The nurse is teaching a patient with asthma how to measure peak ...

[Cooldude101]

The nurse is teaching a patient with asthma how to measure peak expiratory flow rate (PEFR). What should be included in the teaching plan? (Select all that apply.)
 
  a. Assume a recumbent position before measuring PEFR.
  b. Take a deep breath in, exhale, then place the mouthpiece in the mouth and form a firm seal with the lips.
  c. After placing the mouthpiece in the mouth, blow out as hard and as fast as possible through the mouth in only one single breath.
  d. Measure PEFR 3 times and record the highest number.

Question 2

The nurse is caring for several patients who require oxygen therapy. The nurse anticipates an order for noninvasive positive-pressure ventilation (NIPPV) for the patients with which diagnoses? (Select all that apply.)
 
  a. Pulmonary edema
  b. Obstructive sleep apnea
  c. Stroke with dysphagia
  d. Congestive heart failure

[wuly]

Answer to Question 1

C, D
To measure PEFR, the patient should be standing. If the patient is unable to stand, high-Fowler's position or any other position that promotes optimum lung expansion should be used. The patient should take in a deep breath, place the mouthpiece in the mouth, and form a tight seal. Then the patient should blow out as hard and as fast as possible through the mouth in only one single breath. Two additional measurements are taken, and the highest number is recorded.

Answer to Question 2

A, B, D
In the cardiac patient, NIPPV reduces pulmonary edema because the increased alveolar pressure forces interstitial fluid out of the lungs and back into the pulmonary circulation. In patients who retain carbon dioxide, such as with obstructive sleep apnea, NIPPV keeps the airway open and prevents upper airway collapse. In selected patients, such as those with postpolio syndrome and other neuromuscular diseases, congestive heart failure, sleep disorders, and pulmonary diseases, NIPPV is often the treatment of choice in supporting ventilation without the hazards associated with endotracheal intubation. NIPPV is contraindicated in patients at high risk for aspiration, as after a stroke with dysphagia.