Chapter 31 Nursing Care of Patients with Lower Respiratory Tract Disorders

Answers CHAPTER 31 NURSING CARE OF PATIENTS WITH LOWER RESPIRATORY TRACT DISORDERS AUDIO CASE STUDY Jack Has Emphysema and COPD 1. Chronic obstructive pulmonary disease (COPD) is a group of pulmonary disorders characterized by difficulty exhaling because of airways that are narrowed or blocked by inflammation and mucus and because the loss of elastic fibers causes an increase in compliance. More effort is required for the weakened alveoli to push air out through obstructed airways. Emphysema affects the respiratory bronchioles and alveoli distal to the terminal bronchioles, causing destruction of the alveolar walls and loss of elastic recoil. This also causes damage to adjacent pulmonary capillaries. Because of the loss of elastic recoil, passive exhalation is impaired and air is trapped in the alveoli. The combination of damaged alveoli and capillaries causes reduced surface area for gas exchange. 2. The pressure placed on the small airways and alveoli from pursed-lip breathing holds them open so carbon dioxide can be eliminated. 3. No. Some damage is already done. However, the symptoms and progressive nature of COPD will slow down significantly. See Figure 31.6 in Chapter 31. capillary oxygen saturation (SpO 2). Note skin color and ask about cough and sputum. 2. A 48-pack-year history can mean two packs a day for 24 years, or three packs a day for 16 years, and so on. Multiply packs per day by number of years for pack-years. 3. Emphysema causes destruction of alveolar membranes and adjacent capillaries, reducing the surface area available for gas exchange. Reduced gas exchange results in hypoxia, which causes dyspnea. 4. Edith’s lung sounds will most likely sound diminished. 5. Edith probably has a chronically high partial pressure of carbon dioxide (Pa CO2), making a low partial pressure of oxygen (PaO 2) her stimulus to breathe. Her SpO2 should be kept between 88% and 92% to prevent reducing her respiratory drive. 6. Emphysema increases the risk for occurrence of bullae and blebs. Rupture of these can cause a pneumothorax. 7. The Fowler, semi-Fowler, or orthopneic (leaning over bedside table) position increases room for lung expansion and helps reduce dyspnea. Sitting in a chair may also help if it is not too tiring. 8. Edith has probably had many lectures on the evils of smoking. Determine her desire to quit and her knowledge of the relationship between her illness and her smoking. Of course, she will not be able to smoke while she is in the hospital. If she is willing, ask her health care provider for an order for medication, and refer her to a local stop-smoking program (check the Internet or the local American Cancer Society chapter (www.cancer.org) for local smoking cessation programs). Assist her to identify a friend who has quit smoking for support. RESPIRATORY MEDICATIONS REVIEW QUESTIONS—CONTENT REVIEW 1. (2) 2. (4) 3. (5) 4. (6) 5. (1) 6. (3) 7. (7) The correct answers are in boldface. CRITICAL THINKING 1. A complete respiratory assessment should be completed. Edith’s respiratory symptoms can be assessed using the WHAT’S UP? format. Have her rate her degree of dyspnea on a scale of 0 to 10. Auscultate lung sounds and assess activity tolerance. Collect vital signs and peripheral 1. (4) is correct. Corticosteroids have potent antiinflammatory action. (1, 2, 3) are not affected by corticosteroids. 2. (3) is correct. Keeping the patient between 88% and 92% will reduce the risk of depressing the respiratory drive with too much oxygen. (1, 2) are too high and may reduce respiratory drive. (4) reflects hypoxemia. 3. (3) is correct. Intravenous (IV) morphine can reduce acute dyspnea. (1) is incorrect. Cortisone is slower acting. (2) is incorrect. Meperidine (Demerol) will not help. (4) is incorrect. A beta blocker may worsen dyspnea. 4. (1) is correct. Smoking is a major risk factor for many kinds of lung disease. (2, 3, 4) are risk factors for a 1 2 Chapter 31 Answers variety of problems, but they are not as significant as smoking in causing lung disease. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 5. (1) is correct; 86% is low, and the patient would benefit from supplemental oxygen. (2) is incorrect. 86% is not normal. (3) is incorrect. 86% does not warrant emergency treatment unless additional symptoms are present. (4) is incorrect. Walking in the hall will further reduce the peripheral capillary oxygen saturation (SpO 2). 6. (1) is correct. Albuterol is a fast-acting rescue inhaler. (2, 3, 4) are all used for asthma but are slower onset and inappropriate for emergency use. 7. (1, 2, 4) are correct. Movement, fluids, a cool steamer, and coughing and deep breathing will all help mobilize secretions. (3) will stop coughing and worsen retained secretions. (5) won’t help. 8. (2, 3, 4 and 6) are correct; 2, 3, and 4 have been shown to increase risk. (6) reduces cancer risk. (1, 5) do not increase cancer risk. 9. (2) is correct. Radiation for small cell lung cancer is palliative. (1) is incorrect. Surgery is the treatment for cure. (3) is incorrect. The patient will probably require oxygen eventually. (4) is incorrect. Treatment may slow the spread but will probably not totally prevent it. 10. (1) is correct. Airways are inflamed and spastic in asthma. (2) is incorrect. Asthma does not cause fluid collection. (3) is incorrect. Asthma constricts rather than stretches airways. (4) is incorrect. Asthma is not caused by infection, although infection may exacerbate it. 11. (3) is correct. Emphysema destroys alveoli, causing loss of elasticity and air trapping. (1) is incorrect. Inflammation and secretions are more characteristic of bronchitis. (2) is incorrect. Capillaries are damaged in emphysema, but the entire blood supply is not destroyed. (4) is incorrect. Large sacs of sputum are not present in emphysema. 12. (2) is correct. Auscultating lung sounds will help determine whether the lung is re-expanding. (1, 3, 4) may all be appropriate, but they do not monitor whether the chest drainage system is effectively reducing the pneumothorax. 13. The area where the nurse would expect to hear crackles when auscultating the chest on a patient with suspected left lower lobe pneumonia.