NUR243 – Sims G1A Pre-Simulation Questions 1. What is an obstructive lung disorder? Obstructive lung disease is a type of lung disease that occurs due to blockages or obstructions in the airways. Blockages damage the lungs and cause their airways to narrow. This damage leads to difficulty breathing. Types of obstructive lung disorder are: asthma, bronchiectasis, bronchitis and chronic obstructive pulmonary disease (COPD) 2. What should the nurse consider when giving oxygen to the patient with an obstructive lung disorder and why? Supplemental O2 removes a COPD patient's hypoxic respiratory drive causing hypoventilation with resultant hypercarbia, apnea, and ultimate respiratory failure. The main danger of acute oxygen is that carbon dioxide retention may occur in some patients with chronic obstructive pulmonary disease. 3. What are the nursing management issues related to obstructive disorders? Control your breathing. Clear your airways. Exercise regularly. Eat healthy foods. Avoid smoke and air pollution. See your doctor regularly 4. How does a nurse know when a person is experience respiratory failure? People who have trouble breathing often show signs that they are having to work harder to breathe or are not getting enough oxygen, indicating respiratory distress. Other signs include: breathing rate (increase in respirations), color changes (blueish hues on their lips, fingernails or pale grey skin color), grunting (as they exhale), nose flaring (indicates they have to work harder to breathe), retractions (This is one way of trying to bring more air into the lungs, and can also be seen under the rib cage or even in the muscles between the ribs), sweating (the skin may feel cool or clammy. This may happen when the breathing rate is very fast), wheezing (A tight, whistling or musical 1 sound heard with each breath can mean that the air passages may be smaller (tighter), making it harder to breathe), body positions (A person may spontaneously lean forward while sitting to help take deeper breaths. This is a warning sign that he or she is about to collapse.). 5. What does it mean to be in acute respiratory failure? Acute respiratory failure occurs when fluid builds up in the air sacs in your lungs. When that happens, your lungs can't release oxygen into your blood. In turn, your organs can't get enough oxygen-rich blood to function. 6. What is the cardiac consequences of long-term COPD? COPD can cause low oxygen levels in the blood, thereby placing additional stress on the heart and worsening symptoms of left-sided heart failure. On the other hand, left-sided heart failure can contribute to fluid buildup in the lungs, aggravating the symptoms of COPD. 7. What are the appropriate interventions for a person with COPD who is showing signs of respiratory failure? In severe acute exacerbations of COPD with acute respiratory failure, controlled oxygen delivery is a reasonable and effective approach to relieve symptoms, counteract hypoxemia and reduce the work of breathing. 8. What does SP02 represent? SpO2, also known as oxygen saturation, is a measure of the amount of oxygen-carrying hemoglobin in the blood relative to the amount of hemoglobin not carrying oxygen. 9. At what point do nurses intervene with an altered SP02? A normal level of oxygen is usually 95% or higher. Some people with chronic lung disease or sleep apnea can have normal levels around 90%. The “SpO2” reading on a pulse oximeter shows the percentage of oxygen in someone’s blood. 10. What are the parameters that indicated the need for intubation? Indications for intubation to secure the airway include respiratory failure (hypoxic or hypercapnic), apnea, a reduced level of consciousness (sometimes stated as GCS less than or equal to 8), rapid change of mental status, airway injury 11. What needs to be done to prepare for intubation? 2 Monitor the patient’s parameters including: 1. Hemodynamic measurements and status, respiratory parameters, mobility, level of consciousness and perception of pain Communicate changes in patient status to the authorized provider performing the procedure and to other members of the healthcare team as necessary; Implement, if necessary, emergency measures to optimize the patient’s respiratory and circulatory status until other qualified healthcare personnel assume care of the patient. Maintain continuous intravenous access. 12. How do nurses assess for correct placement of endotracheal tube immediately after intubation? Confirming correct tube placement include: visualizing the ETT passing through the vocal cords, auscultation of clear and equal bilateral breath sounds, absence of air sounds over the epigastrium, observation of symmetric chest rise and fall, visualizing condensation (misting) in the tube, and monitoring of SpO2. A Capnography is the most reliable method to confirm endotracheal tube placement in emergency conditions in the prehospital setting. 13. What is the patients most at risk for developing with acute exacerbation of COPD? Viral infections are an even more important risk factor for exacerbations of COPD. A case–control study found viral respiratory pathogens more often in respiratory specimens of hospitalized patients with exacerbated COPD than in control patients 14. Describe furosemide and its purpose, considerations, side effects etc. Furosemide is a loop diuretic. It's used to treat high blood pressure, heart failure and oedema (a build up of fluid in the body). It's also sometimes used to help you pee when your kidneys aren't working properly. You want to assess: weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily you also want to asses if they have hypertension and hypokalemia. Side effects include: circulatory collapse, renal failure, Thrombocytopenia, agranulocytosis, leukopenia, neutropenia, anemia Toxic epidermal necrolysis, erythema multiforme, Stevens-Johnson syndrome 15. What are PVCs in a heart rhythm? What can cause them? 3 Premature ventricular contractions (PVCs) are extra heartbeats that begin in one of your heart's two lower pumping chambers (ventricles). These extra beats disrupt your regular heart rhythm, sometimes causing you to feel a fluttering or a skipped beat in your chest. Heart disease or scarring that interferes with the heart's normal electrical impulses can cause PVCs. Certain medications, alcohol, stress, exercise, caffeine or low blood oxygen, which is caused by chronic obstructive pulmonary disease (COPD) or pneumonia, can also trigger them. 16. What is albuterol? Levabuterol? What is its purpose, considerations, side effects? Albuterol is used to relieve bronchospasm (tightening and swelling of the muscles around the airways) in children and adults with asthma. It's also used to prevent exercise-induced asthma. Asses: Respiratory function - vital capacity, pulse oximetry, forced expiratory volume, ABGs; lung sounds, heart rate and rhythm, B/P, sputum (baseline and peak); whether patient has received theophylline therapy before giving dose Side effects: Paradoxical bronchospasm Levalbuterol is used to prevent or relieve the wheezing, shortness of breath, coughing, and chest tightness caused by lung disease such as asthma and chronic obstructive pulmonary disease Asses: Respiratory function: vital capacity, pulse oximetry, forced expiratory volume, ABGs, lung sounds, heart rate and rhythm (baseline); character of sputum: color, consistency, amount Cardiac status: palpitations, increase/decrease in B/P, dysrhythmias Side effects: QT Prolongation, Anaphylaxis, angioedema References 4 https://www.medicalnewstoday.com/articles/324406 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461124/ https://www.nursingtimes.net/clinical-archive/respiratory-clinical-archive/chronic-opd-2management-and-nursing-care-06-04-2020/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056438/ https://www.homecaremag.com/understanding-spo2-and-normal-oxygenlevels#:~:text=What%20is%20SpO2%3F,of%20hemoglobin%20not%20carrying%20oxygen. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2650592/ https://www.cardio.com/blog/copd-and-heart-failure-what-are-the-symptoms-and-howare-theyrelated#:~:text=COPD%20can%20cause%20low%20oxygen,aggravating%20the%20sympto ms%20of%20COPD. https://www.healthline.com/health/acute-respiratoryfailure#:~:text=Acute%20respiratory%20failure%20occurs%20when,oxygen%2Drich%20blo od%20to%20function https://www.hopkinsmedicine.org/health/conditions-and-diseases/signs-of-respiratorydistress https://www.nursingtimes.net/clinical-archive/respiratory-clinical-archive/acuterespiratory-failure-1-assessing-patients-04-09-2008/ https://err.ersjournals.com/content/27/147/170103#:~:text=Viral%20infections%20are%20 an%20even,versus%2019%25)%20%5B18%5D. https://nursing.ohio.gov/wp-content/uploads/2020/05/Guidelines-for-RN-Role-inEmergent-Intubation.pdf 5
