O2
Abgs and Diagnostics
pneumonia
tb
pe
100
describe the difference between bradypnea, tachypnea, orthopnea, and dyspnea
brady - slow
tachy - fast
ortho - sob unless in upright position
dyspnea - difficulty breathing, sob
100
what is the least invasive means of oxygen assessment on a patient
pulse ox
100
describe the difference between community-acquired, hospital-acquired, and vent-acquired pneumonia.
community - contracted in community, first 48 of hospital stay
hospital - contracted in hospital, after 48 hours considered hospital, hard to treat bc commonly antibiotic resistant and will need multiple antibiotic treatment plan
vent acquired - pneumonia contracted after 48 hours on vent support
100
tb skin tests are read within
48-72 hours
100
what is the most frequent symptom of a pe? most frequent sign? list other manifestations
dyspnea is most frequent symptom, tacypnea is most frequent sign; sudden cheast pain, pueritic, anxiety, fear, tachycardia, apprehension, cough, diaphoresis, hemoptysis, syncope
200
list the sxs of early hypoxia
diaphoretic, restless, tachypnea, dyspnea, tachycardia, hypertension, decreased urine output, fatigue, arrythmias
200
list the 3 arteries abgs are usually drawn from and what complications may arise from taking abgs?
radial, brachial, femoral
pain, infection, hematoma, hemmorage
200
what is expected in the nursing assessment of a pt with pneumonia
SOB, rapid fever, chills, pleuritic pain, crackles, wheezing, cough and sputum production, tachypnea, sore throat, orthopnea, nasal decongestion
200
what mm indurations show signs of positive infection?
5mm immunosuppressed
10mm - high risk
15 mm - everyone else
200
what is a diagnostic workup for PE?
xray, ecg, pulse ox, abgs, d-dimer, MDCTA, or pulmoary arteriogram or V/Q
MDCTA is gold standard, then pulmonary angiography, then V/Q
300
sxs of late hypoxia
cyanosis, retractions, hypotension, cool clammy skin, arrhythmias, decreased urine output, and fatigue
300
List the resp diagnostic tests that require dye and what do you ask your patient before giving these studies? how many hours npo with contrast?
are you allergic to iodine or shellfish
lung scan (computed tomography), pulmonary angiography (consent), fluoroscopy, CT (look at kidneys disease, no pregnancy, no obesity, claustrophobia)
4 hours
300
list nursing mgmt interventions for pneumonia
improve airway patency - remove secretions through cough or suction, frequent turns
2-3 l of fluid a day (at least 2l)
humidified o2
lung expansion, deep breathing exercises
chest physiotherapy
promote rest
maintain nutrition - fluids with electrolytes (what type of solution?)
vaccines and prevention education
300
list sxs of a an active tb assessment
- Cough that lasts three weeks or more
- coughing up blood
- fever
- night sweats
- fatigue
- unintentional weight loss
- chills
- loss of appetite
- chest pain, or pain with breathing or coughing
300
what are nursing mgmt interventions for PE?
monitor thrombolytic therapy (what drug?), Manage pain - semi fowler more comfy for breathing/turn frequently, manage 02- deep breathing and incentive spirometry to prevent ateclatisis, relieve anxiety, monitor for cardiogenic shock or right ventricular failure, post op care
400
list risks associated with o2 problems
skin and tissue breakdown, syncope, acid-base balances, and feelings of hopelessness and social isolation
400
list steps on how to collect a sputum study : when? Before food or after? etc.
morning, before food, clear nose and throat, rinse mouth, cough forcefully and expectorate sputum, use aerosolized hypertonic solution via nebulizer to induce cough, watch for aspiration
400
You're educating a patient with pneumonia on how to deep breathe by using an incentive spirometer. Which of the following is the correct way to use this device?
- A. Encourage the patient to use it twice a day.
- B. The patient exhales into the device rapidly and then coughs.
- C. C
- D. The patient rapidly inhales 10 times from the device and then exhales for 6 seconds.
C. The patient inhales slowly from the device until no longer able, and then holds breath for 6 seconds and exhales.
400
list the meds for tb (think RIPE) and the best type of therapy (DOT)
how long do they take this therapy? 6-12 months
RIPE - rifampin, isoniazid, pyrazinamide, ethambutol
DOT - directly observed therapy
400
A client appears dyspneic, but the oxygen saturation is 97%. What action by the nurse is best?
a. Assess for other manifestations of hypoxia.
b. Change the sensor on the pulse oximeter.
c. Obtain a new oximeter from central supply.
d. Tell the client to take slow, deep breaths.
A ~ Pulse oximetry is not always the most accurate assessment tool for hypoxia as many factors can interfere, producing normal or near-normal readings in the setting of hypoxia. The nurse should conduct a more thorough assessment. The other actions are not appropriate for a hypoxic client.
500
The nurse goes to assess a new patient and finds him lying supine in bed. The patient tells the nurse that he feels short of breath. Which nursing action should the nurse perform first?
A: Raise the head of the bed to 45 degrees.
B: Take his oxygen saturation with a pulse oximeter.
C: Take his blood pressure and respiratory rate.
D: Notify the health care provider of his shortness of breath
raise the hob 45 degrees
500
describe bronchoscopy nursing mgmt before and after the procedure. What is your number one priority after the procedure?
before :
1. informed consent 2. npo 4-8 hours 3. remove dentures 4. watch respirations because of sedatives/ anti anxiety meds
after -
1. not discharged until cough reflex is back!! nothing by mouth until cough returns ( no ice, water, nada). 2. ice chips after cough, eventually fluids 3. monitor resp status(hypoxia, dyspnea, hypotension, tachycardia, arrhythmia, hemoptysis), small amount of blood tinged sputum and fever are normal
500
Which of the following are typical signs and symptoms of pneumonia? Select-all-that-apply:
- A. Stridor
- B. Coarse crackles
- C. Oxygen saturation less than 90%
- D. Non-productive, nagging cough
- E. Elevated white blood cells
- F. Low PCO2 of less than 35
- G. Tachypnea
- A. Stridor
- B. Coarse crackles
- C. Oxygen saturation less than 90%
- D. Non-productive, nagging cough
- E. Elevated white blood cells
- F. Low PCO2 of less than 35
- G. Tachypnea
500
list airborne precautions
- Negative pressure room (door closed at all times)
- Must wear a respirator when providing care (fitted yearly for this mask)
- Strict hand hygiene
- How about if the patient has to leave the room for testing? Many procedures can be performed by the bedside, but if the patient must leave the room they will need to wear a surgical mask.
500
A nurse answers a call light and finds a client anxious, short of breath, reporting chest pain, and having a blood pressure of 88/52 mm Hg on the cardiac monitor. What action by the nurse takes priority?
a. Assess the clients lung sounds.
b. Notify the Rapid Response Team.
c. Provide reassurance to the client.
d. Take a full set of vital signs.
B - notify rapid response