Advanced Med-Surg Proctored ATI Review Exam - Questions and Answers (Complete Solutions) Arterial Blood Gas ABG's via arterial puncture or arterial
... [Show More] line: allows the most accurate method of assessing respiratory function. Steps for collecting ABG's a. Perform Allen test if no arterial line b. sample is drawn into heparinized syringe c. keep on ice and transport to laboratory immediately d. document amount and method of oxygen delivered for accurate results e. apply direct pressure to puncture site at least 5 min (longer for clients at risk for bleeding) Bronchoscopy visualizes the larynx, trachea, bronchi; obtains tissue biopsy; and removes foreign bodies. Steps for a bronchoscopy procedure a. obtain informed consent b. maintain NPO 8 to 12 hr. c. Provide local anesthetic throat spray d. position upright e. administer medications as prescribed, such as atropine (to reduce oral secretions), sedation, and/or anti-anxiety. f. label specimen g. observe postprocedure -gag reflex -bleeding -respiratory status, vital signs, and level of consciousness Mantoux test Positive test indicates exposure to tuberculosis. Diagnosis must be confirmed with sputum culture for presence of acid-fast bacillus (AFB). Mantoux test steps a. administer 0.1 mL of purified protein derivation intradermal to upper half inner surface of forearm (insert needle bevel up) b. Assess for reaction in 48 to 72 hr following injection; induration (hardening) of 10 mm or greater is considered a positive test; 5 mm may be considered significant if immunocompromised. QuantiFERON-TB Gold test (QFT-GT) and T-SPOT.TB Identify the presence of Mycobacterium tuberculosis infection by measuring the immune response to the TB bacteria in whole blood. Thoracentesis Surgical perforation of the pleural space to obtain specimen, to remove fluid or air, or to instill medication. Steps for Thoracentesis a. informed consent b. educate client: remain still, feeling of pressure, positioning c. position upright d. monitor respiratory status and vital signs e. label specimens f. Document client response, amount, color and viscosity of fluid (maximum amount of fluid to be removed at a time is 1L). g. Chest tube at bedside h. Obtain CXR before and after procedure Asthma Chronic inflammatory disorder of the airways resulting in intermittent and reversible airflow obstruction of the bronchioles. Contributing factors of asthma -Extrinsic: antigen-antibody reaction triggered by food, medications, or inhaled substances -Intrinsic: pathophysiological abnormalities within the respiratory tract -Older clients: beta receptors are less responsive to agonist and trigger bronchospasms. Manifestations of asthma -Sudden, severe dyspnea with use of accessory muscles -sitting up, leaning forward -diaphoresis and anxiety -wheezing, gasping -coughing -cyanosis (late sign) -barrel chest Diagnostic procedures for asthma -ABGs -sputum cultures -pulmonary function tests Nursing interventions for asthma -remain with the client during the attack -position in high-fowler's -assess lung sounds and pulse oximetry -administer oxygen therapy -maintain oxygen access Medications for asthma Administer bronchodilators before anti-inflammatory 1. Bronchodilators -short-acting inhaled: albuterol; for rapid relief -Methylxanthines: theophylline; monitor therapeutic range for toxicity. 2. Anti-inflammatory -corticosteriods: fluticasone and prednisone -Leukotriene antagonist: montelukast 3. Combination agents -Ipratropium and albuterol (Combivent) -Fluticasone and salmeterol (Advair) Therapeutic measures for asthma -respiratory treatments -oxygen administration Client Education for asthma -avoidance of allergens and triggers -proper use of inhaler and peak flow monitoring Status asthmaticus life-threatening episode of airway obstruction this is often unresponsive to treatment Manifestations of status asthmaticus -extreme wheezing -labored breathing -use of accessory muscles -distended neck veins -high risk for cardiac and/or respiratory arrest Nursing interventions for status asthmaticus -place in high-fowler's -prepare for emergency intubation -administer oxygen, epinephrine, and systemic steroid as prescribed -provide emotional support Chronic Obstructive Pulmonary Disease encompasses pulmonary emphysema and chronic bronchitis. COPD is not reversible. Pulmonary emphysema -destruction of alveoli, narrowing of bronchioles, and trapping of air resulting in loss of lung elasticity Contributing factors of pulmonary emphysema -cigarette smoking (main causative factor); passive smoke inhalation -advanced age -exposure to air pollution -Alpha-antitrypsin deficiency (inability to break down pollutants) -Occupational dust and chemical exposure Manifestations of emphysema -dyspnea with productive cough -difficult exhalation, use of pursed-lip breathing -wheezing, crackles -barrel chest -shallow, rapid respirations -respiratory acidosis with hypoxia -weight loss -clubbed fingernails -fatigue Chronic bronchitis inflammation and hypersecretion of mucus in the bronchi and bronchioles caused by chronic exposure to irritants Contributing factors to chronic bronchitis -cigarette smoking (main causative factor) -exposure to air pollution and other environmental irritatants Manifestations of chronic bronchitis -productive cough -thick, tenacious sputum -hypoxemia -respiratory acidosis Diagnostic procedure for COPD -chest x-ray -pulmonary function test: air remains trapped in lungs -pulse oximetry: often less than 90% -ABGs: chronic respiratory acidosis -CT-scan Nursing interventions for COPD -assess respiratory status -assess cardiac status for signs of right-sided failure -position upright and leaning forward -schedule activities to allow for frequent rest periods -administer oxygen therapy as prescribed -use incentive spirometry -encourage fluids 2 to 3 L per day unless contraindicated -encourage high-calorie diet -provide emotional support Medications for COPD -bronchodilators -methylxanthines -anti-inflammatory agents -mucolytic agents Therapeutic measures for COPD -chest physiotherapy/pulmonary drainage -lung reduction surgery Education and referral for COPD -breathing techniques -oxygen therapy -medications -nutrition -promote smoking cessation -infection prevention measures -encourage immunizations for pneumonia and influenza -pulmonary rehabilitation -activity pacing Complications of COPD Cor Pulmonale: right-sided heart failure caused by pulmonary disease. Manifestations of Cor Pulmonale -hypoxia (deficient perfusion) and hypoxemia (deficient oxygen in blood) -extreme dyspnea -cyanotic lips -JVD -dependent edema -hepatomegaly (enlarged liver) -pulmonary hypertension Nursing interventions of Cor Pulmonale -monitor respiratory status -monitor cardiac status and assess for indications of right-sided heart failure -administer oxygen therapy as prescribed -ensure adequate rest periods -encourage low-sodium diet -maintain fluid balance; possible fluid restriction -administer medications as prescribed [Show Less]