Basic Anatomy
What is the primary function of the respiratory system?
Oxygen intake and carbon dioxide removal
What is pleural effusion? What signs and symptoms can a nurse expect to hear in a patient suffering from this condition?
Pleural effusion is the accumulation of fluid in the pleural space surrounding the lungs. This may occur due to cancer, inflammation, infection, etc...
S/S include: dyspnea, cough, pleuritic (sharp, stabbing) chest pain
What is pneumonia?
Pneumonia is an infection that inflames the alveoli, causing them to become filled with fluid or pus.
What is asthma?
A chronic inflammatory disorder causing reversible airway obstruction.
What is a pulmonary embolism (PE)?
A blockage of the main artery of the lung or one of its branches due to clot that detached/broke off.
What is the difference between the upper and lower respiratory tract?
The upper respiratory tract warms, humidifies, and filters air.
The lower respiratory tract is where gas exchange occurs.
What is the difference between pleural effusion and pneumothorax?
Pleural effusion is the accumulation of fluid in the pleural space surrounding the lungs.
Pneumothorax is the collection of air in the pleural space surrounding the lungs.
A patient presents to the ED with a 101.2 degree fever, a productive cough with green sputum, and dyspnea. Upon examination, the nurse hears crackles in the lungs. What issue does the nurse suspect the patient has?
a. RSV
b. Pneumonia
c. RSV
d. Fungal infection
B. Pneumonia
The patient has the key symptoms of pneumonia:
-Fever, productive cough
-Chest pain, dyspnea
-Crackles on auscultation
What is COPD?
A collection of lower airway disorders that interfere with airflow and gas exchange. These disorders include emphysema (alveolar problem) and chronic bronchitis (airway problem).
Bronchitis: inflammation and mucus of the bronchi
Emphysema: alveolar destruction
What is the leading cause of malignancies of the respiratory tract?
Smoking is the leading cause.
Why are properly functioning alveoli important to have?
Alveoli are the site of gas exchange i.e. oxygen comes in and carbon dioxide is removed. Additionally, surfuctant on the alveoli reduce surface tension so the lungs do not have to work as hard to expand when breathing.
What is a thoracentesis?
Thoracentesis aka pleural tap is a procedure used to remove fluid or air from the pleural cavity. There should never be air or fluid in the pleural cavity due to the risk of them compressing the lung.
A patient presents to the ED and is diagnosed with pneumonia. What is the nurse's first priority?
a. Oxygen therapy & hydration
b. Incentive Spirometry
c. Prompt Antibiotic administration
d. Put the patient in a private room
C. Prompt Antibiotic Administration
This is the nurse's first priority because bacteria is causing the pneumonia and must be treated with antibiotics. Without treating the infection, the patient is more likely to deteriorate.
A patient begins having an acute asthma attack. Which medication should the nurse administer first?
a. Inhaled corticosteroid
b. Albuterol
c. Oxygen
d. Fluids
B. Albuterol
Albuterol is the rescue medication and number one priority for a patient having an acute asthma attack, because it will open up the airways allowing the patient to breathe better.
A patient is en route to the ED for a suspected pulmonary embolism. What symptoms does the nurse suspect the patient to have? SATA.
a. SOB
b. Tachycardia
c. Coughing
d. Anxiety or feeling of doom
e. Low oxygen saturation
All answers are S/S of a PE.
S/S:
-Sudden SOB
-Tachycardia
-Increased HR
-Tachypnea
-Coughing
-Possible pain in calf (before clot breaks off)
-Anxiety or feeling of i.e. feel as if something is wrong
-Pleuritic chest pain
-Low oxygen saturation
What does the ventilation/perfusion ratio indicate?
Indication of how well alveolar ventilation matches pulmonary capillary perfusion.
Healthy V/Q ratio for the entire lung is 0.8.
A patient presents to the ED with signs and symptoms of a collpased lung (pneumothorax). What procedure will the nurse most likely have to prepare the patient for?
Pleural tap aka thoracentesis in which a needle is inserted into the pleural cavity or space to remove the air.
A patient presents to the ED after spitting up blood. He also complains of a persistent cough for 3 weeks, night sweats that leave him drenched, and a 5 lb weight loss. The patient also states he came back from international travel 4 weeks ago. Which condition does the nurse suspect the patient has?
a. Tuberculosis
b. COPD
c. Pneumonia
d. Influenza
a. Tuberculosis
The patient is exhibiting the classic symptoms of Tuberculosis:
-Persistent cough >3 weeks
-Hemoptysis (spitting up blood)
-Night sweats
-Weight loss
A patient has a history of COPD and presents to the ED with a COPD exacerbation. The provider orders an ABG. The results are pCO2: 60, pH of 7.28, and an HCO3 of 24. How does the nurse interpret these findings?
a. Metabolic Acidosis
b. Respiratory Acidosis
c. Respiratory Alkalosis
d. Metabolic Alkalosis
b. Respiratory Acidosis because the CO2 is greater than 45 (respiratory) and the pH is less than 7.35 (acidic). Those with COPD tend to have an ABG finding of compensated respiratory acidosis with hypoxemia.
Why is lung cancer diagnosed late?
Lung cancer often presents with subtle symptoms in its early stages, leading to late diagnosis and more challenging treatment outcomes.
Wheezing, Rhonchi, Rales (Crackles), Stridor, Pleural Friction Rub
A nurse received a call from an incoming ambulance with a patient suffering from a pneumothorax. What signs and symptoms can the nurse expect the patient to present with? SATA.
a. pleuritic chest pain
b. bradycardia
c. eupnea
d. hypertension
e. midline trachea
f. hypoxia
a, f are some S/S a patient may with pneumothorax may present with.
S/S: pleuritic chest pain, SOB, cough and fever is less common, tachycardia, tachypnea, hypoxia/hypoxemia, hypotension, tracheal deviation/JVD
The nurse is teaching a student about the different stages of tuberculosis. Which statesment indicates the student understands the teaching?
a. Primary infection is always transmissible
b. An active infection is not transmissible
c. Someone in a latent stage of TB is contagious
d. Latent infection is never contagious
d. Latent infection is never contagious
3 stages of Tuberculosis:
i. Primary infection: usually not transmissible
ii. Latent infection: not sick and never contagious
iii. Active infection: sick and may also be able to transmit bacteria to others
A patient presents to the ED with a COPD exacerbation. What is the nurses's first priority?
a. Administer low-flow oxygen at a rate of 2L/min
b. Administer a bronchodilator
c. Encourage the patient to use pursed-lip breathing
d. Promote smoking cessation and pulmonary hygiene
a. Administer low-flow oxygen at a rate of 2L/min
This is the nurse's first priority, because it will stabilize the patient. Think about your ABCs.
Create your own practice questions!!!
This will help you retain the information better!!!
Good luck on Exam #2!!!