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Med-Surg Exam 3 NURS 121

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What is the Purpose of Chest Physiotherapy? (P.416)
- Consists of Postural Drainage, Percussion, and Vibration
- For Patients with Weak Cough and Risk for Retaining Secretions
- Patients with COPD, Cystic Fibrosis, Bronchiectasis
What is the Purpose of Purse Lip Breathing? (P.413)
- Promotes CO2 Excretion; Used when Patient Feels Short of Breath
- Helps Keep Airway Open During Diaphragmatic Breathing
- Inhale Slowly by Nose On the Count of Two
- Exhale Slowly by Pursed Lips to the Count of Four
Signs and Symptoms of a Tension Pneumothorax? (P.460)
- In a Closed Pneumothorax, Tension Builds Up in the Pleural Space
- This Tension Puts Pressure on Heart and Vessels
- Results in Reduced Cardiac Output

- Symptoms of Shock
- Dyspnea, Chest Pain, and Tachypnea
- Breath Sounds Absent or Diminished on Affected Side
Differentiate Between the Different Respiratory Patterns and Lung Sounds. Give Examples of Respiratory Related Respiratory Conditions: Cheyne-Stokes, Kussmaul’s, Eupnea, Hyperventilation, Hypoventilation, Wheezing, Stridor, Crackles, Pleural Friction R
- Cheyne-Stokes (P.331) – Shallow – Deep – Apnea Breathing Cycle.
- Kussmaul’s (P.658) – Body’s Attempt to Reduce Acidosis by Deepening Respirations.
Expired Air has Fruity Odor, Caused by Diabetic Ketoacidosis, Type I.
- Eupnea – Normal Relaxed Breathing.
- Hyperventilation (P.59) – Caused by Anxiety when a Person Takes Rapid Deep Breaths.
Serum pH Level is Increased.
- Hypoventilation (P.58) – Inadequate Breathing that Results in Inadequate Oxygenation.
Build-Up of Carbon Dioxide Leads to Respiratory Acidosis.
- Wheezing – High Pitch Whistling Sound Produced by Air Flowing Through Narrow Breathing Tube
Common in Asthma and COPD.
- Stridor – High Pitch Vibratory Noise Caused by Airway Obstruction, and Turbulent Airflow
- Crackles – Abnormal Breath Sounds Caused by Excessive Fluid in the Airways
- Pleural Friction Rub - Occurs when Thickened, Roughened Pleural Surfaces Rub Together
What Does Oxygen Saturation Value Measure? (P.411)
- Also Called Pulse Oximetry, O2 Sat, and SaO2
- Method of Monitoring Hemoglobin that is Saturated with Oxygen
What is the Purpose of Fowler’s Position in a Dyspneic Patient? (P.49, Found. P.1131)
- Head of Bed Elevated 45 to 60 degrees
- Promotes Cardiac & Respiratory Function by Dropping Abdominal Organs
What is the Rationale for Placing Someone with Respiratory Condition on their Non-Affected Lung Side to Improve Oxygenation? (P.413)
- Gravity Causes Greater Blood Flow to the Dependent “Good” Lung, Increasing Oxygenation
Oxygen Flow Devices (P.413)
Know the Average % Delivered of
Ø Non-Rebreather (Should Vents be Opened or Closed, Should Bag be Inflated?)
Ø Nasal Cannula
Ø Non-Rebreather:
- Vents Allow Expiration but Closed During Inspiration
– Side Vents Closed to Limit Mixing Room Air with O2
- Ensure that Reservoir is Never Allowed to Collapse to Less than Half Full

Ø Nasal Cannula
– O2 Delivered at Rate of 1 to 6 L/minute
Teaching Instructions for Patients using an MDI Corticosteriod and Adrenergic Bronchodilator? (P.415)
- Metered Dose Inhaler – Method to Administer Topical Mediators to Lungs Minimizing Side-Effects
- Do Not Overuse Inhalers with Extra Puffs (May Cause Bronchoconstriction or Death)
What is the Purpose of Incentive Spirometry? (P.415)
- Encourages Deep Breathing in Risk of Collapse or Atelectasis
- Commonly Used in Post-Operative Patients, 10 times/hr when Awake
What are Key Assessment Areas for Someone with a Chest Tube. Consider the Equipment too? (P.417-418)
- Respiratory Rate, Shortness of Breath
- Auscultate for Lung Sounds
- Observe Dressing is Intact
- Palpate Around Insertion for Crepitus
- Too Many To List, Refer to Book
What is the Indication/Rationale for Cough and Deep Breathing? (P.412)
- Effective Coughing Can Keep Airways Clear of Secretions
- Take 2 to 3 Breaths Using Diaphragm
- After 3rd Breath, Hold Breath, then Cough Forcefully
Explain to a Patient what to Expect During and After a Bronchoscopy? (P.413)
- Uses a Flexible Telescope to Examine Larynx, Trachea, & Bronchial Tree
- Can be Used to Remove Obstruction, Foregin Body, or Thick Secretions
- Patient is NPO 6 to 8 hrs Before Procedure
- After Procedure, NPO Until Gag Reflex Return
What are Treatment Options for Someone with Lung Cancer? (P.463)
Ø Are some Considered Palliative Only?
- Treatments are Stage Based
- Non-Small Cell Lung Cancer - Surgical Removal of Tumor
- Lobectomy (Removal of Lobe or Entire Lung) – More Advanced Cases
- Surgery Contraindicated in Metastasized to Distant Areas
- Combination of Chemo, Radiation, and Surgery Used as Adjuvant Treatments
Explain Pleural Effusion and Treatment to a Patient? (P.447)
- Excess Fluid Collects in Pleural Space
- Fluid Normally Enters Capillary Space and then Reabsorbed by Lymphatic System
- Pathological Condition Can Cause Excess Fluid Build-Up or Poor Reabsorption
- Effusion Can be Transudative or Exudative

- Therapeutic Thoracentesis – X-Ray is Used to Determine Location of Fluid
- Needle is Inserted to Drain Fluid
What is the Best Way to Monitor the Progress of a Patient with Asthma? (P.453)
- Monitor Peak Expiratory Flow Rate
- From a Fully Inflated Lung, Amount of Air Pt. Can Blow into Peak Flow Meter
- Treatment is Initiated when Level Falls Below Set Point
Why are Corticosteriods Used in Patients with COPD? (P.450, 452)
- Potent Anti-Inflammatory Agent
At what Flow Rate Should a Patient with COPD Receive Oxygen? Why? (P.450)
- 1 to 2 Liters
- Prevent Suppression of Hypoxic Drive
What Narcotic Medication Helps Reduce Dyspnea in a Patient with End Stage COPD? How? (P.452)
- Codeine, PO
- Dextromethorphan (DM) as in Robitussin DM (No it does not stand for Doctor Mom)
What are the Nursing Interventions for a Patient with Cystic Fibrosis, with Nursing Diagnosis of Ineffective Airway Clearance? (P.446, 456)
- Turn Patient Every q2h or Ambulate by Self
- Administer Ordered Expectorants
- If Patient is Unable to Cough, Suction per Orders
- Obtain Order for Chest Physiotherapy or Flutter Valve
Common Respiratory Changes Associated with Aging? (P.406)
- Lung Tissue Deteriorates; Alveoli are Lost as Walls Detriorate
- This Results in Decreased Ventilation & Lung Capacity
- Cilia of the Mucosa Deteriorate; Alveolar Macrophages Not as Efficient
How Best to Assess for Cyanosis in a Dark Skinned Individual? (P.408)
- Assess Color of Skin, Lips, Mucous Membrane, and Nailbeds
What is the Term Used to Describe Blood Tinged Sputum? (P.443)
- Hemoptysis
What is the Term Used to Describe a Swollen Area Considered a Positive Reading at the Site of PPD Injection? (P.443)
- Test is Considered Positive If an Induration Occurs 48 to 72 hrs
Why is a Candida Skin Test Sometimes Done at the Same Time as PPD? (P.444)
- Test for Anergy or Inability of Immune System to React to an Antigen
- If Candida Produces a Postive Result, the TB Results are Considered Reliable
What are Major Risk Factors for TB? (P.443)
- Crowded or Poorly Ventilated Living Conditions
- Prevalent Among Urban Poor & Minority Groups
What are Common Drug Used to Treat TB? (P.444)
- Treatments Consist of Specific Antibiotic Therapy
- First Line Antibodies – Toxic to Liver and Nervous System
- Second Line Antibodies – More Toxic and Given to Cases that Do Not Respond to First Line
When Should Health Providers Caring for TB Patients (Name of Health Care Provider Mask too) and TB Patients Themselves Wear Masks? (P.443)
- If Physician Orders “Sputum Culture for AFB”
How Long Does an Individual Need to Stay on TB Meds? Why is it Important for the Individual to take the Full Course? (P.442)
- Drugs Must be Take 6 to 8 months or Longer
- First 2 months Directly Observed
- When Antibiotics are Taken Intermittently, More Virulent Bacteria Survive and Multiply
What are the Major Risk Factors for Pulmonary Embolism? (P.457)
- Most Originate in the Deep Veins of Lower Extremeties
- Surgical Procedure Under General Anesthesia, Heart Failures, Fracture
- Fractures of Lower Extremities, Obesity
What is the Common Pharmacological Treatment for Pulmonary Embolism? (P.458)
- Heparin is Given Continuously via Continuous IV Infusion
When is the Chest Tube Normally Removed from a Patient Recovering from a Pneumothorax? (P.???)
- UNABLE TO FIND ANSWER
- When Pneumothorax has Resolved (P.418)????
Define Hemothorax? (P.460)
- Refers to the Presence of Blood in the Pleural Space
Give Rationale for Positioning a Nosebleed Patient Sitting Up and Leaning Slightly Forward? (P.428)
- To Avoid Aspirating or Swallowing Blood
What is the Purpose of Epinephrine Application in Epistaxis? (P.428)
- Constrict Vessels & Slow Bleeding
Risk Factors for Epistaxis? (P.428)
- Dry Cracked Mucous Membranes
- Trauma, Forceful Nose Blowing, Nose Picking, Pressure on Fragile Capillaries
Teaching Issues Surrounding Adrenergic Nasal Spray (Afrin)? (P.431)
- Maybe Used for Up to 3 days; Longer Use May Cause Rebound Congestion
- Constrict Blood Vessels and Reduce Swelling; Care in Patients with Hypertension and Heart Disease
Define Viral Rhinitis, Common Treatment? (P.431)
- Inflammation of Nasal Mucous Membrane
- Release of Histamine Causes Vasodilation and Edema
Most Common Complication of Influenza? (P.434)
- Pneumonia
- Assess Fever, Shortness of Breath, Crackles of Wheeze
Signs/Symptoms of Larynx Cancer? (P.435)
- Hoarseness, Vocal Cords Located in Larynx
- Pain, Shortness of Breath, and Chronic Cough
Risk Factors for Larynx Cancer? (P.434)
- Alcohol, Tobacco Used
- Industrial Chemical Exposure
Priority Nursing Intervention Following Larynectomy Surgery? (P.436)
- Assess Airway Patency and Respiratory Function
Why are Narcotics Cautiously Used in Larynectomy Patients? (P.436)
- Reduces Cough Reflex which is Vital to Clearing the Airway
Signs and Symptoms of Sinusitis? (P.430)
- Pain Over Affected Region
- Purulent Nasal Discharge
- Fever, Generalized Fatigue, Foul Breath
What is the Purpose of a Ventilation Perfusion Scan? On Exam if no Blood Supply is found what Condition is Implicated? (P.411)
- Also Called a Lung Scan
- Radioactive Substance Injected via IV and Scan is Done to View Blood Flow to Lungs
- If an Area has no Blood Supply a Pulmonary Embolism is Suspected
- Another Radioactive Substance is Inhaled and Shows how well O2 is Distributed in Lungs
- Chronic Lung Disease may Cause Poor Ventilation and Perfusion
What Common Condition is Treated with NIPPV? (P425)
- Patients with Severe Respiratory Disease
- Sleep Apnea, or Neuromuscular Disease (Amyotropic Lateral Sclerosis)
Describe the Pathophysiology and Etiology, S/S, and Treatment of Asthma and Emphysema? (P.449-452)
Asthma:
- Inherited, Allergens, Air Pollution

- “Attacks” Last from minute to days. Chest Tightness, Dyspnea, and Difficulty Moving Air In & Out
- Monitor PEFR

Emphysema:

- Hyperinflated Lungs, Barrel Chesting
- Shortness of Breath, Activity Intolerance

- Stop Smoking
- Oxygen 1-2L
- Pneumococcal Vaccination
What Conditions/Factors Place Someone at Risk for Atelectasis? (P.448)
- Post Surgical Patients who do NOT Cough and Deep Breathe
- Anything that Causes Hypoventilation
Describe Cor-Pulmonae and it’s Relationship to Chronic Lung Disease? (P.328)
- Right Ventricle Fails Due to Increased Pulmonary Pressure
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