Pulmonary System NCLEX Review

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The topic covered during this weeks blog is a review of the Pulmonary System for the NCLEX. We will cover Pulmonary Pharmacology Classifications, Testing for Tuberculosis, the ‘P’s’ of Dyspnea, and the Flail Chest Disorder. To be added to our mailing list and receive notifications of new blog posts, click the link below!

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Pulmonary System Pharmacology Classifications

Pharmacology classifications are frequently requested by our students during their preparation for the NCLEX. This is no different during the Pulmonary module, and we are happy to provide you this infographic to show the various classifications of medications that are applicable to this module.

The Pharmacology Classifications that are important for the Pulmonary System module are:

• Oxygen: Oxygen is a medication.  Keep oxygen concentrators open to air for adequate circulation.  Don’t place near a wall or in a closed container.
• Antihistamines: Block the immune system from reacting to a foreign substance.
• Antitussives: Relieve coughing by suppressing the cough center or numbing the nerves.
• Bronchodilators: Bronchodilators open up the airways of the respiratory system to allow for air passage into and out of the lungs.
• Decongestants: Decrease the swelling in clogged breathing passages through vasoconstriction of the blood vessels.  They will also help to drain the sinus cavities of fluid.  Many are available over-the-counter.
• Expectorants: Thin secretions in the respiratory tract
• Inhaled and nasal corticosteroids: Block the ability of the body to respond to foreign substances resulting in a decrease in inflammation or swelling of the breathing passages.
• Leukotriene modifiers: Prevent the release of chemicals during inflammation which can cause the airway passages of the bronchial tree to become constricted or narrower.  They are used to prevent asthma attacks, not for acute exacerbations.
• Mast cell stabilizers: Prevent the release of histamine from cells in the body known as mast cells.  Preventing this release blocks the immune system from reacting to a foreign substance.  Used to prevent asthma attacks especially ones that are caused by exercise.
• Mucolytics: Nebulized medication primarily used for cystic fibrosis clients.  Loosen respiratory secretions so they can be coughed up.
• Antitubercular agents: Liver function studies prior to therapy and monthly during therapy.  Toxic to the liver.

Testing for Tuberculosis

Tuberculosis is a potentially serious disease which primarily affects the lungs.  Transmitted by droplets.  Most people infected with the bacteria don’t develop symptoms of the disease.  Less than 1% of the population readily progresses to clinical illness, or active disease.  In 5%-10%, illness develops after an interval of months, years, or decades, when the bacteria begin to replicate and produce disease.  This is most likely in immunocompromised clients.

Testing for Tuberculosis is conducted through a PPD test which can be read after 48-72 hours. Some considerations for the PPD test that are important for the NCLEX are:

1. Must be given intradermal.
2. After an exposure, takes 6-10 weeks for a positive PPD.
3. If positive test, do a CXR and monitor for symptoms of TB.
4. Abnormal results:
   10 mm in general public or extended care residents
   5 mm in HIV, AIDs or recent close contact with active TB.
5. BCG vaccine is for ________________________.  Anyone getting this vaccine will always test positive.  Evaluate with a CXR.
6. Can have a false positive or a false negative reading.
7. If a Tine test is positive, then a PPD test is to be done to confirm.
8. Notify the primary care provider of a positive reading. CXR should follow to determine if there are white spots where the bacteria have been walled off. May also see nodules or cavities caused by active TB, or old, healed lesions.

The ‘P’s’ of Dyspnea

Dyspnea is a common complaint in respiratory disorders and has many causes. To remember the common causes of dyspnea, you have to remember to ‘P’s’!

• P = pulmonary asthma
• P = possible foreign body
• P = pulmonary embolism
• P = pneumothorax
• P = pneumonia
• P = pump failure
• P = pericardial tamponade
• P = peak seekers
• P = psychogenic
• P = poisons

Proper positioning of the patient can decrease episodes of dyspnea and include sitting upright while leaning on an over bed table, sitting upright in a chair with the arms resting on the knees, and leaning against a wall while standing.

Pulmonary System Disorders: Flail Chest

Flail Chest is the instability of the chest wall due to multiple rib fractures sustained by considerable force. Two or more ribs are fractured at two different places on each rib, leaving a rib section that isn’t connected at either end. Broken segment moves opposite normal. Pulls inward with inspiration.

The clinical assessments of Flail Chest are provided in the below infographic for your review.

To treat Flail Chest:

1. Support the chest with the hands during the emergent phase to help with pain.
2. Chest tube, intubation and ventilation needed.
3. Flail segment may need surgical repair.
4. Epidural catheter or nerve block above and below the fracture may be used for severe pain.

That concludes this weeks addition to the BrainyNurses.com NCLEX Review Blog, We hope that you were able to gain information that will be useful to your review and help you achieve success.

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