Stuffed Up
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
You are now in FLU season. What are measure to prevent the spread?
Vaccination
Handwashing
Respiratory etiquette (coughing into sleeve); 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.
O2 saturation should be > or = 92%
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. Patient semi-fowlers, try to visualize with penlight. Contact PROVIDER
Abdu come to the ED with c/o fatigue, fever, he c/o his chest hurts 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. Possible CXR, sputum Cx for C&S and antibiotics
Grace's father was a heavy smoker and she is worried about second hand exposure. What should she look for?
Hoarseness
Change in resp pattern
Persistent cough or change in cough
Blood streaked sputum
Rust color or purulent sputm
Frank hemoptysis
Chest pain or chest tightness
Shoulder, arm, or chest wall pain
Recurring pleural effusion, pna, or bronchitis
Dyspnea
Fever w/ one or two other signs
Wheezing
Weight Loss
Clubbing of fingers
Tanya is taking Rifampin. What is 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 an 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 TB patient
Negative pressure airflow room, N-95 mask (fitted respirator mask), Gown, gloves
Jake, an 18 year old facial trauma from a MVC has a LeForte 3 fracture. What is your priority and why?
AIRWAY! LeForte 3 is craniofacial disjunction and would be associated with heavy soft tissue damage that could occlude breathing through the mouth and nose. Plan for possible emergent intubation.
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.
Your trauma patient sustained a head injury when he was ejected from the vehicle. Your assessment findings show he has bruising behind his ears. What could this indicate and what is your action?
The "battle sign" bruising could indicate a basilar skull fracture and possible brain trauma and meningeal tears. Check ears for CSF leak. If leaking fluid, test with filter paper to see a "halo" ring indicating cerebral spinal fluid leak
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.
Pulmonary Hypertension? Talk to me...
Mostly women (20-40yo), increased pressure in the PA that can progress to RV failure. Without tx, can die within 2 years from cor pulmonale (profound HF)
Tx: drug therapy: prostacyclin agents (do not interupt!)