Nursing Lecture: Med-Surge Respiratory Practice Questions

Overview

• Focus on practice questions for Med-Surg respiratory concepts
• Objective: Prepare for the NCLEX exam

Key Concepts

Arterial Blood Gas (ABG) and Respiratory Acidosis

• Normal ABG Values:
  • pH: 7.35 to 7.45
  • pCO2: 35 to 45 mmHg
  • Bicarbonate (HCO3): 22 to 26 mEq/L
• Identify Uncompensated Respiratory Acidosis:
  • Look for low pH and elevated pCO2
  • Uncompensated if HCO3 is normal
  • Example:
    • pH 7.29, pCO2 55, HCO3 23 = Uncompensated Respiratory Acidosis

Managing Chest Tube Dislodgment

• Immediate Action:
  • Place a sterile occlusive dressing over the site
  • Tape on three sides
  • Notify healthcare provider
  • Avoid reinsertion of tube by nurse
• Preparation Tips:
  • Keep emergency supplies ready (sterile dressing and tape)

COPD and Inhaler Use

• COPD Overview:
  • Chronic inflammation leading to obstructed airflow
  • Symptoms: chronic cough, wheezing, difficulty breathing
• Inhaler for Fast Relief:
  • Use short-acting bronchodilator (e.g., Albuterol)
  • Avoid long-acting bronchodilators for emergencies

Peak Flow Meter for Asthma

• Purpose:
  • Monitor airflow out of lungs
  • Helps detect if asthma is worsening
• Patient Education:
  • Not used to strengthen lungs
  • Exhale forcefully into device, standing position
  • Monitor zones (Green: 80-100%, Yellow: <80%, Red: <50%)

Incentive Spirometer Use

• Purpose:
  • Prevent pneumonia, maintain lung function
• Correct Use:
  • Inhale slowly and deeply, hold breath for 6 seconds
  • Use at least 10 times every 1-2 hours while awake

Chest Tube Drainage System Assessment

• Intermittent Bubbling:
  • Normal in Water Seal chamber for pneumothorax
  • Indicative of air being expelled
• System Positioning:
  • Keep drainage system below chest level

Exercise-Induced Asthma Management

• Prevention Strategies:
  • Warm up before exercise
  • Use short-acting beta agonist before exercise
  • Avoid exercise during respiratory illness

Tuberculosis Testing

• BCG Vaccine Considerations:
  • May cause false positive with PPD skin test
  • Prefer IGRA blood test for TB detection
• PPD Skin Test Reading:
  • Return for reading 48-72 hours after test

Complications with Mechanical Ventilation

• Positive End Expiratory Pressure (PEEP):
  • Watch for hypotension (e.g., BP of 70/45)
  • Increased intrathoracic pressure can reduce cardiac output

Chest Physiotherapy Timing

• Best Timing for CF Patients:
  • 1 to 2 hours after meals
  • Avoid immediately before or after meals to reduce aspiration risk

Conclusion

• Practice questions are essential for mastering respiratory concepts
• Further resources and reviews are available through linked materials