Upper and Lower Respiratory Disorders

Introduction

• Welcome by Professor D.
• Reminder to like, subscribe, and check social media for more content (Instagram, TikTok: Nexus Nursing).
• Audio lessons available at Nexus Nursing website.

Question 1: Hypertension and Sneezing

• Question: What should a nurse ask a hypertensive client who is sneezing and blowing their nose frequently?
• Answer: Are you taking any over-the-counter medicine for these symptoms?
• Reason: Oral decongestants cause vasoconstriction, increasing blood pressure.
• **Other Choices Analysis: **
  1. Have you had a flu shot recently? - irrelevant
  2. Do you have small children at home? - irrelevant
  3. Do you have any cold sores? - irrelevant

Question 2: Preventing the Spread of Cold Virus

• Question: Key information for preventing the common cold in primary school children?
• Answer: Demonstrate how to wash hands correctly.
• Reason: Hand washing is the primary way to prevent the transmission of infections.
• **Other Choices Analysis: **
  1. Keep a tissue or handkerchief - does not prevent spreading
  2. Current immunizations prevent colds - false
  3. See a doctor if ill - impractical for children

Question 3: Chronic Sinusitis

• Question: Symptoms that indicate a life-threatening complication?
• Answer: Nuchal rigidity.
• Reason: Nuchal rigidity suggests meningitis, which is life-threatening.
• **Other Choices Analysis: **
  1. Muscle weakness - myalgia
  2. Purulent sputum - lung infection (e.g., pneumonia)
  3. Intermittent loss of muscle control - MS

Notes on Meningitis

• First action: Isolate patient
• Next: Draw blood cultures
• Follow-up: Administer antibiotics (post-culture)

Question 4: Pre-Surgery Assessment for Tonsillitis

• Question: Which data should notify the healthcare provider before surgery?
• Answer: Oral temperature of 100.2°F and dry cough.
• Reason: Signs of infection which require surgery cancellation.

Question 5: Influenza Vaccine Priority

• Question: Which groups should get the flu vaccine first in case of shortage?
• Answer: Elderly and chronically ill clients.

Question 6: Influenza A Discharge

• Question: Client's understanding of being prescribed antibiotics?
• Answer: To prevent bacterial pneumonia.
• Reason: Antibiotics prevent secondary bacterial infections post-viral infection.
• **Other Choices Analysis: **
  1. Returning to work quickly - incorrect, needs rest
  2. Early Antibiotics prevent illness - incorrect
  3. Stopping antibiotics early - incorrect, must complete course

Question 7: Delegating to UAP

• Question: Task that can be delegated to a UAP?
• Answer: Encourage client with a cold to drink orange juice.
• Reason: UAP can handle simple encouragement, vitamin C helps infection.
• **Other Choices Analysis: **
  1. Throat assessment (post-op first meal) - RN responsibility due to aspiration risk
  2. Performing throat culture - Requires RN to ensure accuracy
  3. Escorting outside to smoke - Not appropriate

Question 8: Pneumonia in Elderly

• Question: Expected symptoms in a 79-year-old with pneumonia?
• Answer: Confusion and lethargy.
• Reason: Geriatric patients often display altered mental status.
• **Other Choices Analysis: **
  1. High fever and chills - Younger patients
  2. Frothy sputum and edema - Heart failure
  3. Bradycardia and JVD - Heart failure

Question 9: Impaired Gas Exchange Outcomes

• Question: Expected outcome for patient with impaired gas exchange?
• Answer: Alert and oriented to person, place, time, and events.
• Reason: Good gas exchange indicates sufficient oxygen is reaching the brain.
• **Other Choices Analysis: **
  1. Chest PT - Intervention
  2. ADLs - Intervention
  3. Ambulation - Intervention

Question 10: PEG Tube Care

• Question: Key intervention for PEG tube?
• Answer: Elevate head of bed post-feeding.
• Reason: Prevents aspiration using gravity.

Question 11: Community-Acquired Pneumonia

• Question: Priority nursing intervention on admission?
• Answer: Obtain sputum specimen for culture and sensitivity.
• Reason: Determine correct antibiotic treatment.
• **Other Choices Analysis: **
  1. Oral antibiotics before culture - Incorrect process
  2. Meal tray ordering - Can wait
  3. Weighing patient - Can wait

Question 12: TB Discharge Instructions

• Question: Correct understanding of TB medication regimen?
• Answer: Take medication for months (minimum 9 months).
• Reason: Extended treatment needed to fully clear infection.
• **Other Choices Analysis: **
  1. 3 weeks - Insufficient duration
  2. Social contact - Requires three negative sputum tests first
  3. Frequent skin tests - Not for ongoing treatment monitoring

Question 13: Radiological Evaluation Instead of Skin Test

• Question: Which client needs radiological evaluation?
• Answer: Previous skin test read as positive.
• Reason: Positive skin test leads to chest x-ray, followed by sputum culture for diagnosis.

Question 14: Teaching Plan for Pneumonia

• Key Points:
  1. Oxygen via nasal cannula - True
  2. Plan periods of rest - True
  3. Fluid restrictions - False, encourage fluids
  4. Restrict smoking - False, complete cessation
  5. Monitor pulse ox - True

Question 15: Aspiration Pneumonia Choking

• Question: First nursing intervention for dyspnea, coughing, turning blue?
• Answer: Turn client to the side.
• Reason: Helps to expel aspirated material.
• **Other Choices Analysis: **
  1. Nare suction - Insufficient
  2. Trendelenburg position - Increases aspiration risk
  3. Notify doctor - Should follow immediate intervention

Question 16: First Client to See (Medical Unit)

• Question: Which client to prioritize?
• Answer: Client with a pulse oximetry reading of 92.
• Reason: Indicates insufficient perfusion, immediate action needed.
• **Other Choices: **
  1. TB sputum specimen - Less immediate risk
  2. Clogged feeding tube (aspiration pneumonia) - Less critical
  3. Bronchitis with arterial oxygenation of 89 - Important, but 92 is the focus.

Closing

• Video conclusion and additional resources reminder.