If a pleural effusion develops, which of the following actions best describes how the fluid can be removed from the pleural space and proper lung status restored?
-
Solution
Performing thoracentesis
Performing thoracentesis is used to remove excess pleural fluid. The fluid is then analyzed to determine if it’s transudative or exudative. Transudates are substances that have passed through a membrane and usually occur in low protein states. Exudates are substances that have escaped from blood vessels. They contain an accumulation of cells and have a high specific gravity and a high lactate dehydrogenase level. Exudates usually occur in response to a malignancy, infection, or inflammatory process. A chest tube is rarely necessary because the amount of fluid typically isn’t large enough to warrant such a measure. Pleural effusions can’t drain by themselves.
Which of the following best describes pleural effusion?
-
Solution
The accumulation of fluid between the linings of the pleural space.
The pleural fluid normally seeps continually into the pleural space from the capillaries lining the parietal pleura and is reabsorbed by the visceral pleural capillaries and lymphatics. Any condition that interferes with either the secretion or drainage of this fluid will lead to a pleural effusion.
Continuous positive airway pressure (CPAP) can be provided through an oxygen mask to improve oxygenation in hypoxic patients by which of the following methods?
-
Solution
The mask provides pressurized oxygen so the client can breathe more easily.
The mask provides pressurized oxygen continuously through both inspiration and expiration. The mask can be set to deliver any amount of oxygen needed. By providing the client with pressurized oxygen, the client has less resistance to overcome in taking his next breath, making it easier to breathe. Pressurized oxygen delivered at the end of expiration is positive end-expiratory pressure (PEEP), not continuous positive airway pressure.
Which of the following statements best explains how opening up collapsed alveoli improves oxygenation?
-
Solution
Gaseous exchange occurs in the alveolar membrane.
Gaseous exchange occurs in the alveolar membrane, so if the alveoli collapse, no exchange occurs, Collapsed alveoli receive oxygen, as well as other nutrients, from the bloodstream. Collapsed alveoli have no effect on oxygen demand, though by decreasing the surface area available for gas exchange, they decrease oxygenation of the blood.
What effect does hemoglobin amount have on oxygenation status?
-
Solution
Low hemoglobin levels cause reduces oxygen-carrying capacity
Hemoglobin carries oxygen to all tissues in the body. If the hemoglobin level is low, the amount of oxygen-carrying capacity is also low. More hemoglobin will increase oxygen-carrying capacity and thus increase the total amount of oxygen available in the blood. If the client has been tachypneic during exertion, or even at rest, because oxygen demand is higher than the available oxygen content, then an increase in hemoglobin may decrease the respiratory rate to normal levels.
A pulse oximetry gives what type of information about the client?
-
Solution
Percentage of hemoglobin carrying oxygen
The pulse oximeter determines the percentage of hemoglobin carrying oxygen. This doesn’t ensure that the oxygen being carried through the bloodstream is actually being taken up by the tissue.
Which of the following methods is the best way to confirm the diagnosis of a pneumothorax?
-
Solution
Take a chest x-ray
A chest x-ray will show the area of collapsed lung if pneumothorax is present as well as the volume of air in the pleural space. Listening to breath sounds won’t confirm a diagnosis. An IS is used to encourage deep breathing. A needle thoracostomy is done only in an emergency and only by someone trained to do it.
Which of the following treatments would the nurse expect for a client with a spontaneous pneumothorax?
-
Solution
Chest tube placement
The only way to re-expand the lung is to place a chest tube on the right side so the air in the pleural space can be removed and the lung re-expanded.
A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to the base. Which of the following conditions would best explain this?
-
Solution
Spontaneous pneumothorax
A spontaneous pneumothorax occurs when the client’s lung collapses, causing an acute decrease in the amount of functional lung used in oxygenation. The sudden collapse was the cause of his chest pain and shortness of breath. An asthma attack would show wheezing breath sounds, and bronchitis would have rhonchi. Pneumonia would have bronchial breath sounds over the area of consolidation.
A 24-year-old client comes into the clinic complaining of right-sided chest pain and shortness of breath. He reports that it started suddenly. The assessment should include which of the following interventions?
-
Solution
Auscultation of breath sounds
Because the client is short of breath, listening to breath sounds is a good idea. He may need a chest x-ray and an ECG, but a physician must order these tests. Unless a cardiac source for the client’s pain is identified, he won’t need an echocardiogram.