Med-Surg Proctored ATI Review With Complete Solution
2023
Arterial Blood Gas
ABG's via arterial puncture or arterial line: allows the most accurate method of
assessing respiratory function.
Steps for collecting ABG's
a. Perform Allen test if no arterial line
b. sample is drawn into heparinized syringe
c. keep on ice and transport to laboratory immediately
d. document amount and method of oxygen delivered for accurate results
e. apply direct pressure to puncture site at least 5 min (longer for clients at risk for
bleeding)
Bronchoscopy
visualizes the larynx, trachea, bronchi; obtains tissue biopsy; and removes foreign
bodies.
Steps for a bronchoscopy procedure
a. obtain informed consent
b. maintain NPO 8 to 12 hr.
c. Provide local anesthetic throat spray
d. position upright
e. administer medications as prescribed, such as atropine (to reduce oral secretions),
sedation, and/or anti-anxiety.
f. label specimen
g. observe postprocedure
-gag reflex
-bleeding
-respiratory status, vital signs, and level of consciousness
Mantoux test
Positive test indicates exposure to tuberculosis. Diagnosis must be confirmed with
sputum culture for presence of acid-fast bacillus (AFB).
Mantoux test steps
a. administer 0.1 mL of purified protein derivation intradermal to upper half inner surface
of forearm (insert needle bevel up)
b. Assess for reaction in 48 to 72 hr following injection; induration (hardening) of 10 mm
or greater is considered a positive test; 5 mm may be considered significant if
immunocompromised.
QuantiFERON-TB Gold test (QFT-GT) and T-SPOT.TB
Identify the presence of Mycobacterium tuberculosis infection by measuring the immune
response to the TB bacteria in whole blood.
Thoracentesis
Surgical perforation of the pleural space to obtain specimen, to remove fluid or air, or to
instill medication.
Steps for Thoracentesis
,a. informed consent
b. educate client: remain still, feeling of pressure, positioning
c. position upright
d. monitor respiratory status and vital signs
e. label specimens
f. Document client response, amount, color and viscosity of fluid (maximum amount of
fluid to be removed at a time is 1L).
g. Chest tube at bedside
h. Obtain CXR before and after procedure
Asthma
Chronic inflammatory disorder of the airways resulting in intermittent and reversible
airflow obstruction of the bronchioles.
Contributing factors of asthma
-Extrinsic: antigen-antibody reaction triggered by food, medications, or inhaled
substances
-Intrinsic: pathophysiological abnormalities within the respiratory tract
-Older clients: beta receptors are less responsive to agonist and trigger
bronchospasms.
Manifestations of asthma
-Sudden, severe dyspnea with use of accessory muscles
-sitting up, leaning forward
-diaphoresis and anxiety
-wheezing, gasping
-coughing
-cyanosis (late sign)
-barrel chest
Diagnostic procedures for asthma
-ABGs
-sputum cultures
-pulmonary function tests
Nursing interventions for asthma
-remain with the client during the attack
-position in high-fowler's
-assess lung sounds and pulse oximetry
-administer oxygen therapy
-maintain oxygen access
Medications for athma
Administer bronchodilators before anti-inflammatory
1. Bronchodilators
-short-acting inhaled: albuterol; for rapid relief
-Methylxanthines: theophylline; monitor therapeutic range for toxicity.
2. Anti-inflammatory
-corticosteriods: fluticasone and prednisone
-Leukotriene antagonist: montelukast
3. Combination agents
, -Ipratropium and albuterol (Combivent)
-Fluticasone and salmeterol (Advair)
Therapeutic measures for asthma
-respiratory treatments
-oxygen administration
Client Education for asthma
-avoidance of allergens and triggers
-proper use of inhaler and peak flow monitoring
Status asthmaticus
life-threatening episode of airway obstruction this is often unresponsive to treatment
Manifestations of status asthmaticus
-extreme wheezing
-labored breathing
-use of accessory muscles
-distended neck veins
-high risk for cardiac and/or respiratory arrest
Nursing interventions for status asthmaticus
-place in high-fowler's
-prepare for emergency intubation
-administer oxygen, epinephrine, and systemic steroid as prescribed
-provide emotional support
Chronic Obstructive Pulmonary Disease
encompasses pulmonary emphysema and chronic bronchitis. COPD is not reversible.
Pulmonary emphysema
-destruction of alveoli, narrowing of bronchioles, and trapping of air resulting in loss of
lung elasticity
Contributing factors of pulmonary emphysema
-cigarette smoking (main causative factor); passive smoke inhalation
-advanced age
-exposure to air pollution
-Alpha-antitrypsin deficiency (inability to break down pollutants)
-Occupational dust and chemical exposure
Manifestations of emphysema
-dyspnea with productive cough
-difficult exhalation, use of pursed-lip breathing
-wheezing, crackles
-barrel chest
-shallow, rapid respirations
-respiratory acidosis with hypoxia
-weight loss
-clubbed fingernails
-fatigue
Chronic bronchitis
inflammation and hypersecretion of mucus in the bronchi and bronchioles caused by
chronic exposure to irritants
Contributing factors to chronic bronchitis
2023
Arterial Blood Gas
ABG's via arterial puncture or arterial line: allows the most accurate method of
assessing respiratory function.
Steps for collecting ABG's
a. Perform Allen test if no arterial line
b. sample is drawn into heparinized syringe
c. keep on ice and transport to laboratory immediately
d. document amount and method of oxygen delivered for accurate results
e. apply direct pressure to puncture site at least 5 min (longer for clients at risk for
bleeding)
Bronchoscopy
visualizes the larynx, trachea, bronchi; obtains tissue biopsy; and removes foreign
bodies.
Steps for a bronchoscopy procedure
a. obtain informed consent
b. maintain NPO 8 to 12 hr.
c. Provide local anesthetic throat spray
d. position upright
e. administer medications as prescribed, such as atropine (to reduce oral secretions),
sedation, and/or anti-anxiety.
f. label specimen
g. observe postprocedure
-gag reflex
-bleeding
-respiratory status, vital signs, and level of consciousness
Mantoux test
Positive test indicates exposure to tuberculosis. Diagnosis must be confirmed with
sputum culture for presence of acid-fast bacillus (AFB).
Mantoux test steps
a. administer 0.1 mL of purified protein derivation intradermal to upper half inner surface
of forearm (insert needle bevel up)
b. Assess for reaction in 48 to 72 hr following injection; induration (hardening) of 10 mm
or greater is considered a positive test; 5 mm may be considered significant if
immunocompromised.
QuantiFERON-TB Gold test (QFT-GT) and T-SPOT.TB
Identify the presence of Mycobacterium tuberculosis infection by measuring the immune
response to the TB bacteria in whole blood.
Thoracentesis
Surgical perforation of the pleural space to obtain specimen, to remove fluid or air, or to
instill medication.
Steps for Thoracentesis
,a. informed consent
b. educate client: remain still, feeling of pressure, positioning
c. position upright
d. monitor respiratory status and vital signs
e. label specimens
f. Document client response, amount, color and viscosity of fluid (maximum amount of
fluid to be removed at a time is 1L).
g. Chest tube at bedside
h. Obtain CXR before and after procedure
Asthma
Chronic inflammatory disorder of the airways resulting in intermittent and reversible
airflow obstruction of the bronchioles.
Contributing factors of asthma
-Extrinsic: antigen-antibody reaction triggered by food, medications, or inhaled
substances
-Intrinsic: pathophysiological abnormalities within the respiratory tract
-Older clients: beta receptors are less responsive to agonist and trigger
bronchospasms.
Manifestations of asthma
-Sudden, severe dyspnea with use of accessory muscles
-sitting up, leaning forward
-diaphoresis and anxiety
-wheezing, gasping
-coughing
-cyanosis (late sign)
-barrel chest
Diagnostic procedures for asthma
-ABGs
-sputum cultures
-pulmonary function tests
Nursing interventions for asthma
-remain with the client during the attack
-position in high-fowler's
-assess lung sounds and pulse oximetry
-administer oxygen therapy
-maintain oxygen access
Medications for athma
Administer bronchodilators before anti-inflammatory
1. Bronchodilators
-short-acting inhaled: albuterol; for rapid relief
-Methylxanthines: theophylline; monitor therapeutic range for toxicity.
2. Anti-inflammatory
-corticosteriods: fluticasone and prednisone
-Leukotriene antagonist: montelukast
3. Combination agents
, -Ipratropium and albuterol (Combivent)
-Fluticasone and salmeterol (Advair)
Therapeutic measures for asthma
-respiratory treatments
-oxygen administration
Client Education for asthma
-avoidance of allergens and triggers
-proper use of inhaler and peak flow monitoring
Status asthmaticus
life-threatening episode of airway obstruction this is often unresponsive to treatment
Manifestations of status asthmaticus
-extreme wheezing
-labored breathing
-use of accessory muscles
-distended neck veins
-high risk for cardiac and/or respiratory arrest
Nursing interventions for status asthmaticus
-place in high-fowler's
-prepare for emergency intubation
-administer oxygen, epinephrine, and systemic steroid as prescribed
-provide emotional support
Chronic Obstructive Pulmonary Disease
encompasses pulmonary emphysema and chronic bronchitis. COPD is not reversible.
Pulmonary emphysema
-destruction of alveoli, narrowing of bronchioles, and trapping of air resulting in loss of
lung elasticity
Contributing factors of pulmonary emphysema
-cigarette smoking (main causative factor); passive smoke inhalation
-advanced age
-exposure to air pollution
-Alpha-antitrypsin deficiency (inability to break down pollutants)
-Occupational dust and chemical exposure
Manifestations of emphysema
-dyspnea with productive cough
-difficult exhalation, use of pursed-lip breathing
-wheezing, crackles
-barrel chest
-shallow, rapid respirations
-respiratory acidosis with hypoxia
-weight loss
-clubbed fingernails
-fatigue
Chronic bronchitis
inflammation and hypersecretion of mucus in the bronchi and bronchioles caused by
chronic exposure to irritants
Contributing factors to chronic bronchitis
