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Your PT informs you that she can�t breathe while lying flat, and must sleep with two pillows. What type of condition is this?
orthopnea.
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What is the most definite method of diagnosing a pulmonary embolism?
pulmonary angiogram
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What is an atopic allergic reaction caused by an antigen-antibody reaction that occurs in the conjunctiva, usually resulting from a contact allergen called?
allergic conjunctivitis
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Which of the following infections is usually bacterial in origin?
acute follicular tonsillitis
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You are caring for a PT who has been diagnosed with severe acute respiratory syndrome (SARS). Which of the following assessments and/or lab data would expect to see for this PT?
Fever, headache, discomfort, muscle aches, and mild respiratory symptoms
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Which of the following statements accurately describe the disease tuberculosis (TB)?
Most people who become infected with TB organism do not progress to the active disease stage.
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Appropriate nursing care fr a PT with pneumonia includes which of the following interventions?
Assist PT to conserve energy, implement interventions to footer the ability to move sections, and educate PT on proper hand washing.
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What is the presence of infected fluid that accumulates in the pleural space is called?
empyema
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You are assisting a physician with placement of a central line in a PT. While the physician is inserting the line, the PT suddenly develops acute dyspnea and tachyon. The physician quickly directs you to �get me a chest tube tray STAT�. What do you suspect may be happening to the PT?
The development of pneumothoray
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What are the appropriate nursing interventions for a PT with chronic obstructive pulmonary following?
Get a flue vaccination every year and pneumococcal revaccination every 5 years.
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Rapid and deeper respirations are stimulated by the respiratory center of the brain when what happens?
carbon dioxide levels increase
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The tendency of molecules of a substance (gaseous, liquid, or solid) to move from a region of high concentration o one of lower concentration is the passive process in which the exchange of gases between the blood capillary and alveolar area occurs. What is this process is called?
diffusion
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The walls of the thoracic cavity are lined with a serous membrane composed of tough endothelial cells called what?
parietal pleura
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Each alveolus is coated with a thin lipoprotein covering that prevents it from collapsing after each breath. What is this this covering called?
surfactant
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The exchange of oxygen and carbon dioxide external respiration takes place where?
alveoli and pulmonary capillaries
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Mr. K, age 73, is diagnosed with chronic bronchitis. He is very dyspneic and must sit up to breathe. What is an abnormal condition in which there is discomfort in breathing in any but an erect sitting position is?
orthopnea
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Ms. C., age 45, is being evaluated to rule out pulmonary tuberculosis. Which finding is most closely associated with TB?
Night Sweats
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The health care workers for Ms. C., who is diagnosed with active tuberculosis, are instructed in methods of protecting themselves from contracting tuberculosis. The centers of disease controls and prevention currently recommend that health care workers who care for TB-Infected patients wear what?
a small micron fitted filtration mask
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The physician ordered a blood culture and sputum specimen to be obtained for Mr. G., a patient who has pneumonia. When should diagnostic tests be collected?
before initiation of antibiotic therapy
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Mrs. V., age 62, has just returned to her room following a bronchoscope. No food, or fluids should be given after the examination until what returns?
her gag reflex
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Mr. M. was in a motor vehicle accident and has a lacerated pleura secondary to fractured ribs. To promote reexpansion of his lung, what type of thoracic drainage system was used?
Closed system to maintain the lungs normal negative pressure.
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Mr. R., age 45, is a second0day postoperative patient recovering from thoracic surgery. A very therapeutive nursing intention would include what?
coughing and deep breathing the patient by splitting the anterior and posterior chest
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Mr. A., age 71, is admitted with an exacerbation of COPD. He has dependent edema and ascites as well as dyspnea. A complication that may occur in CIPD is which some of the capillaries surrounding the alveoli are destroyed, resulting in pulmonary hypertension, blood returning to the right side of the heart, and signs and symptoms of right-sided HF is what?
cor pulmonale
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Mr. F., age 52, had a laryngectomy due to cancer of the larynx. Discharge instructions are give to Mr. F. and his family. Which response, by written communication from Mr. F, or verbal response by the family, will be a signal to the nurse that the instructions need to be decalcified?
It is acceptable to take over-the-counter medications now that conditions are stable.
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Most pulmonary embolisms (PEs) originate from where?
deep vein thrombosis (DVT)
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Chest pain from pulmonary embolism (PE) is typically what?
pleuritic and worsens upon inspiration
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In the treatment of asthma, peak-flow monitoring is important to help the patient manage the asthma. Peak-flow monitoring measures what?
how well air moves out of the lungs-during forceful exhalation
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The primary goal for the patient with bronchiectasis is that the patient will what?
maintain removal of bronchial secretions.
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A patient was seen in clinic for an episode of epitasis, which was controlled by placement of anterior nasal packing. During discharge teaching, the nurse instructs the patient to do what?
avoid vigorous nose blowing and strenuous activity
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How is TB spread?
inhaling the TB bacteria after a person coughs, speaks, or sneezes
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Which type of medication is used as rescue medication in acute asthma exacerbation
Short-acting beta,-agonists.
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Asthma is best characterized as what type of disease?
an inflammatory disease
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A [patient with COPD asks why the heart is affected by the respiratory disease. The nurse�s response to the patient is based on the knowledge that cor pulmonale is characterized by what?
right ventricular hypertrophy secondary to increased pulmonary vascular resistance
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A patient with tuberculosis has a nursing diagnosis of noncompliance. The nurse recognizes that the most common etiologic factor for this diagnosis in patients with Tb is what?
little or no motivation to adhere to a long-term drug regimen
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What are the three types of anthrax?
cutaneous, gastrointestinal, inhalational
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To get optimal results from pulse oximetry, which of the following statements are correct?
Do not attach the transducer to an extremity that has blood pressure cuff in place. Place the probe over a pulsating vascular bed. Remember that hypothermia, hypotension, and vasoconstriction can affect readings.
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Ineffective airway clearance related to tracheobronchial obstruction and/or secretions is a nursing diagnosis for a patient with COPD. Which of the following are correct?
Offer small, frequent, high-calorie, high-protein feedings. Encourage generous fluid intake. Have patient turn and cough every 2 hours;; teach effective coughing technique.
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Ineffective breathing pattern related to decreased lung expansion during an acute attack of asthma is an appropriate nursing diagnosis. What are the nursing interventions?
Administer oxygen therapy as ordered, remain with patient during acute attack to decrease fear and anxiety, incorporate rest periods into activities and interventions, and maintain semi-fowlers position to facilitate ventilation.
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The patient with respiratory acidosis will demonstrate what?
Disorientation, pH of less than 7.35, rapid respirations.
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The appropriate nursing intervention for Mr. K age 40, diagnosed with active Tb would be what?
place the patient in acid -fast bacilli (AFB) isolation precautions
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Post-op teaching for a patient following a tonsillectomy and adenoidectomy would include what?
avoid attempting to clear the throat, coughing, and sneezing, avoid vigorous nose blowing for 1 to 2 weeks, resume foods and fluids as tolerated, and notify physician in case of increased pain, fever, or bleeding.
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IF the patient has an epistaxis, the correct nursing interventions would include what?
Place the patient in Fowler�s position with the head forward, compress the nostrils tightly below the bone and hold for 10 minutes or longer, or place ice compresses over the nose.
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In pulmonary edema the medical management will often include what?
Furosemide (Lasix) IV, oxygen therapy , orthopenic position, and morphine sulfate to decrease respiratory rate.
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The nursing diagnosis for a patient with pulmonary edema, excess fluid volume, related to altered tissue permeability is appropriate. What would the nursing interventions be?
Assess indicators of patient�s fluid volume status, such as breath sounds, skin turgor, and pedal/sacral/periorbital edema, mx I&O, administer diuretics as ordered, and weigh daily.
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How do you properly educate a patient on collection of a sputum specimen?
explain the need to bring the sputum up from the lungs, encourage fluid intake, notify staff as soon as the specimen is collected so it can be sent to the lab, and place sputum specimen in sterile container
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Medical management and nursing interventions of the patient with pulmonary embolism usually include what?
Bed rest, administration of IV Heparin per protocol, semi-fowlers position, and oxygen per mask or nasal cannula.
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A nurse is providing instructions to a client with a diagnosis of emphysema about positions that will enhance the effectiveness of breathing during dyspnea periods. What position will the nurse instruct the client to assume?
sitting on the side of the bed, leaning on an overbed table
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A nurse is gathering data on a client with a diagnosis of TB. The nurse reviews the results of which diagnostic test that will confirm this dx?
Sputum culture
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What identifies the route of transmission of TB?
The airborne route
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A nurse is caring for a client with emphysema who is receiving oxygen. The nurse checks the oxygen flow rate to ensure that it does not exceed what?
2L/min
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A nurse is teaching a client about pursed lip breathing and the client asks the nurse about its purpose. The nurse tells the client the primary purpose of pursed lip breathing is to what?
Promote carbon dioxide elimination
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The low pressure alarm sounds on the ventilator. The nurse checks the client then attempts to determine the cause of the alarm but is unsuccessful. What initial action will the nurse take?
Ventilate the client manually
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A nurse is assigned to care for a patient following a left pneumonectomy. The nurse would avoid positioning the client how?
On the side
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A nurse is caring for a client following pulmonary angiography via catheter insertion into the left groin. The nurse monitors for an allergic reaction to the contrast medium by noting the presence of what?
Respiratory distress
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A nurse is providing discharge instructions to a client with pulmonary sar coidosis. The nurse determines that the client understands the information if the client verbalizes what early sign of exacerbation?
Shortness of breath
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A nurse working on a respiratory unit is caring for several clients with respiratory disorders. The nurse would identify what client as being at the least risk for developing infection with TB?
A man who is an inspector for the U.S. Postal Service
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A nurse is reading the results of a Mantoux skin test on a client with no documented health problems. The site has no induration and a 1-mm area of ecchymosed. What are the results of this test?
Negative
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A nurse is caring for a client who had a Mantoux skin test implantation 48 hours ago on admission to the nursing unit and reads the result of the skin test as positive. What nursing action is priority?
Report the findings
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A client being discharged from the hospital to home with a diagnosis of TB is worried about the possibility of infecting the family and others. What information would help the client get the most reassurance?
The family will be treated prophylactically and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy.
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A nurse has reinforced discharge teaching with a client who was diagnosed with TB and has been on medication for 1� weeks. Which statement shows that the client has understood the teaching?
�I should not be contagious after 2 to 3 weeks of medication therapy�
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A client with TB asks a nurse about precautions to take after discharge from the hospital to prevent infection of others. The nurse develops a response based on the understanding that TB is transmitted how?
By droplet nuclei
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A nurse is preparing to give a bed bath to an immobilized client with TB. What should the nurse plan to wear when performing this care?
Particulate respirator, gown, and gloves.
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A client with TB, whose status is being monitored in an ambulatory care clinic, asks the nurse when it is permissible to return to work. When does the nurse tell the pt he can return to work?
After three sputum cultures are negative.
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A client with AIDS has histoplasmosis. What signs/symptoms would the nurse look for?
Dyspnea
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A nurse is taking the nursing history of a client with silicosis. What should the patient wear during periods of exposure to silica particles?
Mask
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A nurse is assisting in planning care for a client scheduled for insertion of a tracheotomy. What equipment would the nurse plan to have at the bedside when the client returns from surgery?
Obturator
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A nurse is caring for a client with an end tracheal tube attached to a ventilator. The high-pressure alarm sounds on the ventilator. What nursing intervention does the nurse prepare to perform?
Suction the client
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A nursing is preparing to obtain a sputum speciman from the client. Which nursing action will facilitate obtaining the speciman?
Having the client take three deep breaths.
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An emergency room nurse is caring for a client who sustained a blunt injury to the chest wall. Which sign, if noted in the client, would indicated the presence of a pneumothorax?
Shortness of breath
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A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the nurse expect to note in evaluating the client?
A hyper inflated chest on x-ray
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When is a sputum specimen obtained?
Before antibiotics are given
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What is a thoracentesis?
Surgical perforation of the chest wall for the aspiration of fluid
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How much fluid can be removed during a thoracentesis?
No more than 1300 ml in 30 min
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What is the normal pH of blood?
7.35-7.45
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What is the norm for PaCO2?
35-45
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What is the norm for PaO2?
80-100
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What is the norm for HCO3?
21-28
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What is a normal SaO2?
95-100%
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What will the physician order if a pulse ox is questionable?
An ABG
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What is the nursing goal in a pt with acute bronchitis?
Facilitate recovery and prevent secondary infections
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What type of isolation is recommended for a patient w/TB?
Acid-fast bacillus
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What type of masks do visitors of TB pts use?
Particulate respiration mask
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What is the most effective way to get rid of secretions in a patient with pneumonia?
Fluid
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What will a physician order if there is an accumulation of pus in the pleural space?
A chest tube, chest percussion, or postural drainage
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How long is a pneumonia vaccination good for?
5 years
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How can a nurse facilitate optimal air exchange in a pt with pneumonia?
2-3 L
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What is pleural effusion?
An accumulation of fluid in the pleural space
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What is the term for a pleural effusion infection?
Empyema
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What will happen to the lungs if intrapleural pressure becomes equal to atmospheric pressures?
The lungs will collapse
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What will prevent the drying of mucous membranes?
Frequent oral care
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What is atelectasis?
The collapse of lung tissue that prevents respiratory exchange of CO2 & O2 most often occurring after surgery
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How often is incentive spirometer recommended for a pt with atelectasis?
10 x�s every hour while awake
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What is a pneumothorax?
A collection of air or gas in the pleural space that causes the lung to collapse
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Where is a chest tube placed for a pneumothorax?
In the 5th & 6th intercostal spaces at the mid axillary line
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What position will promote airway clearance and lung expansion?
High Fowler�s
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How is lung cancer classified?
By microscopic study of the tumor
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What are the signs and symptoms of lung cancer?
Cough, hemotypsis, dyspnea, fever, chills
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What is the most common cause of pulmonary edema?
Increased capillary pressure from left ventricular failure
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What does sputum look like in pulmonary edema?
Frothy, pink sputum
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What type of diet is recommended for a pt with pulmonary edema?
Low-sodium diet
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What is pulmonary embolism?
Foreign substance causing obstruction to the blood supply to lung tissue
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What is the normal range for d-dimer?
68-494
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How long is a pt on anticoagulant therapy for a pulmonary embolism?
One year
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What is ARDS?
A complication that occurs as a result of other diseases
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When does ARDS manifest?
12-24 hours after injury
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What is the medical plan for a pt with ARDS?
Treat cause & give O2
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What should a nurse monitor in a pt w/ARDS?
ABG�s & pulse oximetry
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What does a pt w/emphysema become barrel chested?
Because of over inflation of the lungs
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How much fluid should a pt w/emphysema consume each day?
2-3 L
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What effective breathing technique is used for a pt w/emphysema?
Pursed-lip breathing
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What are common airway obstructions?
Dentures, aspiration of vomitus or secretions or the tongue
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What diagnostic tests are used to determine an airway obstruction?
None-it�s diagnosed by assessment
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What will hemoglobin levels be in a pt with chronic bronchitis?
20 g/DL or more
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What is the medical plan for a pt w/chronic bronchitis?
Minimize disease progression and reduce spasms & secretions
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What is a normal peak flo measurement?
80-100%
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What is bronchiectasis?
Irreversible chronic dilation of bronchi that destroys bronchial elastic & muscular elements
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What are the signs & symptoms of bronchiectasis?
Dyspnea, cyanosis & clubbing of the fingers
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What volume is O2 delivered to the pt with bronchiectasis?
Low flow
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What is the cure for bronchiectasis?
Surgical removal of the lung
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What is small cell lung cancer?
Very aggressive cancer
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What will happen if the peripheral lesion perforates the pleural space?
It will cause pleural effusion and severe pain
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What is the most common surgical treatment for lung cancer?
Pneumonectomy
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What is a pneumonectly?
Surgical removal of a lung
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What colored foods are avoided after a tonsillectomy?
Red
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What are the nursing measures for a post-op tonsillectomy?
Maintaining IV fluids until nausea subsides
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