NURSING 6560 EXAM 3 MEDSURG

NURSING 6560 EXAM 3 MEDSURG Chapter 20: 1. Tonsils and adenoids: chain of lymph nodes guarding the body from invasion by organisms entering the nose and the throat. Question from ppt: T or F: The purpose of the cilia is to move the mucus back to the pharynx TRUE 2. A prominent function of the sinuses is to serve as a resonating chamber in speech. The sinuses are a common site of infection. 3. Perfusion is influenced by alveolar pressure. The pulmonary capillaries are sandwiched between adjacent alveoli and, if the alveolar pressure is sufficiently high, the capillaries are squeezed. Pulmonary hypertension, in which the capillaries in the alveoli are squeezed excessively Question from ppt: What is gas exchange between the lungs and blood and between the blood and tissues? Respiration 4. Egophony: abnormal change in tone of voice that is heard when auscultating the lungs. Describes voice sounds that are distorted. It is best appreciated by having the patient repeat the letter E. The distortion produced by consolidation transforms the sound into a clearly heard A rather than E 5. Assessment: Abnormal (adventitious) breath sounds: Crackles Wheezes Friction rub 6. Assessment findings consistent with a pleural effusion include affected lung fields being dull to percussion, absence of breath sounds and a pleural friction rub may also be present Pneumonia- egophony, which can be best assessed by instructing the client to repeat the letter E. The distortion produced by consolidation transforms the sound into a clearly heard A rather than E Emphysema-breath sounds are faint or often completely inaudible and the expiratory phase is prolonged 7. Tidal volume (TV)-volume of air inspired and expired with a normal breath 8. Health History: Dyspnea-(subjective feeling of difficult or labored breathing, breathlessness, shortness of breath), how severe is the shortness of breath? On a scale of 1 to 10, if 1 is not at all breathless and 10 is very breathless, how hard is it to breathe? 9. Diagnostic Tests  Pulmonary function tests refer to Table 20-9-routinely used in patients with chronic respiratory disorders to aid diagnosis. They are performed to assess respiratory function and to determine the extent of dysfunction, response to therapy and screening. PFT measures how much air moves in and out of your lungs when you breathe Sputum tests-sputum samples ideally are obtained early in the morning before the patient has had anything to eat or drink Chapter 21: 1. Oxygen Toxicity  Prevention PEEP or CPAP prevent or reverse atelectasis and allow lower oxygen percentages to be used Question from ppt: The primary oxygen administration method for a patient with COPD is nasal cannula T or F? False – Venturi mask Is the following statement true or false? The patient should be encouraged to use an incentive spirometer approximately 10 breaths per hour between treatments while awake: TRUE 2. Mini-Nebulizer therapy  nursing care refer to chart 21-4  Diaphragmatic breathing (see Chart 21-4) is a helpful technique to prepare for proper use of the small-volume nebulizer 3. Endotracheal intubation: Endotracheal and tracheostomy tubes have several disadvantages. The tubes cause discomfort. The cough reflex is depressed because glottis closure is hindered. 4. Tracheostomy: When a tracheostomy or endotracheal tube is in place, it is usually necessary to suction the patient’s secretions because of the decreased effectiveness of the cough mechanism 5. Tracheostomy: Permits the long-term use of mechanical ventilation 6. Maintain patency by proper suctioning-tracheal suctioning is performed when adventitious breath sounds are detected or whenever secretions are obviously present 7. Criteria for weaning-stable vital signs and arterial blood gases are also important predictors of successful weaning. 8. Chest drainage-fluctuation of the water level in the water seal shows effective connection between the pleural cavity and the drainage chamber and indicates that the drainage system remains patent. 9. Improving airway clearance-if the client is retaining secretions, the nurse should first encourage the client to cough before performing more invasive interventions 10. Patient teaching and home care considerations: In addition, respiratory care and other treatment modalities (oxygen; incentive spirometry; CPT; and oral, inhaled, or IV medications) may be continued at home. Therefore, the nurse needs to instruct the patient and family in their correct and safe use Chapter 22: 1. Rhinitis and rhinosinusitis: acute, chronic a. The nurse also educates the patient about the side effects of prescribed and OTC nasal sprays and about rebound congestion (rhinitis medicamentosa) Question on ppt: Acute pharyngitis of a bacterial nature is most commonly caused by group A beta-hemolytic streptococci TRUE What should the nurse palpate when assessing for an upper respiratory tract infection? Neck Lymph Nodes 2. Prevention of upper airway infections-clients with nasotracheal and nasogastric tubes in place are at risk for development of sinus infections Question on ppt: An early sign of cancer of the larynx includes changes in speech, the voice may sound harsh, raspy, and lower in pitch TRUE Chapter 23: 1. The effectiveness of the client's oxygen therapy is assessed by the ABG analysis or pulse oximetry 2. Strategies to expand lungs and manage secretions-include frequent turning, early ambulation, lung-volume expansion maneuvers (deep-breathing exercises, incentive spirometry), and coughing, serve as the first-line measures to minimize or treat atelectasis by improving ventilation a. Incentive spirometer 3. Advocating adherence to the treatment regimen is key in treating the disease and controlling the spread of infection 4. Gerontologic Considerations-the diagnosis of pneumonia may be missed because the classic symptoms of cough, chest pain, sputum production, and fever may be absent or masked in older adult patients. In addition, the presence of some signs may be misleading 5. Key characteristic of pleuritic pain is its relationship to respiratory movement, taking a deep breath, coughing, or sneezing worsens the pain 6. Pleurisy  Treat underlying cause, provide analgesia, teaching to splint the rib cage when coughing (The nurse also educates the patient to use the hands or a pillow to splint the rib cage while coughing) 7. Exercises to avoid venous stasis  early ambulation, anti-embolism stockings Question on ppt: T or F  Bradypnea is the most common sign for a possible pulmonary embolism. FALSE An initial characteristic symptom of a simple pneumothorax is sudden onset of chest pain T or F? TRUE Chapter 24: Question from ppt: For patients with chronic bronchitis the nurse expects to see the major clinical symptoms of tachypnea and tachycardia T or F? FALSE  It is sputum and productie cough What is the primary clinical symptom of emphysema? Wheezing 1. Medical Management  Reducing risk factors-Chart 24-1-Environmental risk factors for COPD include prolonged and intense exposure to occupational dusts and chemicals, indoor air pollution, and outdoor air pollution 2. Achieving airway clearance-changes in the airway require that the nurse monitor the patient for dyspnea and hypoxemia 3. Bronchiectasis: Nursing Management  Patient teaching  Postural drainage-Patients and families are taught to perform postural drainage and to avoid exposure to people with upper respiratory or other infections 4. Patient teaching  How to identify and avoid triggers-Educating clients about recognizing and avoiding asthma triggers How to perform peak flow monitoring-Peak flow meters measure the highest airflow during a forced expiration Chapter 25: 1. Three layers of the heart  endocardium, myocardium and epicardium