Obstructive Pulmonary Diseases
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| A pt is concerned that he may have asthma. Of the s/s, which may suggest asthma or risk factors for asthma? | show 🗑
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| show | a) PEFR <300 L/min
c) Unable to speak in complete sentences
d) Lack of response to conventional treatment
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| show | a) I use my corticosteroid inhaler when I feel short of breath
Rationale: A rescue plan for patients with asthma includes taking 2 to 4 puffs of a short-acting bronchodilator (not a corticosteroid) every 20 minutes (3 times) to obtain rapid control of symptoms.
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| Which meds would be most apprpriate to administer to a pt w/an acute asthma attack? | show 🗑
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| The plan of care for the patient w/COPD should include? | show 🗑
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| show | c) deliver a precise concentration of O2
Rationale: The Venturi mask is a high-flow device that delivers fixed concentrations of O2 (e.g., 24% or 28%, independent of the patient’s respiratory pattern).
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| show | d) To determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day.
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| show | a) Sperm banking
c) airway clearance techniques (Acapella)
d) GoLYTELY given as needed for severe constipation
e) inhaled tobramycin for Pseudomonas infection
Rationale: Guys-no vas deferens to transport sperm, Airway clearance tech's inc CPT, positive expiratory pressure devices, breathing exercises, and high-frequency chest wall oscillation systems. Severe constipation can be treated by thinning bowel contents. Inhaled tobramycin is effective in patients with CF who have Pseudomonas infections.
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| show | a) blood clots in the sputem
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| show | Peak expiratory flow is increased
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| show | Pulse rate of 72 beats/min
Rationale:
Albuterol is a β2-agonist that can sometimes cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 72 beats/min indicates that the patient does not have tachycardia as an adverse effect.
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| show | Narrowing of the airway
Rationale:
Narrowing of the airway by persistent but variable inflammation leads to reduced airflow, making it difficult for the patient to breathe and producing the characteristic wheezing. Laryngospasm, pulmonary edema, and overdistention of the alveoli do not produce wheezing.
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| The nurse is caring for a patient with an acute exacerbation of asthma. After initial treatment, what finding indicates to the nurse that the patient’s respiratory status is improving? | show 🗑
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| show | Increasing dyspnea
Rationale:
The significant manifestations to report to the health care provider include increasing dyspnea, fever, chills, increased sputum production, bloody sputum, and chest pain.
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| show | Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse.
Rationale:
It is important to keep track of peak flow readings daily, especially when the patient’s symptoms are getting worse. The patient should have specific directions as to when to call the provider based on personal peak flow numbers. Peak flow is measured by exhaling into the flowmeter and should be assessed before and after medications to evaluate their effectiveness.
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| The nurse is teaching a patient how to self-administer beclomethasone, 2 puffs inhaled every 6 hours. What should the nurse teach the patient to do to prevent oral infection while taking this medication? | show 🗑
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| show | Effective and productive coughing
Rationale:
Airway clearance is most directly evaluated as successful if the patient can engage in effective and productive coughing. Absence of dyspnea, improved mental status, and PaO2 within normal range for the patient show improved respiratory status but do not evaluate airway clearance.
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| show | Daily weight
Rationale:
Corticosteroids such as prednisone can lead to weight gain. For this reason, it is important to monitor the patient’s daily weight. The drug should not affect the apical pulse, bowel sounds, or deep tendon reflexes.
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| show | Arterial pH 7.26
Rationale:
The patient’s pH shows acidosis that supports an exacerbation of COPD along with the worsening dyspnea. The PaCO2 has improved from baseline, the tripod position helps the patient’s breathing, and the increase in sputum expectoration will improve the patient’s ventilation.
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| show | “Breathe out slowly before positioning the inhaler.”
Rationale:
It is important to breathe out slowly before positioning the inhaler. This allows the patient to take a deeper breath while inhaling the medication, thus enhancing the effectiveness of the dose. The inhaler should be shaken well. A spacer may be used. Holding the breath after the inhalation of medication helps keep the medication in the lungs, but 30 seconds will not be possible for a patient with COPD.
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| show | Albuterol
Rationale:
Albuterol is a short-acting bronchodilator that should be given initially when the patient has an asthma attack.
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| show | Systemic corticosteroids
Rationale:
Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is insufficient
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| show | Keep track of the number of inhalations used.
Rationale:
It is no longer appropriate to see if a canister floats in water or not because this is not an accurate way to determine the remaining inhaler doses. The best method to determine when to replace an inhaler is by knowing the maximum puffs available per MDI and then replacing it after the number of days when those inhalations have been used (100 puffs/2 puffs each day = 50 days).
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| Before discharge, the nurse discusses activity levels with a 61-yr-old patient with chronic obstructive pulmonary disease (COPD) and pneumonia. Which exercise goal is most appropriate once the patient is fully recovered from this episode of illness? | show 🗑
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| show | “You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia.”
Rationale:
Long-term oxygen therapy in the home will not be considered until the oxygen saturation is less than or equal to 88% and the patient has signs of tissue hypoxia, such as cor pulmonale, erythrocytosis, or impaired mental status. PaO2 less than 55 mm Hg will also allow home oxygen therapy to be considered.
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| show | Work of breathing
Rationale:
When the patient does not have sufficient gas exchange to engage in activity, the etiologic factor is often the work of breathing. When patients with asthma do not have effective respirations, they use all available energy to breathe and have little left over for purposeful activity.
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| show | Hyperinflation of alveoli and destruction of alveolar walls
Rationale:
In COPD, structural changes include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity.
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| show | “More of the medication will get down into my lungs to help my breathing.”
Rationale:
A spacer assists more medication to reach the lungs, with less being deposited in the mouth and the back of the throat. It does not affect the cost or increase the speed of using the inhaler.
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| show | Exercise
Allergies
Emotional stress
Upper respiratory infections
Rationale:
Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, upper respiratory infections, drug and food additives, stress, and gastroesophageal reflux disease (GERD).
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| show | Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed.
Rationale:
The patient must take pancreatic enzymes before each meal and snack and adequate fat, calories, protein, and vitamins should be eaten. Fat-soluble vitamins are needed because they are malabsorbed with the excess mucus in the gastrointestinal system.
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| show | Increase intake to at least 12 eight-ounce glasses of fluid every 24 hours.
Rationale:
Adequate hydration helps to liquefy secretions and thus make it easier to remove them. Unless there are contraindications, the nurse should teach the patient to drink at least 3 L of fluid daily.
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| A patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD) needs to receive precise amounts of oxygen. Which equipment should the nurse prepare to use? | show 🗑
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| Assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)? | show 🗑
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| show | Preventing bronchial collapse and air trapping in the lungs during exhalation
Rationale:
The purpose of pursed-lip breathing is to slow down the exhalation phase of respiration, which decreases bronchial collapse and subsequent air trapping in the lungs during exhalation.
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| show | “If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily.”
Rationale:
The patient should not just keep taking extra puffs of the inhaler to make breathing easier. Excessive treatment could trigger paradoxical bronchospasm, which would worsen the patient’s respiratory status.
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| An 18-yr-old patient at the student health center with a history of frequent lung and sinus infections has manifestations consistent with undiagnosed CF. Which information would be accurate for the nurse to include when teaching the patient about a scheduled sweat chloride test? | show 🗑
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| Which test result identifies that a patient with asthma is responding to treatment? | show 🗑
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| The nurse supervises a team including another registered nurse (RN), a licensed practical/vocational nurse (LPN/VN), and unlicensed assistive personnel (UAP) on a medical unit. The team is caring for many patients with respiratory problems. In what situation should the nurse intervene with teaching for a team member? | show 🗑
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| The provider has prescribed salmeterol (Serevent) for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, what instructions should the nurse provide? | show 🗑
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| The nurse teaches a patient with chronic obstructive pulmonary disease (COPD) how to administer fluticasone by metered-dose inhaler (MDI). Which statement indicates a correct understanding of the instructions? | show 🗑
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| When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse determines that the patient’s nutritional status is impaired after noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care for this patient? | show 🗑
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| A 45-yr-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which manifestation would be an early indication of an exacerbation of asthma? | show 🗑
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| show | Decreased alveolar macrophage function.
Rationale:
The damage to the lungs includes alveolar macrophage dysfunction that increases the incidence of infections and thus increases patient discomfort and cost to treat the infections. Other lung damage that contributes to infections includes cilia paralysis or destruction, increased mucus secretion, and bronchospasms that lead to sputum accumulation and increased cough.
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| show | Teach the patient to use pursed-lip breathing.
Rationale:
Pursed-lip breathing (PLB) prolongs exhalation and prevents bronchiolar collapse and air trapping. PLB is simple and easy to teach and learn. It also gives the patient more control over breathing. Evidence from controlled studies does not support the use of diaphragmatic breathing in patients with COPD.
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| The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. What is the primary reason for the nurse to carefully inspect the chest wall of this patient? | show 🗑
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| show | High Fowler’s
Rationale:
The patient experiencing an asthma attack should be placed in high Fowler’s position and may need to lean forward to allow for optimal chest expansion and enlist the aid of gravity during inspiration
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| The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone after what occurs? | show 🗑
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Created by:
dkorak