ATI-MED-SURG EXAM QUESTIONS& ANSWERS

diffcult to breathe. Risk factors: genetics, immune response, allergens, exercise, air pollution, occupational hazards, respiratory tract infections, nose and sinus issues, drug and food allergens/additives, GERD, ...

diffcult to breathe. Risk factors: genetics, immune response, allergens, exercise, air pollution, occupational hazards, respiratory tract infections, nose and sinus issues, drug and food allergens/additives, GERD, psychological factors (extreme emotion can cause an episode). Types of triggers: strong odors, pollution, anger, stress, pets, exercise, pollen, bugs, chemicals, cold air, spores, dust and smoke. There are di6erent triggers from person to person. Peak ow meter: used to see where they are at, to plan for their cares. FEV1 – forced expiratory volume for 1 second. Aerochamber: seals the medication in the chamber – helpful when patient is coughing while trying to take medication so they don't lose it. Asthma classi$cations (Per the lecture, we don't need to know speci$cs, but we need to be aware of them): Intermittent – symptoms are less than 2 days a week, 0-1 exacerbations per year. No limitations. Persistent mild – Symptoms are greater than 2 days a week, not daily. Exacerbations 2x a year. FEV1 = >80% predicted. Persistent moderate – daily symptoms, night >1/week. SABA usage daily. Some limitations. FEV1 = 60-80% predicted. Persistent severe – symptoms are continuous, nighttime often. SABA several times a day. FEV1 = <80% predicted. Goal of asthma tx: achieve and maintain control. Monitoring the disease and assess at severity. Asthma medications (Meds are the examples mentioned in the lecture). LONG TERM MEDS: Anti-in0ammatories (Singulair) such as corticosteroids (inhaled or oral), leukotriene modi'ers, Anti-igE. Bronchodilators (Atrovent, Serovent) such as long-acting B2-adrenergic agonists and methylxanthines (rarely used). QUICK RELIEF MEDS: Bronchodilators (Albuterol, Proventil) such as short acting inhaled B2 adrenergic agonists, anticholinergic drugs. Anti- in0ammatories (Solumedrol) such as systemic corticosteroids by IV pus patient education on asthma: Identi'cation and avoidance of known personal triggers. Premedication if triggers can't be avoided and you know prior to exposure. Acute management – ASSESSMENT is crucial. Listen to their lungs, what are their sats, etc. Be aggressive with breathing treatments, medications. Provide a calm environment. Discharge teaching: review their meds, have patient demo the technique. Develop an action plan – when to call doc, when to take meds. Pneumonia: inammatory response in lungs – something is irritating the lining. Then alveoli 'lls with uids and debris, increase production in mucous Leads to a decrease in gas exchange, air can't get through to the alveoli. Antibiotic medications needed. Diagnostic: CBC draw – elevated WBC, neutrophils, temperature. If it involves a substantial portion of one or more lobes, it's lobar pneumonia. Bronchopneumonia is more common, and it is distributed in a patchy fashion. Community acquired pneumonia is the 6 th leading cause of death in people over 65. It is community acquired if happened to patient who has not been hospitalized or residing in a long-term care facility within 14 days of onset. Risk factors: abdominal/thoracic surgery, > 65 years old, air pollution, altered LOC, chronic disease, immunosuppressed, LTC resident, smoking, tracheal intubation, URI, NGT, COPD community acquired PNa is caused by Streptococcus pneumoniae. healthcare associated/hospital acquired Hospital acquired occurs 48 hours or longer after hospital admission. Aspiration pneumonia, opportunistic pneumonia: route of entry. Penicillin resistant pneumonia risk factors: >65 years, alcoholism, immunosuppressed. Enteric gram negative bacteria risk factors: LTC resident, underlying cardiopulmonary disease, recent antibiotics. ventilator associated pmeumonia. Pseudomonas risk factors: structural lung disease, corticosteroid treatment, malnutrition, broad spectrum antibiotics >7 days in the last month. Clinical manifestations: elevated WBC, sudden onset of chills, rapidly rising fever, pleuritic chest pain that is aggravated by coughing and deep breathing, low SPO2. Tachypnea, signs of respiratory distress, orthopnea, leaning forward, poor appetite, diaphoresis, easily tired. Diagnostic and assessment $ndings: recent respiratory infection, physical examination, chest xray, blood culture, sputum examination Care: vaccinations for patients older than 65, prompt treatment, supportive measures (bronchodilators, corticosteroids) rest but not overdoing it – improved diaphragm movement, chest expansion, mobilizing of secretions. Drug therapy is broad, especially if organism is unknown. Hydration is important, but keep in mind comorbidities (CHF, renal problems). Nursing management and interventions: assess past history, meds. Goal is to reduce the risk of pneumonia by hand washing, nutrition, cough/sneezing in elbows not hands, identifying at risk patients, monitor patient condition while hospitalized. Tuberculosis: infectious, contagious disease caused by mycobacterium tuberculosis. Involves the lungs and is the leading cause of death in patients with HIV. Global issue. Occurs most in the poor, minority and underserved populations. Speci'c populations at risk: prisons, homeless, people from 3 Rd world countries, inner city population due to close proximity, IV/drug abusers, immunosuppressed and multi-drug resistant individuals. Latent TB vs. TB disease Latent TB has no symptoms, you don't feel sick. You can't spread TB, but you do have a positive skin and blood test. Normal chest xray and in need of treatment to prevent active TB. Active TB has symptoms present – bad cough longer than 3 weeks, pain in the chest, coughing up blood or sputum, weakness, fatigue, no appetite, chills, fever, sweating at night. Feeling sick, positive TB test, abnormal chest xray and in need of treatment. Diagnostics: skin test, interferon assays, chest xray, sputum collection – 3 separate collections on di6erent days. First thing in the morning. Nursing interventions and management: treated as an outpatient; if there is positive sputum, they are considered infectious for 'rst 2 weeks after starting treatment. Advise them to avoid travel, public transportation, limits visitors. Medications: initial phase – INH, rifampin (Rifadin), pyrazinamide (PZA) ethambutol (Myambutol) given daily for 8 weeks. Continuation phase – INH and rifampin or INH and rifapentine daily for 4-7 months. Patient education and med compliance is crucial – encourage adherence. Screening programs for at-risk populations. Put on airborne precautions, wear proper protection (mask). Sputum should be in a bag and treated as infectious drainage. When transporting the patient, they need to wear a mask. Limit visitors, identify and screen close contacts- have them tested. A negative culture must be done to be deemed not infectious/contagious. Discharge teaching: avoid groups of people – church, public places, etc. Don't share a bed. Ensure adequate ventilation in your home. Spend as much time outdoors as possible. TAKE YOUR MEDS. Be aware of S/S in case of relapse (5%). Notify the health department – they monitor TB cases Discuss nursing assessment, independent and collaborative management of dyspnea. Dyspnea is labored or di:cult breathing. Signs and symptoms of respiratory distress: Speaking in words, not sentences. In severe cases, patient may be unable to talk. Sitting forward, wheezing. Respirations are greater than 30. Pulse greater than 120. Usage of accessory muscles/rib movement when breathing. Patient may be agitated. Distention in the neck Analyze the eff?ects of dyspnea on the physical & psychosocial functioning of the patient. shortness of breath is expected during exercise but should return to baseline within 5 minutes after the exercise.Shortness of breath usually increases during exercise, but the activity is not being overdone if breathing returns to baseline within 5 minutes after stopping. Bronchodilators can be administered 10 minutes before exercise but should not be administered for at least 5 minutes after activity to allow recovery. Patients are encouraged to walk 15 to 20 minutes a day with gradual increases, but actual patterns will depend on patient tolerance. Dyspnea most frequently limits exercise and is a better indication of exercise tolerance than is heart rate in the patient with COPD. 6. Identify & Describe Assessments priorities for a patient with respiratory problems- Pulmonary Emboli: occurs when an obstruction of pulmonary artery or branch by blood clot, air, fat, amniotic uid or septic thrombus. Inammatory process then obstructs the area, resulting in absent or diminished blood ow. Bronchioles constrict, increasing pulmonary vascular resistance and pulmonary arterial pressure as well as right ventricular workload. There is a ventilation-perfusion imbalance -> right ventricular failure -> shock. Risk factors: immobility, hypercoagulability, diabetics, venous endothelial disease, heart disease, trauma, postop/postpartum, COPD, obesity, oral contraceptives, history of thrombophlebitis. Prevention: anticoagulants, thrombolytic therapy, SCDs/stockings, frequent ambulation after surgery, exercises. Chronic emboli intervention: umbrella 'lter procedure, placed into the veins to catch any clots so they don't get any further. Signs and symptoms: sudden onset of tachypnea, chest pain, hypoxia, SOB, tachycardia, coughing up blood. Nursing interventions: monitor labs while patient is on anticoagulants (INR for Coumadin therapeutic levels, PTT for Heparin), implement prevention and educate the patient on s/s. Atelectasis is the airless condition of alveoli caused by hypoventilation, obstruction to airways or compression, can't get air all the way through. RISK