L because you can suffocate on CO2