NUR 242 MED SURG EXAM 3| ACTUAL
UPDATED EXAM WITH EXPERTLY AND
CORRECTLY ANSWERED QUESTIONS| ACE
YOUR GRADES |GALEN COLLEGE OF
NURSING.
PUD increased risk factor in - Correct Answer-Smokers
smoking contributes to the pathogenesis of peptic ulcer disease. Smoking causes an acceleration of gastric emptying of liquids, promotes of duodenogastric reflux and causes a reduction in mucosal blood flow.Patient should attend a smoking cessation course.
Gastric Cancer - Correct Answer-Stomach cancers tend to develop slowly over many years. Before a true cancer develops, pre-cancerous changes often occur in the inner lining (mucosa) of the stomach. These early changes rarely cause symptoms and therefore often go undetected
The decline of stomach acids has been linked to the frequent use of antibiotics to treat infection. Antibiotics can kill the bacteria called - Correct Answer-Helicobacter pylori (H. pylori), which is though to be a major cause of stomach cancer
Gastrectomy post care - Correct Answer-Administer protein and vitamin supplements to foster wound repair and tissue building. Eat small, frequent meals.
Stress the importance of long term vitamin B12 injections after - Correct Answer-gastrectomy to prevent surgically induced pernicious anemia
Irritable bowel syndrome (IBS) - Correct Answer-refers to a disorder that involves abdominal pain and cramping, as well as changes in bowel movements
IBS risk factors include - Correct Answer-consuming a diet high in fats and gas producing foods. Consuming carbonated beverages, caffeine and alcohol contribute to the development.
IBS related factors - Correct Answer-Smoking and stress. Emotional experiences such as anxiety and depression are also a factor as this affects the autonomic nervous system and it innervation to the bowel.
Nursing care for the patient with IBS focuses on - Correct Answer- education and emotional support. Help the patient implement lifestyle changes that reduce stress. Remind the patient about regular exercise, Discourage smoking while encouraging the need for regular physical examinations
Intestinal obstruction is - Correct Answer-a partial or complete blockage of the bowel that results in the failure of the intestinal contents to pass through
GERD Risk factors include - Correct Answer-Consumption of foods such as caffeine, alcohol, spicy or fried foods, chocolate, and tomatoes. Lifestyle factors play a big part especially alcohol and smoking.
GERD the nursing assessment should include - Correct Answer-asking about a history of heartburn or atypical chest pain associated with the reflux of GI contents.
GERD manifests differently depending on - Correct Answer-the patient and the severity of the disorder
GERD most common symptoms - Correct Answer--Heartburn (pyrosis) -Dyspepsia (Indigestion)
(May be described as substernal burning moving up and down the chest)
GERD pain usually develops within - Correct Answer-30-60 minutes after meals
Severe heartburn pain can radiate to the neck, jaw, or back and patients may think they are having an MI
GERD symptoms are exacerbated when - Correct Answer-lying down flat or bending over
GERD regurgitation may lead to - Correct Answer-Aspiration or bronchitis
These patients are at risk of aspirating when lying flat
Symptoms of GERD include - Correct Answer-Coughing or wheezing at night, dysphagia, belching and nausea, hoarseness, and insomnia. Assess lungs for presence of crackles.
Hiatal Hernia - Correct Answer-A condition where a part of the stomach that normally is located in the abdominal cavity protrudes through the esophageal hiatus to rest within the chest cavity
Hiatal Hernia symptoms usually worsen after meals. These symptoms may be made worse when - Correct Answer-Lying flat and may resolve with sitting up or walking.
Hiatal Hernia patients should immediately report - Correct Answer- abdominal pain with nausea, vomiting, and fever
Hiatal Hernia lifestyle changes may include - Correct Answer-elevating the head of the bed when sleeping to allow gravity to prevent acid from refluxing into the esophagus and remaining upright after meals.
Hiatal hernia Diet should consist of - Correct Answer-small frequent meals instead of eating two or three larger meals a day. Avoid vigorous movement after meals.
Hiatal hernia foods that should be avoided include - Correct Answer-spicy, greasy foods, onions, tomatoes and citrus fruits
Gastritis occurs when - Correct Answer-the lining of the stomach known as the mucosa becomes inflamed or swollen. When the stomach mucosa becomes inflamed edema, hemorrhage and erosion of the mucosa occur.
Medical treatment for Gastritis depends on the specific cause. Patients will be instructed to stop taking irritating medications such as - Correct Answer- ASA and NSAIDS
Gastritis medications to decrease the amount of hydrochloric acid in the stomach. these would include - Correct Answer-Antacids, H2 antagonists, and Proton pump inhibitors
The patient with Gastritis is at risk for - Correct Answer-Deficient Fluid Volume A nursing priority is to access the patient's hydration status. Includes I&O, Daily Weights, &VS.
Peptic Ulcers Disease - Correct Answer-are a break in the mucous lining of gastrointestinal tract from continued contact with gastric juice. This results in inflammation. Pain that is worsened by the ingestion of food.
Ulcers in the mucosa of GI tract occur from several different causes.Duodenal ulcers are associated with a - Correct Answer-H. Pylori infection
Gastric ulcer pain is described as - Correct Answer-a dull, aching pain, often right after a meal; eating does not relieve pain and may even worsen it. Pain may also occur late at night.
Other symptoms associated with PUD are - Correct Answer-Nausea with or without vomiting, weight loss, anorexia, belching and dyspepsia (indigestion). Patient may report a distended abdomen that is painful.
With obstruction - Correct Answer-gas and fluid accumulate proximal to and within obstructed segment causing bowel distention
A bowel obstruction is divided into two basic categories: - Correct Answer-
Mechanical and Non-mechanical
Treatment of intestinal obstruction is directed toward - Correct Answer- relieving symptoms, managing fluid and electrolyte imbalances, preventing complications, and treating the cause of obstruction
Surgery may be needed to relieve the obstruction if - Correct Answer- gastric decompression does not relieve the symptoms, or if there are signs of bowel necrosis. The type of surgery will depend on the type and area of obstruction and may include intestinal resection with an anastomosis or creation of an ileostomy or colostomy
If the small bowel obstruction is complete, the peristaltic waves become quite vigorous, assuming - Correct Answer-revers direction, propelling intestinal contents toward the mouth rather than the rectum
Small bowel obstruction patient vomits - Correct Answer-stomach contents first, then the bilious contents of the duodenum, and finally the fecal contents of the ileum
A distended abdomen, a bloated sensation, and altered bowel sounds may indicate a - Correct Answer-small bowel obstruction.
Patients with Ileostomy who develop distention and cramping should apply
- Correct Answer-warm, moist towels to abdomen or lightly massage
abdomen
In large bowel obstructionWhat may be the only symptom for several days?
- Correct Answer-constipation
In large bowel obstruction Barium enema may be ordered to reveal - Correct Answer-a distended, air-filled colon. Monitor the patient for bowel movement after a barium enema
Patients with large bowel obstructions may experience intermittent persistent - Correct Answer-lower abdominal cramping. Severe pain may result from strangulation or bowel perforation
When the appendix becomes inflamed and fills with pus it is called - Correct Answer-Appendicitis
Obstruction of the appendiceal lumen causes - Correct Answer-appendicitis
If left untreated, an inflamed appendix will eventually - Correct Answer- burst, or perforate, spilling infectious materials into the abdominal cavity.This can lead to peritonitis, a serious inflammation of the peritoneum that can be fatal unless it is treated quickly with strong antibiotics
The classic symptom of appendicitis is - Correct Answer-abdominal pain.Pain becomes sharper over several hours and worsens with coughing, walking or other jarring movements.
A sharp pain is felt in the lower right abdomen (RLQ) when the area is pressed on and then the pressure is quickly released. this is known as - Correct Answer-rebound tenderness. Pain is relieved by bending the knees
Peritonitis results from - Correct Answer-contamination of a normal sterile peritoneal cavity with bacteria or chemical irritant
Peritonitis: classically the patient will have an acute abdomen with abrupt
onset of diffuse, - Correct Answer-severe abdominal pain
Peritonitis: Depending on signs and symptoms, treatment includes -
Correct Answer-nasogastric decompression, hyperalimentation, and colloids such as plasma and blood cells.
The plan of care will have been effective if the patient's peritonitis has - Correct Answer-been eliminated and the source removed without complications and the patient fluid balance and pain are effectively tolerated
Gastroenteritis is an inflammation of - Correct Answer-the stomach and intestinal tract that primarily affects the small bowel.
Gastroenteritis: The major clinical manifestations are - Correct Answer-
diarrhea resulting in hypokalemia and abdominal pain and cramping
Gastroenteritis Associated clinical manifestations are - Correct Answer- nausea, vomiting, fever, anorexia, distention, tenesmus, and borborygmi
Gastroenteritis: Rapid propulsion of intestinal contents through the small
bowels may lead to a serious - Correct Answer-fluid volume deficit and electrolyte imbalance
Gastroenteritis: Treatment should focus on - Correct Answer-intravenous
fluids and monitoring for cardiac dysrhythmias
Inflammatory bowel disease refers to two chronic diseases that cause
inflammation of the intestines: - Correct Answer-Ulcerative colitis and
Crohn's disease. Both have similar symptoms but are different in the manner in which they affect the digestive tract.
When providing patient education for the patient who has had an ostomy the nurse needs to include many things. The nurse should discuss - Correct Answer-dietary modifications related to nutritional status and provide referral to dietitian for diet planning (lean meats, legumes, water).Teach the importance of maintaining a high fluid intake and manifestations to recognize dehydration
Inflammatory Bowel Disease: The treatment is considered to have been
effective if the patient has a decrease in - Correct Answer-diarrhea, increases their nutritional intake and gains weight, pain is reduced or eliminated, complication do not occur, and they effectively manage stress.
Crohn's disease involves all of the - Correct Answer-intestines
Ulcers and fissures develop in - Correct Answer-Crohn's disease
In Crohn's disease the pain is in the - Correct Answer-lower right quadrant of the abdomen
New therapies are beginning to be utilized for patients with Crohn's disease including - Correct Answer-immune response modifiers such as therapeutic monoclonal antibody certolizumab pegol (Cimzia) and Adalimuab (Humira)
While taking certolizumab pegol (Cimzia) and Adalimuab (Humira) Patients should report - Correct Answer-cold-like symptoms or sore throat, avoid public places while taking this medication, understand abdominal pain, nausea, and vomiting are common side effects of this medication, and learn to give self injection
Crohn's disease: The patient who is acutely ill may need to have - Correct
Answer-total bowel rest and receive parenteral nutrition. This usually is through hyperalimentation.
Crohn's disease: Anxiety is - Correct Answer-common for newly diagnosed
patients and therapeutic communication about the disease is critical to treatment
When medical management for Ulcerative colitis is not successful surgical intervention will result in the patient having an - Correct Answer-ostomy
A stoma is created on the abdomen where an appliance is applied to - Correct Answer-retain stool
Stoma pouch is emptied at intervals and always before it is - Correct Answer-half full. Apply a skin barrier directly to stoma prior to application of pouch system
Ulcerative Colitis involves only the - Correct Answer-large intestine.
Hemorrhages and abscess occur in - Correct Answer-ulcerative colitis
Blood, mucous, and pus can be noted in the stools of the patient with - Correct Answer-ulcerative colitis as well as an urgent sensation to defecate
Ulcerative colitis patients report - Correct Answer-weight loss, anorexia, fatigue, and weakness
The patient with ulcerative colitis may experience a - Correct Answer-fever
Pain is in the lower left quadrant (LLQ) in - Correct Answer-ulcerative colitis
Ulcerative colitis Diagnostic studies include a - Correct Answer-CBC to assess for anemia, leukocytosis from inflammation and abscess formation.Serum albumin and folic acid levels which may be low due to malabsorption. Stool examinations for blood and stool cultures are ordered to rule out infections
Diverticulitis occurs when - Correct Answer-one or more diverticula become inflamed or infected.
Diverticula are - Correct Answer-small, bulging pouches that can form anywhere in the digestive system, including the esophagus, stomach, small intestine, and most commonly in the large intestine
Diverticulitis medical treatment includes a - Correct Answer-liquid or low- fiber diet and antibiotics. Rest is also needed. Over-the-counter pain reliever, such as acetaminophen (Tylenol) may be taken.
Diverticulitis: Opioids are avoided if possible as the tend to be - Correct
Answer-constipating and may aggravate the problem
Diverticulitis patients should void the use of - Correct Answer-over-the- counter (OTC) laxatives to prevent constipation, monitor for signs of bleeding, and limit intake of dietary fat
Hepatitis is a widespread inflammation of the - Correct Answer-liver that results in degeneration and necrosis of liver cells
Hepatitis A has an incubation period of - Correct Answer-15 to 50 days
Hepatitis A is spread via the - Correct Answer-fecal-oral route by fecal contamination either from person-to-person contact or by consuming contaminated food or water
Hepatitis a is more common in countries with - Correct Answer-poor sanitation (handwashing) are most at risk
The hepatitis B virus is spread through - Correct Answer-unprotected sexual intercourse with an infected partner, sharing needles, accidental needle sticks, and hemodialysis. Use standard precautions when caring for a client who has hepatitis HBV.
Hepatitis C is caused by a - Correct Answer-single-stranded RNA virus, has an incubation period of 7 weeks, and is transmitted via blood to blood
Hepatitis C is usually spread by - Correct Answer-sharing needles, needle sticks, unsanitary tattoo equipment, and sharing of intranasal cocaine paraphermalia
Cholelithiasis, or gallstones, develop due to the inflammation of the - Correct Answer-gallbladder, the inflammation is called cholecystitis
Cholelithiasis: The nursing assessment will include dietary preferences
focusing on consumption of - Correct Answer-fatty foods in relation to pain developing
Patients with acute cholecystitis present with - Correct Answer-abdominal pain, although clinical manifestations vary in intensity and frequency
Cholecystectomy is removal of the - Correct Answer-gallbladder
The laparoscopic cholecystectomy is the - Correct Answer-gold standard and is preformed far more often than the traditional open approach
Gall Bladder Disease: Patient education for patients with biliary disorders
includes - Correct Answer-diet teaching. Tell the patient to not skip meals and to exercise regularly. Foods not well tolerated include eggs, pork, onions, poultry, milk, coffee, oranges, corn, beans, and nuts.
Complications associated with malnutrition in adults include - Correct Answer-muscle wasting, lethargy, intolerance to cold, edema, dry skin, or dermatitis, poor wound healing, infection, and possible death
Socioeconomic factors can have a negative effect on nutritional status the assessment should include details on - Correct Answer-social isolation, access to food, depression, substance abuse, and poverty.
Nutritional status is influenced by the ability to - Correct Answer-swallow and the body's ability to absorb nutrients
Nursing interventions to promote intake include providing - Correct Answer- mouth care before meals, getting the patient up to a chair for meals if possible, and trying to increase social interaction during meals. Six small meals a day consisting of high-calorie and nutrient-rich foods, such as milkshakes and cheese, are recommended.
If the patient is unable to consume adequate nutrition by mouth, either - Correct Answer-total enteral nutrition (TEN) or total parenteral nutrition (TPN) is needed.
Total enteral nutrition (TEN) or tube- feeding refers to a method of - Correct Answer-infusing nutrient solutions or formulas directly into the GI tract through tubes that enter through the nose, mouth, or abdominal wall
Bariatric surgery is treatment for patients who have a - Correct Answer-BMI > 40
The laparoscopic adjustable-banded gastroplasty (lab band) is a procedure where an - Correct Answer-adjustable band is used to create a small pouch
Lab Band: Postoperative care depends on the type of surgery. Special
bariatric equipment such as an - Correct Answer-extra wide bed and additional personnel for moving the patient may be required. If there is an NG tube, do not reposition, as it can disrupt the suture line
Lab Band Post-op: Clear liquids are introduced slowly at first. Pureed
foods, juices and soups thinned with broth, water or milk are assed to the diet 24 to 48 hours after clear liquids are tolerated. During the first six weeks, intake is - Correct Answer-limited to liquid or pureed foods before regular food is introduced slowly.
Lab Band Post-op: Leaks are the most common serious common serious
complication and cause of death. Manifestations include - Correct Answer- pain in the back, shoulder, or abdominal area, restlessness, tachycardia, and oliguria.
Lab band Post-op: Use and abdominal binder to prevent - Correct Answer-
wound dehiscence postop, and place the patient in semi-fowler's position.Early ambulation is key to prevent complications; ambulation is expected on the day of surgery
Observe for signs and symptoms of dumping syndrome after gastric bypass, such as - Correct Answer-tachycardia, nausea, diarrhea, and abdominal cramping. Consuming several small meals daily will help dumping syndrome.
Oxygen Therapy: Assess patient's - Correct Answer-general appearance
(facial expression, posture, alertness, speech pattern or signs of distress), vital signs (tachycardia, tachypnea), assess trachea, chest movement, respiratory effort, and use of accessory muscles
Pursed lip breathing inhibits airway collapse and decreases - Correct Answer-dyspnea. Encourage the patients to pucker the lips as if to whistle or blow out a candle, they inhale through the nose and slowly exhale through the pursed lips.
Bronchial breath sounds heard over the trachea has a - Correct Answer- higher, louder pitch. Inspiration and expiration are equal and there is a pause between inspiration and expiration
Bronchovesicular breath sounds are located between the - Correct Answer- scapula and have a moderate-pitched, blowing, sound with equal inspiratory and expiratory phase.
Vesicular breathing is heard over the - Correct Answer-thorax, lower pitched and softer than bronchial breathing
Apnea increases the the carbon dioxide levels and decreases pH levels in the blood, which stimulates the person to - Correct Answer-awaken and resume respirations
Risk factors for sleep apnea include - Correct Answer-obesity as most people with sleep apnea are overweight. Other risk factors include a short or thick neck, smoking, enlarged tonsils or adenoids, oropharyngeal edema, and chronic nasal congestion. Patients with diabetes and those who use alcohol, sedatives, or tranquilizers are also at increased risk.
Sleep apnea: Patients exhibit symptoms of daytime - Correct Answer-
sleepiness and irritability with periods of apnea lasting at least 10 seconds.The airway can become obstructed by the tounge, leading to apnea.
Mild cases of sleep apnea may improve with - Correct Answer-change in sleeping position or weight loss.
The treatment of choice for sleep apnea is - Correct Answer-continuous positive airway pressure (CPAP), which delivers air pressure via an air compressor through a mask placed over the nose or prongs placed in the nares while asleep to prevent alveoli from collapsing
Laryngeal obstruction is a potential life-threatening emergency due to - Correct Answer-the interruption of airflow through the nose, mouth, pharynx, or larynx. Early recognition is essential to prevent further complications, including respiratory arrest
Hoarseness and dramatic shortness of breath presents with acute onset of
- Correct Answer-laryngeal obstruction and progresses rapidly to
respiratory arrest if a patent airway is not established. The patient may exhibit gagging, dysarthria, accessory muscle use with breathing, and coughing
Early signs of respiratory failure include - Correct Answer-restlessness, tachycardia, and tachypnea
Upper airway obstruction medical management focuses on - Correct Answer-maintaining a patent airway. suctioning may be needed to remove secretions causing an obstruction
Tracheostomy is a surgical incision into the - Correct Answer-trachea for the purpose of starting an airway
Nursing care for patients with laryngeal obstruction focuses on maintaining a - Correct Answer-patent airway and promoting airway clearance through frequent position changes, hyperventilation, and frequent suctioning to improve lung aeration. Deep breathing helps re-expand the lung
Tracheostomy: Patient teaching include covering with - Correct Answer-
breathable cloth to help with filtering and use of a shower shield when bathing. Patients should use a humidifier to increase moisture in the air
Tracheostomy: the nurse should apply suction, using a - Correct Answer-
twirling motion while withdrawing the catheter and explain that the sensation of shortness of breath may occur
Trach care, conducted - Correct Answer-each shift, includes application of new ties prior to removing old ties and cleaning stoma with diluted hydrogen peroxide.
Asthma - Correct Answer-And inflammatory disorder of the airways
Asthma causes - Correct Answer-wheezing, shortness of breath, chest tightness, and coughing. A sudden absence of wheezing may indicate occlusion and warrant immediate medical intervention
Asthma treatment goal is to help patients identify - Correct Answer-triggers and avoid those substances and to decrease bronchial inflammation
Asthma is treated with - Correct Answer-long-term control and quick relief medicines. Long-tem control medicines help reduce airway inflammation and prevent asthma symptoms
A common side effect from inhaled corticosteroids is - Correct Answer- thrush. the use of a spacer can help to avoid thrush.
Patient prescribed an albuterol metered-dose inhaler (MDI) with spacer should be instructed to - Correct Answer-breath in slowly and deeply after releasing the medication into the spacer
Asthma: Discharge teaching includes the - Correct Answer-use of rescue
medication, using a bronchodilator prior to exercise, and seeking help if peak expiratory flow reaches the red zone or frequently remains in the yellow zone
COPD is the leading cause of - Correct Answer-death and illness worldwide
Most COPD is caused by - Correct Answer-long-term smoking and can be prevented by not smoking or quitting soon after starting
COPD patients suffers from - Correct Answer-chronic hypoxemia and hypercapnia. Other manifestations may be cyanosis around the lips, neck vein distention, and pitting peripheral edema. Patients using accessory muscles when breathing should be evaluated immediately
COPD: Outcomes include improved breathing pattern, decreased
inspiratory and expiratory wheezing and decreasing dry, nonproductive cough, an oxygen saturation - Correct Answer->90, and ability to demonstrate how and when to use inhaled medications.
Patients with COPD are often fearful and feel isolated because of their decreased ability to - Correct Answer-leave their homes. Suggest that they and their families join support groups where they can share their
experiences and feelings about the disease and learn new techniques to improve their quality of life. Many hospitals sponsor such groups.
Sarcoidosis is a multisystem inflammatory disease that predominantly affects the - Correct Answer-lungs and intrathoracic lymph nodes
Sarcoidosis: Patients experience - Correct Answer-fever, anorexia, fatigue,
night sweats, wight loss, and dyspnea on exertion, coughing, and chest pain
Nursing intervention with sarcoidosis is the same as clients with other - Correct Answer-restrictive lung disease and hypoxemia. Assess for manifestations of improvement, such as increased exercise tolerance, disappearance of initial assessment findings, improvement of pulmonary function studies, and better oxygenation
Activity intolerance is improved by encouraging patients to - Correct Answer-perform as much of their self-care as tolerated. If assessment findings worsen, document and notify the physician
Lung cancer: To optimize quality of life, patients need to be aware of ways
to control their - Correct Answer-symptoms and side effects of treatment through proper nutrition, adequate and managing pain and side effects
A malignant tumor of the lung arising within the bronchial wall or epithelium.The lung is a common site of - Correct Answer-metastasis from cancer elsewhere in the body through venous circulation or lymphatic spread.
The primary predisposing factor in lung cancer is - Correct Answer- cigarette smoking
Lung cancer common side effects: - Correct Answer-New or changing
cough, dyspnea, wheezing, excessive sputum production, chest pain malaise, fever weight loss, fatigue, or anorexia
Elevate the head of the bed to ease the work of - Correct Answer-breathing
Augment the patient ability to cough effectively by - Correct Answer- splinting the patient's chest manually
Instruct the patient to inspire fully and cough two to three times in one breath. allow the patient to sleep in - Correct Answer-reclining chair.Encourage the patient to conserve energy by decreasing activities.
The removal of part of the lung is called a - Correct Answer-pulmonary resection. This includes wedge resection, segmental resection, a lobotomy, or pneumonectomy.
A pulmonary resection is preformed as treatment for - Correct Answer-lung cancer
A lobectomy is the removal of an entire - Correct Answer-lobe of the lung.Postoperatively, the remaining lung over expands to fill the open portion of the thoracic space.
Thoracic surgery: Nursing interventions include monitoring - Correct
Answer-pulse oximetry and ABGs to elevate respiratory status. Teach the patient to cough and deep breath every 1-2 hours while splinting the incision.
Ensure the patient understands how to splint the incision and assist the patient with splinting during the - Correct Answer-initial postoperative phase. Encourage pursed lip and diaphragmatic breathing techniques.Auscultate lung sounds fo signs of pulmonary edema, such as crackles.
Patients have a closed-chest drainage system after all forms of - Correct Answer-chest surgery. The chest drainage system is closed to prevent the inflow of atmospheric pressure.
The wet suction control systems have three main components: - Correct
Answer-The collection chamber collects drainage and allows monitoring of the volume, rate, and nature of drainage, The water-seal chamber is used as a one-way valve, and the suction control chamber uses suction to promote drainage from the pleural space and assist in re-expansion
The dry suction control systems have two main compartments. Advantages of the dry system include - Correct Answer-ease in setup, no noise of bubbling water in the suction-control chamber, no evaporation of water over time, and provision of higher and more precise levels of suction
Thoracentesis is a procedure in which a needle is inserted into the - Correct Answer-pleural space between the lungs and chest wall. This procedure is done to remove excess fluid from the pleural space.
Pneumonectomy: The surgical removal of the lung performed through a
thoracotomy, which is performed via an - Correct Answer-open incision in the chest that leaves an empty space in the thoracic cavity
Pneumonectomy: The surgeon may also perform a thoracoplasty to reduce
the size of the - Correct Answer-thoracic cavity, which consists of removing several ribs. The phrenic nerve may be severed to paralyze the diaphragm in an elevated position. The bronchus is severed and sutured. Removal of the right lung is more dangerous as it is more vascular.
Positioning of the patient after pneumonectomy varies according to - Correct Answer-surgeon preference and the patient's comfort. Some surgeons want the patient placed on the non-operative side immediately after a pneumonectomy to reduce stress on the bronchial stump incision.
Influenza patients may experience - Correct Answer-chills, body aches, coughing and sneezing, extreme fever, fatigue, headache, and nasal congestion
Persons at high risk for influenza-related complications include - Correct Answer-individuals over 65 years of age, residents of nursing homes, and patients with chronic pulmonary or cardiovascular disorders, including asthma
Patients with chronic metabolic disease, renal dysfunction, or immunosuppression should receive a killed virus vaccine every - Correct Answer-year
Pneumonia: Excess fluid in the lungs from an inflammatory process. The
inflammation occurs in the interstitial spaces, the alveoli, and often the bronchioles. Caused by - Correct Answer-bacteria, virus, fungi, or parasites
Types of pneumonia are characterized as either - Correct Answer- community-acquired (CAP) or hospital-acquired (HAP)
Community-acquired pneumonia is usually caused by - Correct Answer- Streptococcus pneumonia bacteria. Older adults with comorbidities who do not receive an influenza vaccine have an increased risk of developing community-acquired pneumonia.
Fatigue, weakness, lethargy, dehydration, confusion, and poor appetite are common in older adults with - Correct Answer-pneumonia. The nurse should schedule rest periods and cluster care activities to avoid activity intolerance.
Pneumonia: Patient education includes encouraging - Correct Answer-deep
breathing and incentive spirometer use every two hours, smoking cessation, and excessive alcohol intake avoidance
The pneumonia vaccine is recommended for patients - Correct Answer-65 years of age or older
SARS: A viral respiratory illness caused by a - Correct Answer-coronavirus
SARS: Primarily spread from - Correct Answer-person-to-person through
droplet transmission when in direct close contact with a person with SARS
Early symptoms in patients with SARS have included - Correct Answer- fever (>100), muscle aches, dry cough, shortness of breath, or difficulty breathing. Early signs of respiratory failure include restlessness, tachycardia, and tachypnea.
Infection control policies for patients with respiratory infections should be strictly followed for patients who are probable - Correct Answer-SARS cases. Place in negative pressure room.
SARS: A surgical mask should be used where possible for symptomatic
patients on the way - Correct Answer-to and from health care facilities as well as during their stay
Patients with active TB are placed on - Correct Answer-Airborne Precautions, and healthcare workers must wear a N95 or high-efficiency particular air (HEPA) respirator when caring for the patient. Placed in a negative pressure room. The door to the patient's room should be kept closed. Surgical mask must be worn by client during transport to other departments.
Suspect TB in any patient who has a persistent cough with - Correct Answer-weight loss, anorexia, night sweats, hemoptysis, shortness of breath, fever, chills, pleuritic chest pain, crackles, and/or fatigue
TB: Diagnosis is based on the health history and symptoms. The Mantoux
skin test is performed, and if positive, a hard raised wheal will present in - Correct Answer-48 to 72 hours. Nurse will administer the test by injecting 0.1 ml of PPD intradermally in the client's forearm
TB: The risk of transmission is reduced after the infectious person has
received proper drug therapy for - Correct Answer-two to three weeks.Patients are treated with isoniazid (INH) and should be instructed to avoid alcohol.
Prevention of aspiration is important to minimize the risk of - Correct Answer-lung abscess
Early intubation in patients who have diminished ability to protect the airway from massive - Correct Answer-aspiration (cough, gag reflexes), should be considered
Repositioning the supine patient to a Semi-Fowler's position minimizes the risk of - Correct Answer-aspiration.
Vomiting patients should be placed on their - Correct Answer-side
Improving oral hygiene and dental care in elderly and debilitated patients mat decrease the risk of - Correct Answer-anaerobic lung abscess
Pulmonary Emphysema: Patients have progressive dyspnea on exertion
leading to dyspnea at - Correct Answer-rest. Fatigue related to decreased oxygenation is essential nursing diagnosis.
Pulmonary Emphysema: Patients should be taught how and when to use -
Correct Answer-pursed lip breathing (exhale slowly through the mouth while puffing cheeks) and breathing through the nose during any physical activity. Individuals should avoid talking during physical activity.
Pulmonary Emphysema: Weight loss and malnutrition is a common
complication, as shortness of breath makes it extremely difficult to finish a - Correct Answer-meal. Large meals should be consumed when hungry and rested. Patients should monitor their body weight, drink plenty of fluids (2- 3L daily), decrease sodium, avoid overeating, and eat small frequent meals (4-6) high in calories and protein.
Pulmonary Emphysema: Nursing care includes determining - Correct
Answer-breathing positions and relaxation techniques for patients short of breath. Positioning with proper body alignment allows for optimal respiratory excursion. Assist client to sit in chair a few times each day.