Deck 50: Oxygenation

Question 1

What factors may have led the medical staff to suspect that Ms. Singh had more than a very bad cold? Would you have come to the same conclusion?

Answer 1

Johti Singh is a middle-aged woman who has a medical history of having the bad cold for many weeks, which is still persistent. The primary assessment of any patient with respiratory problems involves the health history of the client, her physical examination and performing various diagnostic procedures.
Ms. Singh has been a consistent cigarette smoker for a long time. She also showed the signs of rapid respirations, adventitious and diminished breath sounds and appearance of thick yellow sputum. These symptoms depict the condition of ineffective airway clearance. Also, she has been diagnosed with pneumonia.
Other abnormal signs such as elevated temperature, rapid, labored respirations, fatigue and mild dehydration are also reported. These observations reveal a condition, which is more serious than a bad cold. A bad cold is not supposed to extend for such a long time and should not be accompanied with pneumonia.

Question 2

The larynx, trachea, bronchi, and lungs with an expanded view showing the structures of an alveolus anti the pulmonary blood vessels.

From Medical Terminology: A Word-Bunding Approach, 7th ed. (Figure 11.5), by J. Rice. 2012, Upper Saddle River. NJ: Pearson Education, Inc. Reproduced by permission of Pearson Education, Inc., Upper Saddle Hiver, New Jersey.
Pneumonia occurs when microorganisms get into the lower respiratory tract and overwhelm the body's defenses. Name at least two normal defense mechanisms present in the upper airway that help prevent microorganisms getting into the lower respiratory tract.

Answer 2

Pneumonia refers to a medical condition in which, the ventilation of the distal alveoli gets impaired due to the clogging of the airways by the microorganisms in the lower respiratory tract. It is generally associated with edema, inflammation and excess of mucus production.
The respiratory system is structurally separated into two regions, the upper and the lower respiratory tract. The upper portion of the respiratory tract comprising of nose, pharynx, mouth and larynx acts as a barrier for the entry of microorganisms into the lower respiratory tract. The two such mechanisms are mentioned as follows:
1. The presence of hair at the entrance of the nares helps in trapping the large particles in the air. A sneeze reflex is also initiated due to the presence of irritants in the nasal passage. Sneezing helps in the rapid exit of a large volume of air through the mouth and nose, thus, clearing the nasal passages.
2. The lymphoid tissue present in the pharynx involving the nasopharynx and the oropharynx helps in the trapping and destroying the pathogens entering with the air.

Question 3

A client with chronic pulmonary disease has a bluish tinge around the lips. The nurse charts which term to most accurately describe the client's condition?
1) Hypoxia
2) Hypoxemia
3) Dyspnea
4) Cyanosis

Answer 3

Hypoxia refers to a condition in which the oxygen supply to all the tissues of the body is insufficient. This is a severe case of hypoxemia when the cardiovascular system is unable to compensate the oxygen deficiency in blood.
Hypoxemia refers to a condition in which the level of oxygen in the blood decreases due to impaired diffusion of oxygen at the alveolar-capillary level. This condition can be characterized by low hemoglobin level, pulmonary edema, increased heart rate as well as cardiac output.
Dyspnea refers to a condition in which the client experiences difficulty in breathing. Patients suffering from dyspnea show signs such as flaring of the nostrils, increased heart rate, labored appearing breathing, diaphoresis and cyanosis.
Hence, the options 1, 2 and 3 are incorrect.
Since, the client is suffering from chronic pulmonary disease and has reported appearance of a blush tinge around the lips; this condition can be most appropriately described as cyanosis. Cyanosis can also be identified by bluish discoloration of the nail beds, skin and mucous membranes, which occurs due to reduced hemoglobin oxygen saturation.
Hence, the correct answer is option
.

Question 4

The care plan appropriately focuses on the acute care of this client. Once she is significantly improved, the nurse will perform discharge teaching. What areas should be included?

Question 5

The larynx, trachea, bronchi, and lungs with an expanded view showing the structures of an alveolus anti the pulmonary blood vessels.

From Medical Terminology: A Word-Bunding Approach, 7th ed. (Figure 11.5), by J. Rice. 2012, Upper Saddle River. NJ: Pearson Education, Inc. Reproduced by permission of Pearson Education, Inc., Upper Saddle Hiver, New Jersey.
Microorganisms can travel past the upper respiratory tract defense mechanisms. What defense mechanisms are present in the lower respiratory tract that may help the client?

Question 6

To prevent postoperative complications, the nurse assists the client with coughing and deep-breathing exercises. This is best accomplished by implementing which of the following?
1) Coughing exercises 1 hour before meals and deep breathing 1 hour after meals
2) Forceful coughing as many times as tolerated
3) Huff coughing every 2 hours or as needed
4) Diaphragmatic and pursed-lip breathing 5 to 10 times, four times a day

Question 7

The client already has some signs of respiratory distress. What signs might indicate that her condition was deteriorating into a more emergency situation? How would you handle this?

Question 8

The larynx, trachea, bronchi, and lungs with an expanded view showing the structures of an alveolus anti the pulmonary blood vessels.

From Medical Terminology: A Word-Bunding Approach, 7th ed. (Figure 11.5), by J. Rice. 2012, Upper Saddle River. NJ: Pearson Education, Inc. Reproduced by permission of Pearson Education, Inc., Upper Saddle Hiver, New Jersey.
The microorganisms have quickly multiplied and overpowered the clients defense mechanisms. The client has pneumonia and the alveoli are filled with infectious fluid. How will this affect gas exchange at the respiratory or alveolar/ capillary membrane?

Question 9

The nurse is preparing to perform tracheostomy care. Prior to beginning the procedure the nurse performs which action?
1) Tells the client to raise two fingers to indicate pain or distress.
2) Changes the twill tape holding the tracheostomy in place.
3) Cleans the incision site.
4) Checks the tightness of the ties and knot.

Question 10

It appears that the client's sputum has not been cultured. In caring for this client, what infection control guidelines would be needed?

Question 11

Which action by the nurse represents proper nasopharyngeal/ nasotracheal suction technique?
1) Lubricate the suction catheter with petroleum jelly before and between insertions.
2) Apply suction intermittently while inserting the suction catheter.
3) Rotate the catheter while applying suction.
4) Hyperoxygenate with 100% oxygen for 30 minutes before and after suctioning.

Question 12

Singh's oxygen order is for a face mask at 6 L/min. She repeatedly pulls it off and you find it lying in the sheets. How might you intervene?

Question 13

Which client statement informs the nurse that his teaching about the proper use of an incentive spirometer was effective?
1) "I should breathe out as fast and hard as possible into the device."
2) "I should inhale slowly and steadily to keep the balls up."
3) "I should use the device three times a day, after meals."
4) "The entire device should be washed thoroughly in sudsy water once a week."

Question 14

While a client with chest tubes is ambulating, the connection between the tube and the water seal dislodges. Which action by the nurse is most appropriate?
1) Assist the client to ambulate back to bed.
2) Reconnect the tube to the water seal.
3) Assess the client's lung sounds with a stethoscope.
4) Have the client cough forcibly several times.

Question 15

The nurse makes the assessment that which client has the greatest risk for a problem with the transport of oxygen from the lungs to the tissues? A client who has
1) Anemia.
2) An infection.
3) A fractured rib.
4) A tumor of the medulla.

Question 16

Which term does the nurse document to best describe a client experiencing shortness of breath when lying down who must assume an upright or sitting position to breathe more comfortably and effectively?
1) Dyspnea
2) Hyperpnea
3) Orthopnea
4) Acapnea

Question 17

A client with emphysema is prescribed corticosteroid therapy on a short-term basis for acute bronchitis. The client asks the nurse how the steroids will help him. The nurse responds by saying that the corticosteroids will do which of the following?
1) Promote bronchodilation.
2) Help the client to cough.
3) Prevent respiratory infection.
4) Decrease inflammation in the airways.

Question 18

The nurse is planning to perform percussion and postural drainage. Which is an important aspect of planning the client's care?
1) Percussion and postural drainage should be done before lunch.
2) The order should be coughing, percussion, positioning, and then suctioning.
3) A good time to perform percussion and postural drainage is in the morning after breakfast when the client is well rested.
4) Percussion and postural drainage should always be preceded by 3 minutes of 100% oxygen.