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Final Exam Blueprint
After a thoracentesis, a chest x-ray is ordered, why? What SS should we look out for after thoracentesis?
• To rule out pneumothorax and mediastinal shift
• Assess for leakage or bleeding, listen to the lungs for absent or reduced sounds, skin swelling
around puncture site (subq emphysema), excess coughing, air hunger, rapid shallow respirations
What should we monitor for after lung biopsies?
• Hemoptysis or frank bleeding from vascular or lung trauma
• Pneumothorax (monitor for decreased or absent breath sounds)
What is methemoglobinemia? What causes this?
• Conversion of normal hemoglobin to hemoglobin that doesn’t carry oxygen.
• Benzocaine spray
Pneumothorax SS?
• Pain on affected side that that’s worse at end of inhalation and exhalation, rapid HR, rapid and
shallow resp, air hunger, cyanosis, nagging cough (new onset)
What are some complications of tracheal suctioning? (QSEN page 509)
• Hypoxia, infection, trauma, bronchospasm, cardiac dysrhythmias, tissue integrity
What are some nursing interventions regarding suctioning?
• Humidify air to reduce thick, dried secretions
• Hyper oxygenate the patient to prevent hypoxia
• Prevent trauma to mucosa suctioning only when needed and lubricating the catheter with sterile
water
• Suction for only 10 to 15 seconds bc longer can lead to alveolar collapse
• Use sterile technique to prevent infection
What do you do for a posterior epistaxis?
• These need to be packed, if packing doesn’t work possible cauterization, also possible
epistaxis catheter
• avoid nose blowing
• no NSAIDS, no aspirin, take TYLENOL
What are some concerns when it comes to facial trauma?
• Halo around blood indicative of CSF leakage > skull fracture
• Battle scar > indicative of skull fracture
What are the Short Acting Beta 2 Agonist (SABAs) used for?
• Reliever or rescue drugs ex: Albuterol, Levalbuterol
• If used excessively causes tachycardia
• Should take 5 minutes prior to LABAs
, 2
What are LABAs (long-acting beta 2 agonists)?
• Controller drugs have slow onset and longer duration than SABA
• Prevent asthma attacks, don’t stop them
• Ex: Salmeterol, Indacterol, Formoterol
What are the specific drugs for Pulmonary Tuberculosis therapy?
• INH and Rifampin
• Rifampin impacts birth control pills > tell patients to have another form of birth control, causes
jaundice, and turns secretions an orange-reddish color
• NO ALCOHOL while on these drugs bc they already mess up liver
What drugs used for pneumonia?
• Beta 2 agonists (Albuterol and Salmeterol)
• Guaifensin
!!!Symptoms of PT?
• persistent cough, unintended weight loss, night sweats, hemoptysis, SOB, fever or chills
What should we ask the patient regarding PT?
• If they’ve had a pos tb test > get a chest x-ray IMMEDIATELY
• If they’ve had a BCG vaccine? > they will have a positive tdap if they’ve had this vaccine
Patient education for Tuberculosis?
• Patient needs to maintain good hygiene and avoid infecting others
• Usually no longer contagious after 2-3 weeks of drug regimen, MUST stay on drug for 6 months
What is DOT? When is it used?
• Directly observed therapy
• Patient is non-compliant to tuberculosis drug therapy
!!!!What are signs of respiratory inadequacy?
• Cannot speak more than 4 or 5 words?
• Very confused, (not enough O2 to brain like they're sleepy now, can't concentrate, agitated)
• Circumoral cyanosis
• Tachycardia bc heart now must work harder to pump blood
• Fatigue
• Intercostal retractions and suprasternal retractions (working harder and harder to breathe)
What is a total laryngectomy?
• Removes the whole larynx
Total Laryngectomy discussions with pt. ?
• 11th cranial nerve removed > pt. Will suffer from shoulder drop
• How will they communicate with you (text, board, gestures?)
Final Exam Blueprint
After a thoracentesis, a chest x-ray is ordered, why? What SS should we look out for after thoracentesis?
• To rule out pneumothorax and mediastinal shift
• Assess for leakage or bleeding, listen to the lungs for absent or reduced sounds, skin swelling
around puncture site (subq emphysema), excess coughing, air hunger, rapid shallow respirations
What should we monitor for after lung biopsies?
• Hemoptysis or frank bleeding from vascular or lung trauma
• Pneumothorax (monitor for decreased or absent breath sounds)
What is methemoglobinemia? What causes this?
• Conversion of normal hemoglobin to hemoglobin that doesn’t carry oxygen.
• Benzocaine spray
Pneumothorax SS?
• Pain on affected side that that’s worse at end of inhalation and exhalation, rapid HR, rapid and
shallow resp, air hunger, cyanosis, nagging cough (new onset)
What are some complications of tracheal suctioning? (QSEN page 509)
• Hypoxia, infection, trauma, bronchospasm, cardiac dysrhythmias, tissue integrity
What are some nursing interventions regarding suctioning?
• Humidify air to reduce thick, dried secretions
• Hyper oxygenate the patient to prevent hypoxia
• Prevent trauma to mucosa suctioning only when needed and lubricating the catheter with sterile
water
• Suction for only 10 to 15 seconds bc longer can lead to alveolar collapse
• Use sterile technique to prevent infection
What do you do for a posterior epistaxis?
• These need to be packed, if packing doesn’t work possible cauterization, also possible
epistaxis catheter
• avoid nose blowing
• no NSAIDS, no aspirin, take TYLENOL
What are some concerns when it comes to facial trauma?
• Halo around blood indicative of CSF leakage > skull fracture
• Battle scar > indicative of skull fracture
What are the Short Acting Beta 2 Agonist (SABAs) used for?
• Reliever or rescue drugs ex: Albuterol, Levalbuterol
• If used excessively causes tachycardia
• Should take 5 minutes prior to LABAs
, 2
What are LABAs (long-acting beta 2 agonists)?
• Controller drugs have slow onset and longer duration than SABA
• Prevent asthma attacks, don’t stop them
• Ex: Salmeterol, Indacterol, Formoterol
What are the specific drugs for Pulmonary Tuberculosis therapy?
• INH and Rifampin
• Rifampin impacts birth control pills > tell patients to have another form of birth control, causes
jaundice, and turns secretions an orange-reddish color
• NO ALCOHOL while on these drugs bc they already mess up liver
What drugs used for pneumonia?
• Beta 2 agonists (Albuterol and Salmeterol)
• Guaifensin
!!!Symptoms of PT?
• persistent cough, unintended weight loss, night sweats, hemoptysis, SOB, fever or chills
What should we ask the patient regarding PT?
• If they’ve had a pos tb test > get a chest x-ray IMMEDIATELY
• If they’ve had a BCG vaccine? > they will have a positive tdap if they’ve had this vaccine
Patient education for Tuberculosis?
• Patient needs to maintain good hygiene and avoid infecting others
• Usually no longer contagious after 2-3 weeks of drug regimen, MUST stay on drug for 6 months
What is DOT? When is it used?
• Directly observed therapy
• Patient is non-compliant to tuberculosis drug therapy
!!!!What are signs of respiratory inadequacy?
• Cannot speak more than 4 or 5 words?
• Very confused, (not enough O2 to brain like they're sleepy now, can't concentrate, agitated)
• Circumoral cyanosis
• Tachycardia bc heart now must work harder to pump blood
• Fatigue
• Intercostal retractions and suprasternal retractions (working harder and harder to breathe)
What is a total laryngectomy?
• Removes the whole larynx
Total Laryngectomy discussions with pt. ?
• 11th cranial nerve removed > pt. Will suffer from shoulder drop
• How will they communicate with you (text, board, gestures?)
