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A patient with asthma takes montelukast daily but uses it during an acute episode of severe wheezing. Explain why this medication will not provide the rapid relief the patient needs.
What is because montelukast helps prevent asthma symptoms by blocking leukotrienes, but it does not relax the airways quickly enough to treat an acute asthma attack?
A patient reports using an over-the-counter nasal decongestant spray for five consecutive days because of persistent congestion. Explain why prolonged use is discouraged, and how many days a decongestant should be used as most.
What is rebound congestion, which occurs when prolonged use of nasal decongestant sprays causes congestion to return or worsen, and 3 days?
A patient prescribed an inhaled corticosteroid for asthma reports that their mouth feels sore and develops white patches on the tongue. Identify the likely complication and explain how the nurse should teach the patient to prevent it.
What is oral thrush, a fungal infection that can be prevented by rinsing the mouth with water and spitting it out after each inhaled corticosteroid dose, and using a spacer with a metered-dose inhaler when appropriate?
A patient experiencing acute bronchospasm receives albuterol. Explain its mechanism of action, the expected therapeutic response, and two adverse effects you would monitor for.
What is a short-acting beta₂ agonist that relaxes bronchial smooth muscle to open the airways and relieve bronchospasm, with tachycardia and tremors as two adverse effects to monitor for?
A patient with emphysema develops progressive changes in the alveoli that impair normal exhalation. Explain the pathophysiological changes that occur, and identify the characteristic physical assessment finding associated with these changes.
What is the destruction of alveolar walls that causes decreased diffusion, air trapping, hyperinflation, and difficulty exhaling, leading to a characteristic barrel-shaped chest?
A patient with chronic bronchitis has thick secretions and an ineffective cough. Develop a nursing plan to improve airway clearance, including assessments and appropriate interventions.
What is assessing breath sounds, respiratory rate, oxygen saturation, and sputum; encouraging fluids if not restricted, promoting coughing and deep breathing, repositioning the patient, encouraging mobility as tolerated, and administering prescribed bronchodilators or mucolytic medications to help clear secretions?
A patient with acute respiratory distress syndrome (ARDS) has an SpO₂ of 82% despite receiving high-flow oxygen via nasal cannula. The patient has bilateral pulmonary infiltrates and persistent hypoxemia due to impaired diffusion across the alveolar-capillary membrane. Which positioning intervention should the nurse anticipate to improve oxygenation, and how does this intervention help improve gas exchange?
What is prone positioning, which helps improve oxygenation by recruiting more posterior alveoli and allowing oxygen to move more effectively into the blood?
A patient with suspected pneumonia has a temperature of 102.4°F, WBC count of 18,000/mm³, and crackles in the right lower lobe. Identify two diagnostic tests that could help support the diagnosis and nursing considerations for both.
What is a chest X-ray to identify lung infiltrates or consolidation, and a sputum culture to identify the organism causing the infection? For a chest X-ray, the nurse should explain the procedure will happen bedside and instruct the patient to remove metal objects from the chest area, such as necklaces and clothing with metal fasteners. For a sputum culture, the nurse should collect the sample before antibiotics are initiated.
A patient with severe asthma initially has loud wheezing but later develops diminished breath sounds, difficulty speaking, and increasing fatigue. List the three main physiologic changes in asthma, explain why the nurse should not interpret quieter breath sounds as improvement, and identify the priority response.
What are airway edema, bronchoconstriction, and increased mucus production? Quieter breath sounds can signal dangerously reduced airflow, or a “silent chest.” The priority is to call a rapid and provide oxygen support immediately.
A patient with emphysema experiences difficulty exhaling and clearing trapped air. What acid-base imbalance is the patient at risk for and why, and how would the nurse explain pursed-lip breathing to the patient?
What is respiratory acidosis, which can occur when the lungs cannot remove enough carbon dioxide? Pursed-lip breathing helps by breathing in through the nose and slowly breathing out through pursed lips, creating back pressure that helps keep the airways open longer and release trapped air.
A patient with COPD is placed on 6 L/min NC for increased SOB. Shortly afterward, he becomes bradypneic and drowsy. Explain the primary stimulus for breathing in a healthy individual, and how the regulation of respiratory drive differs in this patient.
What is the brain’s response to rising carbon dioxide levels in a healthy person, while someone with chronic COPD may rely more on low oxygen levels to stimulate breathing?
A patient with pneumonia develops impaired oxygenation due to alveolar inflammation and fluid accumulation. Differentiate ventilation, respiration, and diffusion, and explain which process is directly impaired by the alveolar changes.
What are ventilation (movement of air in and out of the lungs), respiration (the exchange of oxygen and carbon dioxide between the body and its environment), and diffusion (movement of gases across the alveolar-capillary membrane)? Alveolar inflammation and fluid buildup directly impair diffusion, making it harder for oxygen to pass into the blood.
A patient with pneumonia has worsening dyspnea, confusion, HR 124, RR 32, BP 92/58, and SpO₂ 86% on room air. Explain what these findings may indicate about the patient's condition, and identify your immediate nursing priorities.
What are signs of severe respiratory distress and possible sepsis, requiring immediate nursing action? Priorities include assessing airway and breathing, calling a rapid, administering oxygen, and closely monitoring vital signs and mental status.
A patient with asthma receives a prescribed rescue bronchodilator but continues to have significant wheezing and accessory muscle use. What should the nurse reassess, and what actions should follow if the patient shows inadequate improvement?
What is reassessing respiratory rate, breath sounds, SpO₂, work of breathing, and response to the rescue medication? If the patient does not improve, call a rapid, administer oxygen as indicated, and anticipate additional treatments (e.g., nebulized albuterol and IV corticosteroids) and possible escalation of respiratory support to BiPap or intubation?
An older adult who has been mostly immobile develops a gradual onset of fever, tachypnea, crackles, and yellow-green sputum. Explain how immobility may contribute to this patient's condition, why secretions are a concern, and five interventions to prevent onset?
What is pneumonia caused in part by pooled secretions during immobility, which can allow bacteria to grow and make airway clearance more difficult? Five interventions include repositioning the patient regularly, encouraging incentive spirometer use, promoting adequate hydration if not contraindicated, encouraging coughing and deep breathing, and promoting early mobility as tolerated.
A patient with longstanding COPD develops a cardiac complication. Explain how chronic respiratory disease can affect the heart, the name of this phenomenon, and identify the additional assessments needed to evaluate this complication.
What is cor pulmonale, or right-sided heart failure caused by chronic lung disease and increased pressure in the pulmonary blood vessels? Additional assessments include monitoring heart rate, blood pressure, SpO₂, lung sounds, peripheral edema, jugular venous distention, daily weight, and intake and output to evaluate oxygenation and fluid buildup.