Know how to instruct a pt. to use a metered dose inhaler (MDI) 1. Take cap off and shake inhaler 2. Breathe out all the way 3. Hold the inhaler the way your doc said: A) 1-2 inches in front of your mouth B) Use spacer/holding chamber C) Put the inhaler in your mouth, you will see a lot of people do...
NUR 330 Exam 3 Review Questions and
Answers
Know how to instruct a pt. to use a metered dose inhaler (MDI) ✅1. Take cap off and
shake inhaler
2. Breathe out all the way
3. Hold the inhaler the way your doc said: A) 1-2 inches in front of your mouth B) Use
spacer/holding chamber C) Put the inhaler in your mouth, you will see a lot of people do
this
4. Breathe in slowly: as you start breathing in slowly, through your mouth, press down
on the inhaler one time. Keep breathing in slowly, as deeply as you can
5. Hold you breath as you count to 10 slowly, if you can. For inhaled quick-relief meds
wait about one minute between puffs if it is NOT a quick relief med. Rinse mouth after
inhaling a steroid or could cause thrush (a yeast infection in the mouth identified by
while painful patches)
6. Clean MDI PRN with hot water only. Dry overnight
7. Know when it will run out. Most MDIs have 200 puffs. If you are to take 8 puffs per
day, divide this by the number of puffs in the inhaler (200/8=25). You will have 25 days
to use this inhaler. write the dates on the canister in which it will run out.
Know what to teach pt about a pulmonary function test (PFT) and what to instruct them
for the test. ✅Teach: It is used to evaluate lung function. It involves the use of
spirometer to assess air movement as pt. performs prescribed respiratory maneuvers.
Instruct: Avoid scheduling immediately after meal time. Avoid administration of inhaled
bronchodilator 6 hours before procedure. Explain procedure to pt. Assess for resp.
distress before procedure and report. Provide rest after the procedure
How to find your personal best peak flow number... ✅- The highest peak flow number
you can achieve over a 2 week period when asthma is under control
- Because each pt. asthma is different, each pt. PEF may be higher or lower than the
PEF of another pt. similar to body weight and height.
- To find the best peak flow number:
* Do at least 2x/day for 2-3 weeks
* When you wake up & in later afternoon or early evening
* 15-20 minutes after taking inhaled short acting beta2-agonist for quick relief
* As instructed by health care provider
What to do for a patient once you know their peak flow number... ✅- Let your health
care provider know
- They will give you the number's that will tell pt. what to do
- The peak flow numbers are put into zone set up like traffic lights, that help you know
what to do when your peak flow number changes...
,Peak flow number: Green Zone ✅80% of your personal best numbers signals good
control. No asthma symptoms present. Take your medications as usual
Peak flow number: Yellow Zone ✅50% to less than 80% of your personal number
signals caution. If remain in this zone after several measures of peak flow, take inhaled
short-acting beta 2 agonist.
If continue in yellow zone, asthma may not be under good control. Ask doctor if need to
change or increase your patient's daily medications
Peak flow number: Red zone ✅Les than 50% of your personal best numbers signals a
medical alert. You MUST take an inhaled short acting beta 2 agonist immediately.
Call health care provider or ED & ask what to do, or go directly to hospital ED
Actions to take when Peak Flow Numbers change ✅PEF goes between ____L/min
and ____ L/min (50% less than 80% of personal best, yellow zone)
ACTION: take inhaled short acting beta 2 agonist as prescribed by your doctor
PEF increases 20% or more when measured before & after taking an inhaled short-
acting beta 2 agonist
ACTION: Talk to your doctor about adding more medicine to control your asthma better
What should nurses teach patients with asthma.. ✅- What is asthma
- What is good asthma control
- Environmental/ trigger control
- Medications
- How to use an inhaler, spacer, nebulizer
- Breathing techniques
- Correct use of peak flow meter
- Asthma action plan
Asthma: Subjective Data ✅Past- Allergic reactions, sinus issues, previous sinus
attacks & hospitalizations, Gastroesophageal reflux, Occupational exposures to
chemical irritants
Medications- Adherence, inhaler technique, meds that may precipitate attack in
susceptible asthmatics
Activity- exercise; fatigue; decreased or absent exercise tolerance
Sleep- rest: awaken from sleep due to cough or breathing problems; insomnia
Coping- stress tolerance: emotional distress, stress in work environment or home
How to recognize respiratory acidosis ✅pH <7.35
PaCO2 >45
Know the values of PaO2 to identify if hypoxia is an issue... ✅Two best indicators is
SATS >90 (to prevent hypoxia) and ABGs
PaO2 above 80 to prevent hypoxia
Know the importance of pursed lip breathing ✅Breathing exercises may assist patient
during rest and activity by:
- Decreasing dyspnea
- Improving oxygenation
- Slowing the respiratory rate
How to teach patient pursed lip breathing and when ✅Smell the roses; blow out the
candles
What is Cor Pulmonale ✅Right sided hypertrophy of the heart caused by pulmonary
hypertension
What would you want to teach a patient with COPD who needs oxygen therapy? ✅-
O2 therapy should not exceed 2 L
- Critical to start on low level O2 and monitor them with ABGs
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