Nur 265 - Respiratory Test Questions
With Correct Solutions.
Chronic Obstructive Pulmonary Disease - Answer Characterized by airflow obstruction resulting from
chronic bronchitis and emphysema
• Cigarette smoking - causative factor in 90% of patients
• Environmental & genetic factors (alpha1-antirypsin deficiency)
• Second hand smoke, urban pollution, occupational exposure to toxins
COPD - Pathophysiology - Answer • Chronic Bronchitis - excessive accumulation of mucous secretions
block the airway, bronchospasm and inflammation of the bronchi and bronchioles
• Emphysema - There is destruction of the walls of the overdistended alveoli which results in impaired
gas exchange
COPD - Smoking - Answer Interferes with cilliary cleansing mechanism of respiratory tract; causing
airflow to be obstructed. The aveoli become over distended and there is diminished lung capacity. Also
irritates mucous glands, increasing mucous secretions. This all causes protease release which breaks
down the elastin in the aveoli.
Arterial blood gases PaO2: Range and abnormal findings - Answer 80 - 100
↑=excessive O2 admin
↓=COPD, asthma, chronic bronchitis, cancer of bronchi and lungs, CF, respiratory distress syndrome,
anemias, atelectasis, hypoxia
Arterial blood gases PaCO2: Range and abnormal findings - - Answer 35 - 45
↑=COPD, asthma, pneumonia, anesthesia effects, opoids, respiratory acidosis
↓=hyperventiliation, respiratory alkalosis
Arterial blood gases -pH: Range and abnormal findings - Answer 7.35 - 7.45
,↑=metabolic or respiratory alkalosis
↓=metabolic or respiratory acidosis
Arterial blood gases HCO3: Range and abnormal findings - - Answer 21 - 28
↑=respiratory acidosis as compensation for a primary metabolic alkalosis
↓=respiratory alkalosis as compensation for a primary metabolic acidosis
COPD - Emphysema - Answer Some alveoli are destroyed and others become large and flabby which
decreases area for effective gas exchange trapping air in the lungs. The hyper inflated lung flattens the
diaphragm and increases the work of breathing
• The patient adjusts by increasing respiratory rate. Carbon dioxide retention and respiratory acidosis
occur.
• In late stage emphysema, there is a low oxygen level because the oxygen has a hard time moving from
disease lung tissue into the bloodstream.
COPD - Symptoms - Answer • Dyspnea (even at rest in late stages), cough, orthopnea
• Patient can't forcibly exhale air from lungs
• Risk for respiratory: infections, insufficiency and failure
• FEV/FVC ratio <70% = COPD
• "Barrel Chest", air trapped in lungs (from Emphysema)
• Diminished breath sounds with expiration. Dry crackles and wheezes heard at base with forced
expiration
• Increased total lung capacity, functional residual capacity and residual volume due to trapped air
• ABG's (In advanced cases) = high PCO2, low PO2
• Chest X-Ray: low flat diaphragm and hyperinflation
COPD - Typical Clinical Picture - Answer Increased RR, rapid, shallow respirations, use of accessory
muscles (abdomen and neck), limited diaphragmatic excursion (diaphragm is flattened)
• If the PO2 is chronically decreased: clubbing of fingers, cyanosis, delayed capillary refill
• Patient with an 8 pack a year history usually has obstructive changes but no manifestations
,• Patient with a 20 pack history or longer often has early stage COPD found as changes in pulmonary
function test
COPD - Treatment - Answer • First intervention: improve gas exchange and maintain patent airway
• Monitor COPD patient q2h even if he is there for other reasons
• Deterioration of condition may require intubation and mechanical ventilation
Oxygen Therapy - Answer • ABGs are best means to determine need for oxygen and its effectiveness
• Pulse Ox can be used to determine the oxygen needed
• Typical patient requires oxygen flow of 2-4 liters via nasal cannula or 40% Venturi mask
• Patients with low oxygen level and high CO2 level require 1-2 liters/min via nasal cannula because low
oxygen level is the patients's primary stimulus to breathe
COPD - Medulla Oblongata (MO) Respiratory Center (ANS) - Answer Has 2 stimuli for respiration: the
oxygen drive and carbon dioxide drive.
• When blood O2 is below normal, through the oxygen drive, the MO stimulates the patient to breathe
• When blood CO2 is above normal, through the carbon dioxide drive, the MO stimulates the patient to
breathe
• Patients with COPD who always have an increased CO2 level, the carbon dioxide drive stops working
and only the oxygen drive stimulates breathing. If this patient is given a high O2 flow rate and the O2
level becomes too high, the oxygen drive will not stimulate breathing and the patient may stop
breathing.
• Once respirations stop, they may not start back
COPD - Breathing Techniques - Answer • Pursed Lip Breathing - close mouth, breathe in through the
nose and out through pursed lips slowly taking twice the amount of time it took to breathe in. Use
during physical activity
• Abdominal Breathing - the patient lies on his back with his knees bent. Breathe from the abdomen
while keeping the chest still with a book on the abdomen to create resistance
• Positioning - patient should be kept in semi Fowlers or Fowler's position to ease the work of breathing
• Exercise conditioning - exercises the large muscle groups or restraints the respiratory muscles as part of
a pulmonary rehabilitation programs (breathes against a set resistance or hyperventilates into a machine
that controls O2/CO2 concentrations)
, COPD - Nursing Care - Answer • Energy conservation - pace activities with rest periods in-between.
Place frequently used objects nearby, adjust work heights, do not work with arms raised and refrain from
talking during activities
• Controlled coughing - hug pillow against stomach with head bent slightly downward. After the third to
fifth deep breath (in through nose, out through pursed lips) the patient produces 2 or 3 strong coughs
through the same breath
• Suctioning - nasotrahceally by RT of the nurse or orally if the patient has difficulty expectorating
effectively
COPD - Diet - Answer • 2-3 Liters of fluids PO to liquefy secretions, rest before meals and may need
assistance.
• May need 4-6 small meals, bronchodilator may be used 30 minutes before eating.
• Avoid caffeine (dehydrating), milk, chocolate and dry foods (stimulate coughing). Eat a high calorie,
high protein diet.
• Severe COPD patient may be thin with loss of muscle mass in the extremities and enlarged neck
muscles
• Positioning - For patients who can tolerate it, should sit in chair for one hour periods 2-3 times a day
COPD - Postural Drainage - Answer Moves secretions from smaller bronchial airways to main bronchus
and trachea. Then the patient coughs up secretions.
• The patient should inhale bronchodilators and mucolytic agents before postural drainage. Is usually
done before meals and at bedtime.
• Patient should assume each position for 10-15 minutes
COPD - CPT - Answer Percussion alternates with vibration in each position
• After the postural drainage procedure, encourage the patient to cough, auscultate the lungs (before
and after) and encourage the patient to exhale through pursed lips
COPD - Medications - Answer • Bronchodilators - SE: CNS excitetment, increased pulse and respirations
• Albuterol (Proventil, Ventolin) - inhalation or PO
• Theophyllines (Aminophylline by IV infusion, Elixophylline PO) - increase the enzyme that reduces
smooth muscle bronchospasm
