part 4

Question 1

pt w/ sinus may complain of

Answer 1

headache

malasie

bad tase in the mouth

nasal congestion or obstruction

purulent drainage from thw nose

Question 2

hoarseness and loss of voice (aphonia) are common symptom of

Answer 2

laryngitis

Question 3

if hoarseness or a sore throat that last 2weeks should be what

Answer 3

should be noted because this may assist in the early detection of throat malignancy

Question 4

when assessing an older adult pt it is important to obtain a

what percentage of throat cancer occurs in people who

Answer 4

history of alcohol intake throughout adulthood

approximately 90 of throat cancer occurs in people who both smoke and IMMODATERELY DRINK ALCOHOL

Question 5

cough is moist and deep, often accompanied by rhonchi or wheezing and ends in production of sputum

Answer 5

productive cough

Question 6

is dry and harsh, no sputum is produced

Answer 6

nonproductive

Question 7

what are the early sign of inadequate O2 in the blood

and an assessment starts where

Answer 7

restlessness
agitation or
mental confusion
increase heart rate

head to toes

Question 8

when you are listening to a pt lung sound what are you trying to listen to

Answer 8

abnormal sound like

• adventitous
• wheezes
• crackle

Question 9

what type of sounds are common in pt w/ asthma

Answer 9

wheezes

Question 10

are a whistling, musical, high-pitched around produced by air being forced a narrowed airway

another type of coarse or sonorous wheezing is low-pitched rattling sounds are

Answer 10

wheezes

rhonchi

Question 11

are produce by air passing through moisture in smaller airway

Answer 11

Crackles

Question 12

are high in pitch and can be heard in pt wo have atelectasis, fibrosis, pneumonia or early congestive heart failure

Answer 12

fine crackles

Question 13

fine crackle are heard in pt w/

Answer 13

• atelectasis,
• fibrosis,
• pneumonia or
• early congestive heart failure

Question 14

are louder and low in pitch and are heard u=in pt w/ bronchitis, pulmonary edema and resolving pneumonia

Answer 14

coarse crackle

Question 15

what do fine crackle sound similar to

Answer 15

rubbing hair

Question 16

which is a grating or scratchy sound similar to creaking shoe leather or opening squeaky door

Answer 16

pleural friction rub

Question 17

occur when irritated visceral and parietal pleura rub against each other

what are some s/s

Answer 17

pleural friction rub

pain

Question 18

croaking sound can be heard w/out a stethoscope when there is partial obstruction of the upper air passage

Answer 18

stridor

Question 19

these sound are typically heard in children w/ croup but can be heard in adults w/ upper airway obstruction

its important to distinguish between airway swelling and foreign body obstruction

Answer 19

stridor

Question 20

the inflammation that is producing the obstruction often also affects what which produces

Answer 20

it affect the larynx producing hoarseness

Question 21

what the nursing goal for pts w/ a respiratory disorder are

Answer 21

Promote oxygenation.

Prevent infection.

Prevent further lung damage.

Promote rehabilitation.

Question 22

effectiveness of intervention for and treatment of pts w/ respiratory disorder is based on what ?

what should your breath sounds show?

what should your pulse oximeter show?

what should your arterial blood gas show ?

what should your lung sound show ?

should there be a decrease or increase in coughing ?

should there be decrease or increase in sputum production ?

would there be a decrease in wheezing ?

sign if infection should what ?

the pt should show report what and show are what and ability to show what ?

Answer 22

Improved breathing pattern,

an improvement on the pulse oximeter readings,

an improvement on arterial blood gas values,

an improvement lung sounds.

Decreases in coughing,

sputum production,

yes there should be a decrease in wheezing,

there should be a decrease in signs of infection

Lessened dyspnea and more energy and ability to perform more self-care

Reassessment is an ongoing nursing activity

Question 23

why should you encourage a pt to deep-breath and cough

Answer 23

because it helps removes sputum and decrease the like hood of complications like pneumonia

Question 24

agent used to inhibit the cough reflex in the cough center in the brain

Answer 24

antitissue

Question 25

what is the most effective method to liquefy secretion so they can be expectorated

Answer 25

adequate hydration

Question 26

what type of med can given to soothe the nerve ending in the upper respiratory mucosa ? the dose of these med are given in what ? and what should not be taken w it immediately after why ?

Answer 26

cough syrup small amount water because it rinses off the topical application of the med

Question 27

bacterial infection and chronic respiratory disease the sputum is usually what should you offer ? by doing this it helps remove what ?

Answer 27

- foul smelling - leaves a bad taste in the mouth and bad breath mouth care remove pathogenic microorganism from the oral cavity that will diminished the possibility that they will be aspirated deep into the air passage

Question 28

when is mechanical suctioning is needed | and what type of technique should be used?

Answer 28

when the pt cannot clear the airway of excessive amount of secretion ascetic technique

Question 29

O2 is administered to relieved what coach the pt to do what what position is best for a pt w/ dyspnea

Answer 29

relief dyspnea to perform pursed-lip and diaphragmatic breathing high fowler

Question 30

for serve dyspnea what position is the most effective and why whats a other way to allow maximum expansion

Answer 30

orthpnea because the pt has some problem breathing when supine pt sits upright and lean over the overbed table (which is padded w pillow) and elevated and round the shoulder to allow maximum expansion of the lung

Question 31

what are some risk factor for dyspnea

Answer 31

pressure from organ, fluid or tissue below or near the lung full stomach abdominal distention from edema flatus(gas) fecal material OBESITY

Question 32

the tissue is most sensitive to changes in what and what does that indicate or what type of s/s is this

Answer 32

to changes in oxygen levels including the brain and heart what indicate hypoxia which shows first in those organ

Question 33

alteration in the brain function included what show up in the VS if hypoxia is not identified

Answer 33

restlessness anxiety confusion the heart rate increases in an attempt to increase O2 delivery

Question 34

whats show the measurement and display pf CO2

Answer 34

Capnography

Question 35

is the result of excessive amount of CO2? and how does it happen ? what another name for it?

Answer 35

- Hypercapnia - it happens by the result of hypoventilation during which the usual amount of CO2 is not eliminated by exhalation - hypercarbia

Question 36

is a deficit of CO2 | how does it happen and it can result in what?

Answer 36

hypocapnia | -it occur from hyperventilation and can result in respiratory alkalosis

Question 37

condition associated w hypocapnia 1. are those w/ increase what? 2. those who are taking what ? 3. and those who are using what ?

Answer 37

1. those in which there is an increase metabolic rate such as thyrotoxicosis, persistent fever, and acute anxiety 2. salicylate. overdose 3. improper use of mechanical ventilation

Question 38

what are some (6)signs of respiratory alkalosis?

Answer 38

``` hyperactive neuromuscular reflexes tetany carpopedal spasm vertigo blurred vision diaphoresis ```

Question 39

low blood O2 level low level of tissue O2

Answer 39

hypoxemia hypoxia