Respiratory
True or False. Overusing nasal sprays for congestion can cause a paradoxical effect of congestion.
What is True.
What is the most common type of pneumonia?
Viral
One or both of these processes are inadequate with acute respiratory failure.
Oxygenation and Ventilation
What is the classic characteristic for developing ARDS?
Refractory hypoxemia.
What is the difference between ARF and ARDS and which one is worse?
ARF is Acute respiratory failure and includes the respiratory system and ARDS is acute respiratory distress syndrome and include multiple body systems. ARDS is worse.
An 82-year-old patient has a weaker cough and reports difficulty clearing respiratory secretions. Which age-related change best explains this finding?
A. Increased ciliary activity and stronger respiratory muscles
B. Decreased effectiveness of mucociliary clearance and reduced cough strength
C. Increased alveolar elasticity and improved gas exchange
D. Increased immune response to respiratory pathogens
B. Decreased effectiveness of mucociliary clearance and reduced cough strength
Which age group commonly suffers from hypothermia and confusion if diagnosed with pneumonia?
Older or debilitated patients.
If hypoxemic, the PaO2 will be less than ____ on greater than ____ oxygen.
60mm Hg and 60%
Why is hand hygiene, semi-fowlers position, daily oral care with chlorhexidine important for a patient on a ventilator with ARDS?
To prevent ventilator assisted pneumonia (VAP).
What is the priority concern in all respiratory problems?
Airway patency.
When suctioning via a tracheostomy, what must you ensure, to avoid the complication of infection?
Sterile technique.
This test is the gold standard for diagnosis of Tuberculosis.
Sputum culture for Acid-fast Bacillius test
Frequent assessments of the respiratory system are a priority, due to what failure leads to respiratory failure.
Compensatory mechanisms
A client with a severe asthma exacerbation has received repeated bronchodilator treatments. The client is becoming drowsy, and the PaCO₂ has risen from 30 to 46 mmHg. How should the nurse interpret this change?
No ventilation! Impending ventilatory failure; immediately escalate care and prepare for advanced airway support.
If a patient is short of breath and has a SpO2 of 93% on 2L NC O2, what initial action should the nurse take?
Increase the O2 flow.
The nurse hears fine crackles at both posterior lung bases in an older adult. After the patient coughs and changes position, the crackles disappear. What is the best interpretation?
Normal aging with increased secretions (Disappearing crackles are not as concerning as persistent crackles but do not rule out disease.)
A client develops severe hypoxemia after sepsis. Chest imaging shows bilateral opacities, and oxygenation remains poor despite supplemental oxygen. Which condition is most likely, and what ventilatory strategy is commonly used?
Acute respiratory distress syndrome (ARDS); Use the ventilator with lung-protective ventilation using low tidal volumes and appropriate PEEP.
What is the first clinical sign of respiratory failure?
Change in mental status
This complication is usually related to hypotension, hypoxemia or drugs treating ARDS related infections.
Acute kidney injury.
A client hospitalized with pneumonia becomes confused and lethargic. Respirations are shallow at 8/min, SpO₂ is 84% despite supplemental oxygen, and ABGs show pH 7.19, PaCO₂ 72 mmHg, and PaO₂ 49 mmHg. What is the nurse’s priority action?
Activate rapid-response support and immediately assess and support airway, breathing, oxygenation, and ventilation; prepare for possible intubation.
You have four patients:
(1) an 80-year-old with stable chronic exertional dyspnea;
(2) an 85-year-old with persistent crackles and new orthopnea;
(3) an 81-year-old with new confusion, respiratory rate 31/min, and SpO₂ 86%;
(4) a 77-year-old with a chronic cough unchanged for months. Who is your first assessment, and which findings drive your decision?
Patient 3: acute confusion, marked tachypnea, and significant hypoxemia suggest immediate respiratory deterioration.
A client with COPD becomes increasingly somnolent. ABGs show pH 7.25, PaCO₂ 68 mmHg, HCO₃⁻ 28 mEq/L, and PaO₂ 54 mmHg. Interpret the ABG and identify the priority intervention the nurse will take.
Respiratory acidosis with severe hypoxemia, consistent with acute hypercapnic respiratory failure. Urgently support oxygenation and ventilation.
What condition can happen if a patient is using high oxygen levels for an extended time?
Pulmonary fibrosis related to O2 replacing nitrogen in the alveoli which keeps them open.
What is best practice for positioning with ARDS patients?
Prone positioning to recruit alveoli.
What classification of drugs are not recommended when patients have been diagnosed with ARDS?
Beta Agonist (Albuterol). It increases HR and can cause arrythmias in critically ill patients when often lead to death.