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A shallow, monotonous respiratory pattern coupled with immobility
places the patient
at an increased risk of developing atelectasis. These specific factors are less
likely to
result in pulmonary embolism or aspiration. ARDS involves an exaggerated
inflammatory response and does not normally result from factors such as
immobility
and shallow breathing.
The nurse should encourage hydration because adequate hydration thins
and loosens
pulmonary secretions. Oral suctioning is not sufficiently deep to remove
tracheobronchial secretions. The patient should have the head of the bed
raised, and rest
should be promoted to avoid exacerbation of symptoms.
The purified protein derivative (PPD) is always injected into the
intradermal layer of
the inner aspect of the forearm. The subcutaneous and intramuscular routes
are not
utilized.
The key characteristic of pleuritic pain is its relationship to respiratory
movement.
Taking a deep breath, coughing, or sneezing worsens the pain. The patient's
ABGs
would most likely be abnormal and shortness of breath would be expected.
In addition to irritating the mucous cells of the bronchi and inhibiting the
function of
alveolar macrophage (scavenger) cells, smoking damages the ciliary
cleansing
mechanism of the respiratory tract. Smoking also increases the amount of
mucus
production and distends the alveoli in the lungs. It reduces the oxygencarrying capacity
of hemoglobin, but not by directly competing for binding sites.
A patient who has ARDS usually requires intubation and mechanical
ventilation.
Oxygen by nasal cannula would likely be insufficient. Deep suctioning and
nebulizers
may be indicated, but the priority is to secure the airway.

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In the case of a simple pneumothorax, auscultating the breath sounds will
reveal absent
or diminished breath sounds on the affected side. Paradoxical chest wall
movements
occur in flail chest conditions. Sudden loss of consciousness does not
typically occur.
Muffled or distant heart sounds occur in pericardial tamponade.
Anticoagulant therapy prevents further clot formation, but cannot be
used to dissolve a
clot. The therapy continues for approximately 3 to 6 months and is not
combined with
ASA. Vitamin K reverses the effect of anticoagulant therapy and normally
should not
be taken.
When working with toxic substances, the employee must wear or use
protective devices
such as face masks, hoods, or industrial respirators. Immunizations do not
confer
protection from toxins and a paper mask is normally insufficient protection.
Never
position a fan directly blowing on the toxic substance as it will disperse the
fumes
throughout the area.
As with rib fracture, treatment of flail chest is usually supportive.
Management includes
clearing secretions from the lungs, and controlling pain. If only a small
segment of the
chest is involved, it is important to clear the airway through positioning,
coughing, deep
breathing, and suctioning. Intubation is required for severe flail chest injuries,
and
surgery is required only in rare circumstances to stabilize the flail segment.
The effectiveness of the patient's oxygen therapy is assessed by the ABG
analysis or
pulse oximetry. ABG results may not be readily available. Presence or
absence of
cyanosis is not an accurate indicator of oxygen effectiveness. The patient's
LOC may be
affected by hypoxia, but not every change in LOC is related to oxygenation.
Hemoglobin, hematocrit, and red blood cell levels do not directly reflect
current

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oxygenation status.
Successful treatment of TB is highly dependent on careful adherence to
the medication
regimen. The disease is not self-limiting; occupational and physical therapy
are not
necessarily indicated. TB is curable.
If the pneumothorax is large and the lung collapses totally, acute
respiratory distress
occurs. The patient is anxious, has dyspnea and air hunger, has increased
use of the
accessory muscles, and may develop central cyanosis from severe
hypoxemia. These
symptoms are not definitive of pneumothorax, but because of the patient's
recent
trauma they are inconsistent with anxiety, bronchitis, or aspiration.
Aspiration may occur if the patient cannot adequately coordinate
protective glottic,
laryngeal, and cough reflexes. These reflexes are often affected by stroke. A
patient
with mid-stage Alzheimer's disease does not likely have the voluntary muscle
problems
that occur later in the disease. Clients that need help with ADLs or have
severe arthritis
should not have difficulty swallowing unless it exists secondary to another
problem.
Common diagnostic tests performed for patients with potential ARDS
include plasma
brain natriuretic peptide (BNP) levels, echocardiography, and pulmonary
artery
catheterization. The BNP level is helpful in distinguishing ARDS from
cardiogenic
pulmonary edema. The carboxyhemoglobin level will be increased in a client
with an
inhalation injury, which commonly progresses into ARDS. CRP and CBC levels
do not
help differentiate from a cardiac problem.
Strategies to prevent atelectasis, which include frequent turning, early
ambulation,
lung-volume expansion maneuvers (deep breathing exercises, incentive
spirometry),

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and coughing, serve as the first-line measures to minimize or treat
atelectasis by
improving ventilation. In patients who do not respond to first-line measures
or who
cannot perform deep-breathing exercises, other treatments such as positive
endexpiratory pressure (PEEP), continuous or intermittent positive-pressure
breathing
(IPPB), or bronchoscopy may be used.
The key characteristic of pleuritic pain is its relationship to respiratory
movement.
Taking a deep breath, coughing, or sneezing worsens the pain. A soft diet is
not
necessarily indicated and there is no need for the patient to avoid speaking.
Ambulation
has multiple benefits, but pain management is not among them.
For patients at risk for PE, the most effective approach for prevention is to
prevent deep
vein thrombosis. Active leg exercises to avoid venous stasis, early
ambulation, and use
of elastic compression stocking are general preventive measures. The
patient does not
require increased dietary intake of protein directly related to prevention of
PE, although
it will assist in wound healing during the postoperative period. The patient
should not
be maintained in one position, but frequently repositioned, unless
contraindicated by
the surgical procedure. Aspirin should never be administered with warfarin
because it
will increase the patient's risk for bleeding.
Risk is determined by the pack-year history (number of packs of
cigarettes used each
day, multiplied by the number of years smoked), the age of initiation of
smoking, the
depth of inhalation, and the tar and nicotine levels in the cigarettes smoked.
The
younger a person is when he or she starts smoking, the greater the risk of
developing
lung cancer. Risk declines after smoking cessation. The type of cigarettes is a
significant variable, but this is not the most important factor.

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The most frequent symptom of lung cancer is cough or change in a
chronic cough.
People frequently ignore this symptom and attribute it to smoking or a
respiratory
infection. A new onset of allergies, frequent respiratory infections and fatigue
are not
characteristic early signs of lung cancer.
Initially, the patient with tracheobronchitis has a dry, irritating cough and
expectorates
a scant amount of mucoid sputum. The patient may report sternal soreness
from
coughing and have fever or chills, night sweats, headache, and general
malaise. Pleural
effusion and pulmonary embolism do not normally cause sputum production
and would
likely cause acute shortness of breath. Hemoptysis is characteristic of TB.
Pneumococcal vaccination reduces the incidence of pneumonia,
hospitalizations for
cardiac conditions, and deaths in the general older adult population. A
onetime
vaccination of pneumococcal polysaccharide vaccine (PPSV) is recommended
for all
patients 65 years of age or older and those with chronic diseases. Antibiotics
are not
given on a preventative basis and antiretroviral medications do not affect the
most
common causative microorganisms. Culture and sensitivity testing by
swabbing is not
performed for pneumonia since the microorganisms are found in sputum.
Asbestos is among the more common causes of pneumoconiosis. Organic
acids,
propane, and gypsum do not have this effect.

Early signs of acute respiratory failure are those associated with impaired
oxygenation
and may include restlessness, fatigue, headache, dyspnea, air hunger,
tachycardia, and
increased blood pressure. As the hypoxemia progresses, more obvious signs
may be
present, including confusion, lethargy, tachycardia, tachypnea, central

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cyanosis,
diaphoresis, and, finally, respiratory arrest. Pneumonia is infectious and
would not
result from trauma. Pneumoconiosis results from exposure to occupational
toxins. A
pleural effusion does not cause this constellation of symptoms.
Surgical resection is the preferred method of treating patients with
localized nonsmall
cell tumors with no evidence of metastatic spread and adequate
cardiopulmonary
function. The other listed treatment options may be considered, but surgery
is preferred.
The nurse assesses the patient with pulmonary emboli frequently for
signs of
hypoxemia and monitors the pulse oximetry values to evaluate the
effectiveness of the
oxygen therapy. ABGs are accurate indicators of oxygenation status, but are
not
analyzed at the bedside. PFTs and incentive spirometry volumes do not
accurately
reveal oxygenation status.
The key characteristic of pleuritic pain is its relationship to respiratory
movement.
Taking a deep breath, coughing, or sneezing worsens the pain. Pleuritic pain
is limited
in distribution rather than diffuse; it usually occurs only on one side. The pain
may
become minimal or absent when the breath is held. It may be localized or
radiate to the
shoulder or abdomen. Later, as pleural fluid develops, the pain decreases.
The scenario
does not indicate any trauma to the patient, so a traumatic pneumothorax is
implausible.
Empyema is unlikely as there is no fever indicative of infection. Myocardial
infarction
would affect the patient's vital signs profoundly.
In severe cases in which there is widespread subcutaneous emphysema,
a tracheostomy
is indicated if airway patency is threatened by pressure of the trapped air on
the trachea.
The other listed tubes would neither resolve the subcutaneous emphysema

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nor the
consequent airway constriction.
Systemic hypotension may occur in ARDS as a result of hypovolemia
secondary to
leakage of fluid into the interstitial spaces and depressed cardiac output from
high
levels of PEEP therapy. Pulmonary hypertension, not pulmonary hypotension,
sometimes is a complication of ARDS, but it is not the cause of the patient
becoming
hypotensive.
The home care nurse should monitor the patient for residual effects of the
PE, which
involved a severe disruption in respiration and oxygenation. PE has a
noninfectious
etiology; pneumonia is not impossible, but it is a less likely sequela.
Swallowing ability
is unlikely to be affected; activity level is important, but secondary to the
effects of
Deoxygenation.
Surgery is primarily used for NSCLCs, because small cell cancer of the
lung grows
rapidly and metastasizes early and extensively. Difficult visualization and a
patient's
medical instability are not the limiting factors. Lung cancer is not a selflimiting
disease.
Key aspects of any assessment of patients with a potential occupational
respiratory
history include job and job activities, exposure levels, general hygiene, time
frame of
exposure, effectiveness of respiratory protection used, and direct versus
indirect
exposures. The patient's current respiratory status would also be a priority.
Occupational lung hazards are not normally influenced by immunizations.
The diagnosis of pneumonia may be missed because the classic
symptoms of cough,
chest pain, sputum production, and fever may be absent or masked in older
adult
patients. Mortality from pneumonia in the elderly is not a result of limited

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antibiotic
options or lower lung compliance. The pneumococcal vaccine is appropriate
for older
Adults.
Treatment of lung cancer depends on the cell type, the stage of the
disease, and the
patient's physiologic status (particularly cardiac and pulmonary status).
Treatment does
not depend solely on the patient's age or the patient's preference between
the different
treatment modes. The decision about treatment does not primarily depend
on a
discussion between the patient and the physician of which treatment is best,
though this
discussion will take place.
If the patient has undergone surgical embolectomy, the nurse measures
the patient's
pulmonary arterial pressure and urinary output. Pressure is not monitored in
a patient's
vena cava. White cell levels and pupillary responses would be monitored, but
not to the
extent of the patient's pulmonary arterial pressure.
Aggressive, supportive care must be provided to compensate for the
severe respiratory
dysfunction. This supportive therapy almost always includes intubation and
mechanical
ventilation. In addition, circulatory support, adequate fluid volume, and
nutritional
support are important. Oral intake is contraindicated by intubation.
Counseling and
occupational therapy would not be priorities during the acute stage of ARDS.
Most empyemas occur as complications of bacterial pneumonia or lung
abscess.
Cancer, smoking, and asbestosis are not noted to be common causes.
Supportive treatment of pneumonia in the elderly includes hydration
(with caution and
with frequent assessment because of the risk of fluid overload in the elderly);
supplemental oxygen therapy; and assistance with deep breathing,
coughing, frequent
position changes, and early ambulation. Mobility is not normally discouraged

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and an
NG tube is not necessary in most cases. Probiotics may or may not be
prescribed for the
Patient.
Increased tactile fremitus over the area of pulmonary consolidation is
expected with bacterial pneumonias. Dullness to percussion would be
expected. Pneumococcal pneumonia typically presents with a loose,
productive cough. Adventitious breath sounds such as crackles and
wheezes are typical. A grating sound is more representative of a pleural
friction rub rather than pneumonia.
Coughing is less painful and more likely to be effective when the patient
splints the chest during coughing. Fluids should be encouraged to help
liquefy secretions. Nasal oxygen will improve gas exchange, but will not
improve airway clearance. Pursed lip breathing is used to improve gas
exchange in patients with COPD, but will not improve airway clearance.
Patients should continue to cough and deep breathe after discharge.
Fatigue is expected for several weeks. The Pneumovax and influenza
vaccines can be given at the same time in different arms. Explain that a
follow-up chest x-ray needs to be done in 6 to 8 weeks to evaluate
resolution of pneumonia.
The risk for aspiration is decreased when patients with a decreased level
of consciousness are placed in a side-lying or upright position. Frequent
turning prevents pooling of secretions in immobilized patients but will not
decrease the risk for aspiration in patients at risk. Monitoring of
parameters such as breath sounds and oxygen saturation will help detect
pneumonia in immunocompromised patients, but it will not decrease the
risk for aspiration. Conditions that increase the risk of aspiration include
decreased level of consciousness (e.g., seizure, anesthesia, head injury,
stroke, alcohol intake), difficulty swallowing, and nasogastric intubation
with or without tube feeding. With loss of consciousness, the gag and
cough reflexes are depressed, and aspiration is more likely to occur.
Other high-risk groups are those who are seriously ill, have poor
dentition, or are receiving acid-reducing medications.
Sputum specimens are obtained on 2 to 3 consecutive days for
bacteriologic testing for M. tuberculosis. The patient should not provide
all the specimens at once. Blood cultures are not used for tuberculosis
testing. A chest x-ray is not bacteriologic testing. Although the findings
on chest x-ray examination are important, it is not possible to make a
diagnosis of TB solely based on chest x-ray findings because other
diseases can mimic the appearance of TB.

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Negative sputum smears indicate that Mycobacterium tuberculosis is not
present in the sputum, and the patient cannot transmit the bacteria by
the airborne route. Chest x-rays are not used to determine whether
treatment has been successful. Taking medications for 6 months is
necessary, but the multidrug-resistant forms of the disease might not be
eradicated after 6 months of therapy. Repeat Mantoux testing would not
be done because the result will not change even with effective treatment.
Teach the patients with pulmonary tuberculosis how to minimize exposure
to close contacts and household members. Homes should be well
ventilated, especially the areas where the infected person spends a lot of
time. While still infectious, the patient should sleep alone, spend as much
time as possible outdoors, and minimize time in congregate settings or
on public transportation.
The nurse is considered to have a latent TB infection and should be
treated with INH daily for 6 to 9 months. The four-drug therapy would be
appropriate if the nurse had active TB. TB skin testing is not done for
individuals who have already had a positive skin test. BCG vaccine is not
used in the United States for TB and would not be helpful for this
individual, who already has a TB infection.
A high-efficiency particulate-absorbing (HEPA) mask, rather than a
standard surgical mask, should be used when entering the patients room
with active TB because the HEPA mask can filter out 100% of small
airborne particles. Hand washing before entering the patients room is
appropriate. Because anorexia and weight loss are frequent problems in
patients with TB, bringing food to the patient is appropriate. The student
nurse should perform hand washing after handling a tissue that the
patient has used, but no precautions are necessary when giving the
patient an unused tissue.
Because smoking is the major cause of lung cancer, the most important
role for the nurse is teaching patients about the benefits of and means of
smoking cessation.
Continuous bubbling is expected in the suction-control chamber and
indicates that the suction-control chamber is connected to suction. An air
leak would be detected in the water-seal chamber.
Cor pulmonale is right ventricular failure caused by pulmonary
hypertension, so clinical manifestations of right ventricular failure such as
peripheral edema, jugular venous distention, and right upper-quadrant
abdominal tenderness would be expected. Crackles in the lungs are likely
to be heard with left-sided heart failure. Findings in cor pulmonale include

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evidence of right ventricular hypertrophy on electrocardiogram ECG and
an increase in intensity of the second heart sound. Heaves or thrills are
not common with cor pulmonale. Chronic hypoxemia leads to
polycythemia and increased total blood volume and viscosity of the
blood. The hemoglobin and hematocrit values are more likely to be
elevated with cor pulmonale than decreased.
A baker is exposed to dust from flour. A quarry worker is exposed to rock
dust and silica. A welder is exposed to gases and fumes that can be
inhaled and result in silicosis. A banker, nurse, and mechanic may have
work hazards but not specific to the development of silicosis.
Factors associated with the development of ARDS include aspiration
related to near drowning or vomiting; drug ingestion/overdose;
hematologic disorders such as disseminated intravascular coagulation or
massive transfusions; direct damage to the lungs through prolonged
smoke inhalation or other corrosive substances; localized lung infection;
metabolic disorders such as pancreatitis or uremia; shock; trauma such
as chest contusions, multiple fractures, or head injury; any major surgery;
embolism; and septicemia. Smoke inhalation does not increase the risk
for lung cancer, bronchitis, and tracheobronchitis

The nurse should use strict hand hygiene to help minimize the client's
exposure to infection, which could lead to pneumonia. The head of the
bed should be kept at a minimum of 30 degrees. The client should be
turned and repositioned at least every 2 hours to help promote secretion
drainage. Oral hygiene should be performed every 4 hours to help
decrease the number of organisms in the client's mouth that could lead
to pneumonia.
For a patient with a lung abscess the nurse encourages a diet that is high
in protein and calories to ensure proper nutritional intake. A
carbohydrate-dense diet or diets with limited fats are not advisable for a
patient with a lung abscess.
The client has developed a pneumothorax, and the best action is to
prevent further deflation of the affected lung by placing an airtight
dressing over the wound. A vented dressing would be used in a tension
pneumothorax, but because air is heard moving in and out, a tension
pneumothorax is not indicated. Applying direct pressure is required if
active bleeding is noted.
The client demonstrates understanding of how to prevent relapse when

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he states that he must continue taking the antibiotics for the prescribed
10-day course. Although the client should keep the follow-up appointment
with the physician and turn and reposition himself frequently, these
interventions don't prevent relapse. The client should drink 51 to 101 oz
(1,500 to 3,000 ml) per day of clear liquids.
Bubbling in the water-seal chamber occurs in the early postoperative
period. If bubbling is excessive, the nurse checks the system for any kind
of leaks. Fluctuation of the fluid in the water-seal chamber is initially
present with each respiration. Fluctuations cease if the chest tube is
clogged or a kink develops in the tubing. If the suction unit malfunctions,
the suction control chamber, not the water-seal chamber, will be affected.
Clamping can result in a tension pneumothorax. The other options would
not occur if the chest tube was clamped during transportation.
For a patient with pleural effusion, a diet rich in protein and calories is
pivotal. A carbohydrate-dense diet or diets with limited fat are not
advisable for a patient with lung abscess.
A client with drug-resistant tuberculosis isn't contagious when he's had a
negative acid-fast test. A client with nonresistant tuberculosis is no longer
considered contagious when he shows clinical evidence of decreased
infection, such as significantly decreased coughing and fewer organisms
on sputum smears. The medication may not produce negative acid-fast
test results for several days. The client won't have a clear chest X-ray for
several months after starting treatment. Night sweats are a sign of
tuberculosis, but they don't indicate whether the client is contagious.
The cardinal physiologic abnormalities of acute respiratory failure are
hypercapnia, hypoventilation, and hypoxemia. The nurse should focus on
resolving these problems.
The clinical manifestations of pulmonary contusions are based on the
severity of bruising and parenchymal involvement. The most common
signs and symptoms are crackles, decreased or absent bronchial breath
sounds, dyspnea, tachypnea, tachycardia, chest pain, blood-tinged
secretions, hypoxemia, and respiratory acidosis. Patients with moderate
pulmonary contusions often have a constant, but ineffective cough and
cannot clear their secretions.
Clients are encouraged to perform passive or active exercises, as
tolerated, to prevent the development of a thrombus from forming.
Constrictive, tight-fitting clothing is a risk factor for the development of a
pulmonary embolism in postoperative clients. Clients at risk for a DVT or

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a pulmonary embolism are encouraged to drink throughout the day to
avoid dehydration. Estrogen replacement is a risk factor for the
development of a pulmonary embolism.
Early signs and symptoms of pulmonary sarcoidosis may include
dyspnea, cough, hemoptysis, and congestion. Generalized symptoms
include anorexia, fatigue, and weight loss.
The client requires additional teaching if he states that coworkers need to
be checked regularly. Such casual contacts needn't be tested for
tuberculosis. However, a person in close contact with a person who's
infectious is at risk and should be checked. The client demonstrates
effective teaching if he states that he'll take his medications for 9 to 12
months, that coworkers don't need medication, and that he requires
laboratory tests while on medication. Coworkers not needing
medications, taking the medication for 9 to 12 months, and having
scheduled laboratory tests are all appropriate statements.
Vitamin B6 (pyridoxine) is usually administered with INH to prevent INHassociated peripheral neuropathy. Vitamins C, D, and E are not
appropriate.
In ALS, an early sign of respiratory distress is increased restlessness,
which results from inadequate oxygen flow to the brain. As the body tries
to compensate for inadequate oxygenation, the heart rate increases and
blood pressure drops. A decreased LOC is a later sign of poor tissue
oxygenation in a client with respiratory distress.
For a client with chest trauma, a diagnosis of Impaired gas exchange
takes priority because adequate gas exchange is essential for survival.
Although the other nursing diagnoses Anxiety, Decreased cardiac
output, and Ineffective tissue perfusion (cardiopulmonary) are possible
for this client, they are lower priorities than Impaired gas exchange.
Nasogastric, orogastric, and endotracheal tubes increase the risk of
pneumonia because of the risk of aspiration from improperly placed
tubes. Frequent oral hygiene and checking tube placement help prevent
aspiration and pneumonia. Although a client who smokes is at increased
risk for pneumonia, the risk decreases if the client has stopped smoking.
Ambulation helps prevent pneumonia. A client who receives opioids, not
acetaminophen, has a risk of developing pneumonia because respiratory
depression may occur.
Asbestosis is caused by inhalation of asbestos dust, which is frequently

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encountered during construction work, particularly when working with
older buildings. Laws restrict asbestos use, but old materials still contain
asbestos. Inhalation of silica may cause silicosis, which results from
inhalation of silica dust and is seen in workers involved with mining,
quarrying, stone-cutting, and tunnel building. Inhalation of coal dust and
other dusts may cause black lung disease. Pollen may cause an allergic
reaction, but is unlikely to cause pneumoconiosis.
Factors associated with the development of ARDS include aspiration
related to near drowning or vomiting; drug ingestion/overdose;
hematologic disorders such as disseminated intravascular coagulation or
massive transfusions; direct damage to the lungs through prolonged
smoke inhalation or other corrosive substances; localized lung infection;
metabolic disorders such as pancreatitis or uremia; shock; trauma such
as chest contusions, multiple fractures, or head injury; any major surgery;
embolism; and septicemia.
Under normal conditions, approximately 5 to 15 mL of fluid between the
pleurae prevent friction during pleural surface movement. Under normal
conditions, there is approximately 5 to 15 mL of fluid between the
pleurae. This amount would exceed the normal amount. Under normal
conditions, there is approximately 5 to 15 mL of fluid between the
pleurae. This amount would exceed the normal amount. Fluid between
the pleurae functions to prevent friction during pleural surface
movement.
A cough that changes in character is one of the hallmark signs of lung
cancer. Low-grade fever, hoarseness, and weight loss may be attributed
to other disease processes and don't necessarily indicate lung cancer.
A cough that changes in character is one of the hallmark signs of lung
cancer. Low-grade fever, hoarseness, and weight loss may be attributed
to other disease processes and don't necessarily indicate lung cancer.
As the acute phase of bacterial pneumonia subsides, normal lung
function returns and the PaO2 typically rises, reaching 85 to 100 mm Hg.
A PaCO2 of 65 mm Hg or higher is above normal and indicates CO2
retention common during the acute phase of pneumonia. Restlessness
and confusion indicate hypoxia, not an improvement in the client's
condition. Bronchial breath sounds over the affected area occur during
the acute phase of pneumonia; later, the affected area should be clear on
auscultation.
SARS, a highly contagious viral respiratory illness, is spread by close
person-to-person contact. Contained in airborne respiratory droplets, the

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virus is easily transmitted by touching surfaces and objects contaminated
with infectious droplets. The nurse should give top priority to instituting
infection-control measures to prevent the spread of infection to
emergency department staff and clients. After isolation measures are
carried out, the nurse can begin an I.V. infusion of dextrose 5% in halfnormal saline and obtain nasopharyngeal and sputum specimens.
ARF is defined as a decrease in the arterial oxygen tension (PaO2) to less
than 50 mm Hg (hypoxemia) and an increase in arterial carbon dioxide
tension (PaCO2) to greater than 50 mm Hg (hypercapnia), with an arterial
pH of less than 7.35.
The nurse places the client in semi-Fowler's position to aid breathing and
increase the amount of air taken with each breath. Increased fluid intake
is important to encourage because it helps to loosen secretions and
replace fluids lost through fever and increased respiratory rate. The nurse
monitors fluid intake and output, skin turgor, vital signs, and serum
electrolytes. He or she administers antipyretics as indicated and ordered.
Antibiotics are not given for viral pneumonia. The client's activity level is
ordered by the physician, not decided by the nurse.
Class 1 is exposure, but no evidence of infection. Class 0 is no exposure
and no infection. Class 2 is a latent infection, with no disease. Class 4 is
disease, but not clinically active.
After thoracic surgery, draining secretions, air, and blood from the
thoracic cavity is necessary to allow the lungs to expand. This makes
options B, C, and D are incorrect.
The Mantoux test doesn't differentiate between active and dormant
infections. If a positive reaction occurs, a sputum smear and culture as
well as a chest X-ray are necessary to provide more information. Although
the area of redness is measured in 3 days, a second test may be needed;
neither test indicates that tuberculosis is active. In the Mantoux test, an
induration 5 to 9 mm in diameter indicates a borderline reaction; a larger
induration indicates a positive reaction. The presence of a wheal within 2
days doesn't indicate active tuberculosis.
Pneumothorax (air in the pleural space) is a potential complication of all
central venous access devices. Signs and symptoms include chest pain,
dyspnea, shoulder or neck pain, irritability, palpitations, lightheadedness, hypotension, cyanosis, and unequal breath sounds. A chest
X-ray reveals the collapse of the affected lung that results from

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pneumothorax. Triple-lumen catheter insertion through the subclavian
vein isn't associated with pulmonary embolism, MI, or heart failure.
Chemical irritation from noxious fumes, gases, and air contaminants
induces acute bronchitis. Aspiration related to near drowning or vomiting,
drug ingestion or overdose, and direct damage to the lungs are factors
associated with the development of acute respiratory distress syndrome.
In a client with bacterial pneumonia, retained secretions cause dyspnea,
and respiratory tract inflammation causes wheezing. Bacterial pneumonia
also produces a productive cough and fever, rather than a nonproductive
cough and normal temperature. Sore throat occurs in pharyngitis, not
bacterial pneumonia. Abdominal pain is characteristic of a GI disorder,
unlike chest pain, which can reflect a respiratory infection such as
pneumonia. Hemoptysis and dysuria aren't associated with pneumonia.

A tension pneumothorax causes the lung to collapse and the heart, the
great vessels, and the trachea to shift toward the unaffected side of the
chest (mediastinal shift). A traumatic pneumothorax occurs when air
escapes from a laceration in the lung itself and enters the pleural space
or enters the pleural space through a wound in the chest wall. A simple
pneumothorax most commonly occurs as air enters the pleural space
through the rupture of a bleb or a bronchopleural fistula. Cardiac
tamponade is compression of the heart resulting from fluid or blood
within the pericardial sac.
Chemical irritation from noxious fumes, gases, and air contaminants can
induce acute tracheobronchitis. Aspiration related to near drowning or
vomiting, drug ingestion or overdose, and direct damage to the lungs are
factors associated with the development of acute respiratory distress
syndrome.
Because lung cancer produces few early symptoms, its mortality rate is
high. Lung cancer has increased in incidence due to increase in number
of women smokers, growing aging population, and exposure to pollutants
but not indicative of mortality rates.
Ineffective airway clearance is the priority nursing diagnosis for this
client. Pneumonia involves excess secretions in the respiratory tract and
inhibits air flow to the capillary bed. A client with pneumonia may not
have an Ineffective breathing pattern, such as tachypnea, bradypnea, or
Cheyne-Stokes respirations. Risk for falls and Impaired tissue integrity
aren't priority diagnoses for this client.

Chapter 23 - Management of Patients With Chest and Lower Respiratory Tract

17
Disorders
Prep-U
The acute phase of ARDS is marked by a rapid onset of severe dyspnea
that usually occurs less than 72 hours after the precipitating event
Chest percussion reveals dullness over the involved area. The nurse may
note diminished or absent breath sounds over the involved area when
auscultating the lungs and may also hear a friction rub. Chest
radiography and computed tomography (CT) scan show fluid in the
involved area.
Subcutaneous emphysema is the result of air leaking between the
subcutaneous layers not serious complication but is notable and
reportable. Pink skin and blood in the collection chamber are normal
findings. When two tubes are inserted, the posterior or lower tube drains
fluid,whereas the anterior or upper tube is for air removal.