Tuberculosis
Isolation precautions for clients with active TB.
Answer: What is airborne precautions (private, negative airflow room), client wears surgical mask when leaving room.
Client presentation with emphysema.
Answer: What is barrel chest, increased chest diameter, weight loss/thin appearance, increased RR and work of breathing (accessory muscle use), prolonged expiratory phase.
Rationale: Advanced emphysema causes barrel chest and an increased chest diameter. Increased RR and use of accessory muscles.
Weight loss and wasting occur due to decreased appetite and calorie burning with the work of breathing.
30 pack year smoking history.
Answer: What is 3 packs of cigarettes daily for 10 years of 1 pack of cigarettes for 30 years.
Clinical manifestations of laryngeal cancer.
Answer: Early Manifestation: What is hoarseness for several weeks
Later manifestations: dysphagia, dyspnea, weight loss
Rationale: Hoarseness that does not resolve for several weeks is the earliest manifestation of cancer of the larynx because the tumor impedes the action of the vocal cords during speech. The voice may sound harsh and lower in pitch than normal.
Dysphagia and dyspnea are later manifestations of cancer of the larynx. They occurs as the tumor grows in size and impedes the esophagus. Weight loss is a later manifestation of laryngeal cancer, usually indicative of metastasis.
Nursing considerations after bronchoscopy procedure.
Answer: What is assess for gag reflex before offering oral medications or foods.
Assess SpO2 every 15 minutes for 2 hours.
Rationale: Until the gag reflex returns, and the sedation effects have resolved, the client is at high risk for aspirating food or fluids.
The client might have a hoarse voice for a few days after the procedure. Drinking fluids can help.
Positive tuberculin skin test.
Answer: What is an induration that is 100mm or greater in diameter.
Complications of Chronic Bronchitis.
Answer: What is increased secretions and increased work of breathing.
Raitonale: Chronic bronchitis results in large amounts of sputum that block airways. Adequate fluids are important to keep secretion thin and easier to expel.
Encouraging ambulation to expel secretions.
It is important to keep a high-calorie diet with fats are important to maintain nutritional status compensating for the work of breathing.
Nursing considerations when performing tracheostomy care.
Answer: What is avoiding tube dislodgement and accidental decannulation.
Secure new trach ties before removing the old ones.
Rationale: Tube dislodgement and accidental decannulation are potential complications of a tracheostomy. Both can be prevented by securing the tube in place. By keeping the old ties in place while applying new ties, the nurse can secure the tube and prevent dislodgement.
The nurse should maintain sterile technique when providing tracheostomy care.
The nurse should clean the inner cannula with sterile saline. If the inner cannula is disposable, the nurse should remove it and replace it with a new one.
The nurse should apply suction only when withdrawing the catheter. Applying suction during catheter insertion causes trauma to the tracheal mucosa.
Prior to suctioning, the nurse should hyperoxygenate the client with 100% oxygen. Because prolonged suctioning can cause hypoxia, tissue trauma, or alveolar collapse, the nurse should limit suctioning passes to 10 to 15 seconds.
In addition to smoking, long-term heavy use of this substance also increases the risk of laryngeal cancer.
Answer: What is alcohol?
Rationale: Chronic heavy alcohol consumption, especially when combined with smoking, significantly increases the risk of developing laryngeal cancer
Nursing considerations for collecting acid-fast bacilli smear and culture.
Answer: What is have client rinse their mouth with water before collection of sputum. Collect sputum in the morning before a meal. Have the client cough and expectorate into a sterile specimen collection container.
Rationale: Rinsing the mouth and collecting before a meal reduces the risk of contamination of the sputum sample. Collecting the sputum in the morning is ideal because the client might have more difficulty coughing up secretions towards the night.
This symptom is one of the most common signs of active pulmonary tuberculosis and often lasts for more than three weeks.
Answer: What is a persistent cough?
Rationale: A persistent cough lasting more than three weeks is a common symptom of active pulmonary TB, often accompanied by other symptoms like fever, night sweats, and weight loss
Complications of COPD.
Answer: What is respiratory infection
Rationale: Clients with COPD have a high risk for respiratory infection. Crackles indicate excessive fluid and could indicate infection.
Nursing Considerations for thoracentesis.
Answer: What is confirming consent is obtained. Educate client on importance of remaining still for the procedure. Positioning the client sitting upright, leaning forward over the bedside table.
Rationale: For a thoracentesis the client is positioned sitting upright, leaning forward with arms and head on a bedside table. This position spreads the ribs and allows for optimal intercostal space for needle insertion.
Surgical removal of part or all of the larynx is known by this term.
Answer: What is laryngectomy?
Rationale: Laryngectomy involves the removal of part (partial laryngectomy) or all (total laryngectomy) of the larynx, which may affect speech and breathing.
Initial diagnostic test for a client exposed to TB.
Answer: What is Nucleic acid amplification test (NAAT)?
Rationale: The CDC recommends that the NAAT test replace other diagnostic screening tests for tuberculosis. The test is performed on a client's sputum.
A chest x-ray is used for diagnosis of active pulmonary tuberculosis as well as for the detection of old, healed lesions, but it is not the first diagnostic test the provider will prescribe.
A CT scan aids in confirmation of a diagnosis of pulmonary tuberculosis, but it is not the first diagnostic test the provider will prescribe.
A sputum culture is used to confirm a diagnosis of tuberculosis, but it is not the first diagnostic test the provider will prescribe.
A skin test is only used for screening and cannot diagnose active TB.
Tuberculosis is primarily transmitted through this method, especially when an infected person coughs, sneezes, or speaks.
Answer: What is airborne transmission?
Rationale: TB bacteria are spread through the air in tiny droplets when a person with active pulmonary TB coughs, sneezes, speaks, or sings. Inhaling these droplets can lead to infection, especially in close or prolonged contact situations
Side effects of ipratropium bromide.
Answer: What is dry mouth, dry eyes
Rationale: This medication is an anticholinergic that primarily works through bronchodilation of the airways. The anticholinergic effects can cause dry mouth as a common side effect so sucking on hard candy can help to decrease this. Dry eyes is also common, lubricating eye drops might be helpful.
This is the leading cause of lung cancer worldwide.
Answer: What is smoking?
Rationale: Cigarette smoking is the primary cause of lung cancer, responsible for about 85% of cases due to carcinogens in tobacco smoke damaging lung cells
This symptom, often mistaken for a sore throat, can be an early warning sign of laryngeal cancer if it persists.
Answer: What is a persistent sore throat?
Rationale: A persistent sore throat that doesn't go away, especially if accompanied by difficulty swallowing or ear pain, can be an early symptom of laryngeal cancer and should be evaluated by a healthcare professional
Client education for MDI medications and adverse effects of albuterol (Proventil.
Answer: What is shake before use (3-5seconds), close mouth over the mouthpiece to form a seal, press button down to release medication, then inhale slowly and deeply, hold medication and breath for 10 seconds prior to exhaling. Wait 30 seconds before administering a second dose. Rinse mouth after administering.
Answer: What is tachycardia, nervousness, tremors, agitation, irritability, cardiac dysrhythmias.
Rationale: Albuterol works by stimulating the sympathetic nervous system and causing bronchodilation.
This organ is most commonly affected by tuberculosis.
Answer: What are the lungs?
Rationale: Tuberculosis most commonly affects the lungs, leading to pulmonary TB. However, it can also spread to other parts of the body in extrapulmonary TB
This chronic lung disease, often caused by smoking, includes emphysema and chronic bronchitis.
Answer: What is Chronic Obstructive Pulmonary Disease (COPD)?
Rationale: COPD is a progressive lung disease that makes it hard to breathe and is commonly caused by long-term exposure to irritating gases, especially from smoking. It includes emphysema and chronic bronchitis
This imaging test is commonly used for the early detection and diagnosis of lung cancer.
Answer: What is a computed tomography (CT) scan?
Rationale: CT scans provide detailed images of the lungs, helping detect tumors at an earlier stage compared to traditional X-rays. They are often used in lung cancer screening programs, especially for high-risk individuals
Nursing considerations for client undergoing laryngectomy.
Answer: Follow ABCs of care and assess for airway patency after any neck surgery.
Rationale: When using the airway, breathing, circulation approach to client care, the nurse determines that the priority assessment is airway patency. After head and neck surgery, a major, life-threatening complication is airway obstruction. The priority actions involve airway maintenance and gas exchange.
After this the nurse should assess pain, s/s of infection, drainage/dressing.
Client education for new prescription of theophylline.
Answer: What is Take with 8 oz of water, do not take with food, do not increase protein in your diet. Avoid caffeine. Increase fluid intake to 2L/day while taking medication.
Rationale: The nurse should instruct the client that caffeine should be avoided while taking theophylline, as it can increase central nervous system stimulation. The nurse should instruct the client that a high-protein diet should be avoided, as it decreases theophylline's duration of action. The nurse should instruct the client that theophylline should be administered with 8 oz of water if GI upset occurs. It should not be administered with food. The nurse should instruct the client to increase fluid intake to 2L/day while taking theophylline to decrease the thickness of mucous secretions related to emphysema.