Pulmonary Care and Disorders Flashcards

A patient in the progressive care unit is being treated for a severe exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following assessment findings would indicate the most urgent need for intervention?

Answer: Decreased level of consciousness and confusion

A decreased level of consciousness and confusion are signs of hypercapnia and severe respiratory distress, indicating impending respiratory failure. This is a life-threatening situation that requires immediate intervention, possibly including non-invasive or invasive mechanical ventilation. While the other options are concerning, they do not represent the same level of immediate threat as a change in mental status.

A nurse is caring for a patient who was recently extubated after several days of mechanical ventilation. Which of the following parameters is the BEST indicator of the patient's readiness to be weaned from mechanical ventilation?

Answer: A rapid shallow breathing index (RSBI) of 95

The rapid shallow breathing index (RSBI), which is the ratio of respiratory frequency to tidal volume (f/VT), is a strong predictor of weaning success. An RSBI of less than 105 is a commonly accepted parameter indicating that a patient is likely to be successfully weaned. The other values, while important, are not as comprehensively predictive as the RSBI.

A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation with a low tidal volume strategy. What is the primary rationale for this intervention?

Answer: To reduce the risk of barotrauma and volutrauma.

The primary goal of a low tidal volume ventilation strategy (typically 4-8 mL/kg of predicted body weight) in ARDS is to minimize ventilator-induced lung injury (VILI). High tidal volumes can overdistend and injure the less-affected alveoli, leading to volutrauma and barotrauma. Keeping plateau pressures below 30 cm H2O is a key component of this protective strategy.

A 68-year-old male with a history of heart failure is admitted with a diagnosis of community-acquired pneumonia. He presents with a productive cough, fever of 38.9°C, and crackles in the right lower lobe. Which of the following orders should the nurse prioritize?

Answer: Titrate oxygen to maintain SpO2 > 92%.

While all orders are important, ensuring adequate oxygenation is the immediate priority according to the ABCs (Airway, Breathing, Circulation). Hypoxia is a common and life-threatening complication of pneumonia. Once oxygenation is stabilized, the nurse should proceed with obtaining cultures before administering antibiotics to ensure the correct pathogen is identified.

Which of the following is a key nursing intervention for a patient admitted with a suspected pulmonary embolism (PE)?

Answer: Placing the patient in a high Fowler's position.

Placing the patient in a high Fowler's position helps to maximize chest expansion and alleviate dyspnea, which is a common and distressing symptom of a pulmonary embolism. While anticoagulation is the cornerstone of treatment, immediate positioning to improve breathing is a critical initial nursing action. Ambulation is contraindicated as it could dislodge more clots. Fluid boluses should be given with caution as they can worsen right ventricular strain.

A progressive care nurse is educating a patient being discharged after an asthma exacerbation. Which statement by the patient indicates a need for further teaching?

Answer: "If I feel short of breath, I will take my oral prednisone immediately."

Oral corticosteroids like prednisone are not rescue medications for acute shortness of breath. They are used for managing more severe, prolonged exacerbations, typically as a prescribed tapering course. The patient should have a clear action plan that involves using their short-acting beta-agonist (rescue inhaler) for acute symptoms and seeking medical attention if symptoms do not improve. The other statements demonstrate correct understanding of asthma self-management.