HESI MED-SURG RESPIRATORY

HESI MED-SURG RESPIRATORY HESI Med-Surg Respiratory What is a common adverse effect of the tetracycline antibiotics? Photosensitivity Why should tetracyclines be avoided in pregnant clients and children under 8 years? It can cause yellow-brown discoloration of teeth and growth retardation Antibiotics ending in -mycin are usually? nephrotoxic and ototoxic What is the patho behind chronic bronchitis? Chronic sputum with cough production on a daily basis for a minimum of 3 months in each of 2 consecutive years chronic hypoxemia, cor pulmonale increase in mucus, cilia production increase in bronchial wall thickness which obstructs air flow reduced responsiveness of the respiratory center to hypoxemic stimuli Assessment of a patient with chronic bronchitis Generalized cyanosis "blue bloater" Right-sided heart failure distended neck veins crackles expiratory wheezes Patho behind Emphysema Reduced gas exchange surface area Increased air trapping - increased AP diameter "barrel chest" decreased capillary network increased work, increased O2 consumption Assessment of a patient with emphysema Normal skin pigmentation "pink puffer" Barrel Chest Purse-lip breathing Distant quiet breath sounds Wheezes Pulmonary blebs on radiograph Nursing Plan for the patient with chronic bronchitis and emphysema Lowest FiO2 possible to prevent CO2 retention Monitor for signs and symptoms of fluid overload Maintain PaO2 between 55 and 60 Baseline ABGs Teach purse-lip breathing and diaphragmatic breathing Teach Tripod position Administer bronchodilators and anti-inflammatory agents Normal Blood gas pH in adults? Children? Adults - 7.35-7.45 Children - 7.36-7.44 Normal PCO2 blood gas 35-45 mmHg; same in adults and children Normal PO2 blood gas 80-100 mmHg; same in adults and children Normal HCO3 blood gas 21-28 mEq/L; same in adults and children Patients with COPD (emphysema and chronic bronchitis) are in a state of chronic? respiratory acidosis which results in metabolic alkalosis as compensation True or False: Damage to the lung in COPD is reversible and doesn't increase in severity. False. It is irreversible and increases in severity What is the earliest sign of cancer of the larynx? hoarseness or a change in vocal quality that last more than 2 weeks With cancer of the larynx comes what kind of color changes in the mouth or tongue? they often appear white, gray, dark brown, or black and may appear patchy True or False: After a laryngectomy, the patient will need a tracheostomy. True. What are the greatest immediate postop risks (first 24 hours) associated with a laryngectomy and tracheostomy? Observe the client for any signs of bleeding or occlusion Patients with laryngectomies and tracheostomies can no longer cough as they could before because the glottis has been removed. What should you teach your patient? The glottal stop technique to remove secretions: take a deep breath, momentarily occlude the tracheostomy tube, cough, and simultaneously remove the finger from the tube. What are the capsules in the lungs call when a patient has tuberculosis? Ghon lesions Describe a positive TB test in a healthy client an induration 10 mm or greater in diameter 48-72 hours after the skin test Some important points to teach the client with TB Take all prescribed meds daily for 9-12 months You may return to work after three negative sputum cultures. You must be in respiratory isolation while hospitalized. Teaching points for the drug Rifampin which is used to treat TB Reduces effectiveness of oral contraceptives; client should use other birth control methods during treatment. Gives body fluids orange tinge; stains soft contact lenses Teaching points for Isoniazid (INH) which is used to treat TB Increases phenytoin (Dilantin) levels Teaching points for Ethambutol which is used to treat TB Vision check before starting therapy and monthly thereafter; may have to take for 1-2 years IF a chest tube becomes disconnected, what do you do? DO NOT CLAMP IT! Immediately place the end of the tube in a container of sterile saline or water until a new drainage system can be connected. What do you do if the chest tube is accidentally removed from the client? Cover with a dry sterile dressing. IF an air leak is noted, tape the dressing on three sides only; this allows air to escape and prevents the formation of a tension pneumothorax. Notify the HCP! When will fluctuations (tidaling) occur in the chest tube system and what does this mean? This will occur if there is no external suction. These fluctuating movements are a good indicator that the system is intact; they should move upward with each inspiration and downward with each expiration. If fluctuations (tidaling) cease in the chest tube system what do you do? Check for kinked tubing, accumulation of fluid in tubing, occlusions, or change in the client's position because expanding lung tissue may be occluding the tube opening. Remember, when external suction is applied, the fluctuations cease.