2.1 Respiratory Flashcards

Question

Patient with pneumonia | Infectiuous classifications

Answer 1

``` Community acquired: Streptococcus pneumonia (most common) Mycoplasma pneumonia Haemophilus pneumonia Influenzae Chlamydia pneumonia Influenza virus ``` ``` Nosocomial (hospital acquired): Staphylococcus aureus Gram negative bacterial -Klebsiella pneumonia -Pseudomonas aeruginosa -E coli ``` Opportunistic: Pneumocystis

Answer 2

Lower respiratory tract normally sterile Defense mechanisms: mucous membranes of nose (sneezing) reflex closure of epiglottis, bronchial tree cilia, mucus lining respiratory tract (coughing) Aging impairs immune responses

Answer 3

Pneumonia: The inflammatory response causes fluid to accumulate in the alveoli and edema to form as alveolar capillaries dilate and allow fluid to leak into interstitial tissues

Answer 4

Four patterns: Lobar pneumonia- involves the entire lobe of lung Bronchopneumonia- fluid tends to remain in the bronchia's and bronchi with less congestion in the alveoli Interstitial pneumonia- found in the interstitial tissue Miliary pneumonia- primarily seen in pts who are immunocompromised, typically enters through blood stream

Answer 5

Acute bacterial pneumonia (quick onset): Respiratory: cough productive of rust colored or purulent sputum - Chest aching or pleuritic pain when coughing/breathing - Limited breathing sounds, fine crackles, rales heard over affected area of lung - Pleural friction rub may be audible - Systemic: shaking chills (rigor), fever Bronchopneumonia (slower onset): -Insidious onset, low grade fever, cough, scattered crackles Atypical presentation (older adults): fever, tachypnea, altered mental status, agitation, slight cough, minimal distress

Answer 6

Typically infection resolves uneventfully Pleuritis is most common complication Lung abscess (relatively uncommon): -Most common etiology -Aspiration, resultant pneumonia -At-risk population Empyema- accumulation of purulent exudate in the pleural cavity.

Answer 7

Pneumococcal or lobar pneumonia Onset? abrupt Respiratory manifestations? Cough productive of purulent or rust-colored sputum; pleuritic or aching chest pain; decreased breath sounds and crackles over affected area; possible dyspnea and cyanosis Systemic manifestations? Chills and fever

Answer 8

Bronchopneumonia Onset? gradual Respiratory manifestations? Cough, scattered crackles; minimal dyspnea and respiratory distress Systemic manifestations? Low-grade fever

Answer 9

Legionnaire disease Onset? gradual Respiratory manifestations? Dry cough; dyspnea Systemic manifestations? Chills and fever; general malaise; headache; confusion; anorexia and diarrhea; myalgias (muscle pain) and arthralgias (joint pain)

Answer 10

Primary atypical pneumonia Onset? gradual Respiratory manifestations? Dry, hacking, nonproductive cough Systemic manifestations? Fever, headache, myalgias, and arthralgias dominate

Answer 11

Viral pneumonia Onset? sudden or gradual Respiratory manifestations? Dry cough Systemic manifestations? Flulike symptoms

Answer 12

Pneumocystis pneumonia Onset? abrupt Respiratory manifestations? Dry cough; tachypnea and shortness of breath; significant respiratory distress Systemic manifestations? Fever

Answer 13

Mycoplasma pneumoniae College students and military recruits are primary affected population Primary atypical pneumonia is highly contagious Called “walking pneumonia” Mild respiratory manifestations Pharyngitis or bronchitis Dry, hacking, nonproductive cough ``` Systemic manifestations Fever Headache Myalgias Arthralgias ```

Answer 14

Mild disease Affects older adults, people with chronic conditions Cytomegalovirus (CMV) pneumonia is increasing in immunocompromised people. Occurs in community epidemics Influenza and adenovirus Respiratory Dry cough Systemic Flulike symptoms

Answer 15

AIDS and other immunocompromised patients Pneumocystis jiroveci Produces patchy involvement throughout the lungs Alveoli thicken, swell, and fill with fluid ``` Abrupt onset of symptoms: Fever Tachypnea Shortness of Breath Nonproductive cough ```

Answer 16

``` Tachypnea, SOB Dry, nonproductive cough Intercostal retractions Cyanosis Fever ```

Answer 17

Risk Factors: Emergency Surgery or Obstetric Procedure, depressed cough reflexes, impaired swallowing, elderly surgical patients, nutrition via NG or Gastric tube, and decreased LOC Aspiration of gastric contents into lungs Low p H of gastric contents causes inflammation Pulmonary edema/respiratory failure can result Complications: abscesses bronchiectasis gangrene of pulmonary tissue

Answer 18

``` Chest x-ray Sputum gram stain Sputum C&S CBC, WBC w/ dif Serology when blood and sputum tests are negative Pulse ox, continuously ABG's Fiberoptic bronchoscopy ```

Answer 19

Agents that "break up" mucus Acetylcysteine Potassium iodide Guaifenesin ``` Broad spectrum antibiotic Macrolide Penicillin Second- or third-generation cephalosporin Fluoroquinolone ``` Bronchodilators Sympathomimetic drugs Methylxanthines

Answer 20

Immunization Pneumococcal vaccine -Pneumococcal Conjugate (PCV13, Prevnar), common used in children -Pneumococcal Polysaccharide (PPSV23, Pneumovax), given to adults, lifetime one dose. Influenza vaccine ``` Treatments Oxygen therapy -For patients who are tachypneic, hypoxemic -Low- or high-flow systems Chest physiotherapy -Percussion -Vibration -Postural drainage ```

Answer 21

Diagnoses, outcomes, and interventions - Ineffective Airway Clearance - Ineffective Breathing Pattern - Activity Intolerance Continuity of care Usually treated in the community unless their respiratory status is significantly compromised or risk factors -Advanced age -Coexisting heart, kidney, or liver disease are present

Answer 22

Chronic, recurrent infectious disease usually affecting the lungs Mycobacterium tuberculosis: Relatively slow-growing, acid-fast organism with a waxy outer capsule Airborne transmission by droplet nuclei: Suspended in air for hours

Answer 23

Incidence and prevalence United States - Incidence fell until the mid-1980s - Resurgence late 1980s and early 1990s - Link to H I V/AIDS - Incidence is now declining Worldwide - Continues to be a significant health problem - An estimated 2 million deaths each year

Answer 24

Characteristics of infected person Extent of air contamination Duration of exposure Susceptibility of host: Those in lower socioeconomic groups, injection drug users, the homeless, and people with alcoholism or H I V infection

Answer 25

``` Fatigue Weight loss Anorexia Low-grade afternoon fever Dry cough Night sweats Tuberculosis empyema Bronchopleural fistula ```

Answer 26

``` Early detection Accurate diagnosis Effective disease treatment Preventing spread to others Screening -Methods of tuberculin testing -Intradermal P P D (mantoux) test -Multiple-puncture (tine) testing ```

Answer 27

Intradermal injection for tuberculin testing. The injection causes a local inflammatory response (wheal). Measurement of induration following tuberculin testing. The PPD will be administered intradermally on the dorsal aspect of the forearm , causing a wheel to develop approximately 6-10mm in diameter. the patient will have to return to the clinic after 48 to 72 hours to have the test read. The health care professional will measure the diameter of the induration.

Answer 28

Less than 5 millimeter: Negative response, does not rule out infection 5-9 millimeter: Positive for people who are in close contact with someone with T B, are immunocompromised, have an organ transplant 10-15 millimeter: Positive for people who have other risk factors Greater than 15 millimeter: Positive for all people

Answer 29

A positive tuberculin test alone does not indicate active disease Sputum smear is microscopically examined for acid-fast bacilli Positive sputum culture is definitive Sensitivity testing to determine appropriate drug therapy Polymerase chain reaction (P C R)-rapid detection of M. tuberculosis D N A Chest x-ray Liver function tests

Answer 30

Single-drug therapy: Isoniazid (I N H) Bacillus Calmette-Guerin (B C G) vaccination ``` Not widely used in the United States Two-or-more-drugs therapy: Isoniazid Rifampin Pyrazinamide Ethambutol Streptomycin ``` If a drug-resistant strain of T B: Therapy tailored to that resistance

Answer 31

Health promotion -Risk to public health Awareness of TB as reemerging threat Early diagnosis and appropriate treatment is best for prevention Focus on infection control and ensuring compliance with prescribed treatment Diagnoses, outcomes, and interventions - Deficient Knowledge - Ineffective Therapeutic Regimen Management - Risk for Infection

Answer 32

Spores are present in the air that everyone breathes. Normal respiratory and immune defenses prevent infection in most people. Risk factors -Inadequate immune system

Answer 33

Histoplasmosis - Most common fungal infection in US - Found in soil and linked to bird and bat droppings - Histoplasma capsulatum - Most infections develop into latent asymptomatic disease - Primary acute histoplasmosis: Mild, self-limiting influenza type illness - Chronic progressive disease: Older adults in lungs but can involve other organs Disseminated histoplasmosis - Oftentimes fatal - Fever - Dyspnea - Cough - Weight Loss - Ulcerations of mouth and oropharynx - Muscle Wasting - Hepatomegaly - Splenomegaly

Answer 34

Spores are common in the environment; rarely cause disease except in the immunocompromised Invade blood vessels and produce hyphae that can cause thrombosis Manifestations - Dyspnea - Nonproductive cough - Pleuritic chest pain - Chills, fever - Hemoptysis or massive pulmonary hemorrhage can occur if the organism invades a pulmonary blood vessel

Answer 35

``` Diagnosis Microscopic examination of sputum specimen Blood cultures Cerebrospinal fluid cultures Chest x-ray ```

Answer 36

``` Treatments Oral itraconazole (Sporanox), a broad-spectrum antifungal agent, is commonly prescribed to treat histoplasmosis ``` Intravenous amphotericin B surgery (lobectomy)

Answer 37

Education -Geographical locations and risk factors (exposure to bird droppings) Antifungal drugs -Teach about drug and interactions Pregnancy and birth control -Itraconazole is contraindicated during pregnancy and lactation. Monitor carefully during infusion and therapy -Amphotericin B is toxic must be monitored closely

Answer 38

Obstructive and Central Sleep Apnea Obstructive Sleep Apnea: Respiratory drive remains intact but airflow ceases due to occlusion of airway (most common type) Central sleep apnea rare: Caused by a neurological disorder

Answer 39

Pathophysiology - Loss of normal pharyngeal muscle tone - Pharynx collapses during inspiration & tongue pulls against post. pharyngeal wall - Obstruction causes O2 sat, P O2, and p H to fall, P C O2 to rise -Asphyxia causes brief arousal from sleep Restores airway patency and airflow Episodes can occur hundreds of times a night

Answer 40

``` Loud, cyclic snoring, and restless sleep Excessive daytime sleepiness Irritability Gasping or choking during sleep Morning headache ``` Later Manifestations: Depression, intellectual impairment, and impotence Hypertension

Answer 41

``` Complications Sleep fragmentation Loss of slow-wave sleep Dysrhythmias Sudden cardiac death Pulmonary hypertension Common in those who are morbidly obese ```

Answer 42

``` Risk Factors Male gender Increasing age Obesity Large neck circumference Use of alcohol and C N S depressants ```

Answer 43

Overnight sleep study - Electroencephalogram - Measurements of ocular activity and muscle tone - Ventilatory activity and airflow - Continuous arterial oxygen saturation - Heart rate - Transcutaneous arterial P C O2

Answer 44

Mild-to-moderate apnea - Weight reduction - Abstaining from alcohol - Improving nasal patency - Avoiding supine sleeping position - Nasal continuous positive airway pressure (C P A P) is the treatment of choice for sleep apnea - Bi P A P ventilator provides less resistance to exhaling

Answer 45

Tonsillectomy Adenoidectomy Uvulopalatopharyngoplasty (U P P P) Tracheostomy

Answer 46

Obstructive sleep apnea is often treated in the home Education of patient and family - Equipment use - Strategies to decrease contributing factors - Diagnoses, outcomes, and interventions - Disturbed Sleep Pattern - Fatigue - Ineffective Breathing Pattern - Impaired Gas Exchange - Risk for Injury - Risk for Sexual Dysfunction

Answer 47

- Leading cause of cancer deaths in United States - Accounts for 25% of all cancer deaths - Most people with lung cancer die within 1 year of initial diagnosis

Answer 48

Vast majority of primary lung lesions are bronchogenic carcinomas. -Bronchogenic carcinoma further differentiated by cell type Small-cell carcinomas -15% of lung cancers Non-small-cell carcinomas (adenocarcinoma, squamous cell carcinoma, and large cell carcinoma) -85% of lung cancers Spread via lymph system to other organs

Answer 49

Small-cell (oat cell) carcinoma, 15% of all lung cancers - Central mass - Aggressive tumor

Answer 50

Adenocarcinoma, 20-40% of all lung cancers - Peripheral mass - Early metastasis

Answer 51

Squamous cell, 25-30% of all lung cancers | -Central mass in large bronchi

Answer 52

Large cell carcinoma, 10-15% of all lung cancers | -Peripheral mass larger than adenocarcinoma

Answer 53

Populations at risk - Exposure to tobacco smoke - Age over 50 - Exposure to ionizing radiation and inhaled irritants - Exposure to radon

Answer 54

``` Chronic cough Hemoptysis Wheezing SOB Dull, aching chest pain or pleuritic pain Hoarseness and/or dysphagia Weight loss, anorexia Fatigue, weakness Bone pain Clubbing of fingers/toes ```

Answer 55

Superior vena cava syndrome -Partial or complete obstruction of superior vena cava Paraneoplastic syndromes -Syndrome of inappropriate ADH secretion (SIADH), hyponatremia, edema, Cushing Syndrome, hypercalcemia, venous thrombosis or pulmonary embolism.

Answer 56

``` Chest x-ray Sputum specimen Bronchoscopy C T scan Cytologic examination, biopsy C B C, liver function, serum electrolytes Tuberculin test Pulmonary function tests, A B G s ```

Answer 57

Medications - Combination chemotherapy treatment of choice for small-cell lung cancer - Bronchodilators Surgery - Only real chance for cure in non-small cell lung cancers - Most tumors inoperable Radiation therapy - Used alone or in combination with surgery or chemotherapy - Either curative or palliative - “Debulks” tumors prior to surgery - Relieve manifestations, complications - External beam, intraluminal radiation, brachytherapy

Answer 58

Diagnoses, outcomes, and interventions Ineffective Breathing Pattern Assess respiratory status and oxygenation, pain, elevate HOB, Incentive Spirometer, Cough and Deep Breathe, Suction, Chest Physiotherapy. Activity Intolerance Assess physiologic responses to activity, plan rest periods between activities, increase activities gradually, teach energy conserving measures, keep frequently used objects within reach, administer O2 as prescribed, encourage physical activity Pain Assess pain, PRN pain meds for comfort or “around the clock” schedule for cancer pain, distraction, massage, positioning, and relaxation techniques. Anticipatory Grieving Spend time with patient/family, encourage expression of feelings/concerns, assist in grieving process, identify healthy coping measures, and encourage use of support systems

Answer 59

Benign or malignant - Benign: Papillomas, Nodules, Polyps - Malignant: Squamous Cell Carcinoma most common Chronic shouting, projecting, or vocalizing Cigarette smoking and chronic irritation from industrial pollutants

Answer 60

Laryngeal -Most common malignancy is squamous-cell carcinoma -Leukoplakia White, patchy, and precancerous lesions on tongue/mouth -Erythroplakia Red, velvety patches thought to represent a later stage - Initial cancerous lesion, carcinoma in situ (CIS), will develop into squamous-cell cancer if untreated - Laryngeal cancer can develop in glottis, supraglottis, and subglottis

Answer 61

Pathophysiology and manifestations Laryngeal cancer - Cancers of the vocal cords or glottis tend to be well-differentiated, slow-growing - Metastasis occurs late in illness - Manifestations Hoarseness: Change in voice quality - Cancer of supraglottis (epiglottis, aryepiglottic folds, arytenoid muscles, cartilage, and false vocal cords): Invades locally, metastasizes early - Subglottic tumors (below vocal cords): Often asymptomatic until enlarging tumor obstructs airway

Answer 62

``` Tobacco Alcohol Poor nutrition Human papillomavirus infection Exposure to asbestos Race: More common in African Americans ```

Answer 63

Benign tumors may resolve with correction of underlying issue Early detection of malignant tumors is critical to survival Diagnosis - Direct or indirect laryngoscopy when cancer is suspected - Biopsy - C T scan, MRI, chest x-ray, & PET

Answer 64

Benign vocal cord polyps - Inhaled steroid spray - Some cases call for surgery ``` Radiation therapy -Treatment of choice -Preserves voice -Chemoradiotherapy Chemotherapy ``` - Treats distant metastasis - Palliation when tumor unresectable - Cisplatin and 5-fluorouracil

Answer 65

Goals - Remove the malignancy - Maintain airway patency - Achieve optimal cosmetic appearance ``` Laser laryngoscopy (carcinoma in situ, vocal cord polyps, & early vocal cord cancers) ``` Laryngectomy - Partial laryngectomy - ---Hemilaryngectomy - ---Vertical partial laryngectomy - Total Radical neck dissection Modified neck dissection

Answer 66

Following a total laryngectomy, the patient has a permanent tracheostomy. No connection between the trachea and esophagus remains.

Answer 67

The tracheoesophageal prosthesis (T E P) allows diversion of air from the trachea through a one-way valve into the esophagus and oropharynx, producing speech when the tracheostomy stoma is occluded. The one-way valve prevents food from entering the trachea.

Answer 68

Speech rehabilitation Necessary if entire larynx is removed Techniques - Tracheoesophageal puncture (TEP) with placement of a one-way shunt valve - Esophageal speech - Use of speech generators

Answer 69

Emphasize the need for patients with chronic hoarseness to seek treatment Health promotion Prevent tobacco use in children, adolescents, and young adults Discourage use of alcohol

Answer 70

Diagnoses, outcomes, and interventions - Risk for Impaired Airway Clearance - Impaired Verbal Communication - Impaired Swallowing - Imbalanced Nutrition: Less Than Body Requirements - Anticipatory Grieving

Answer 71

Asthma - Chronic inflammatory disorder of airways - Recurrent episodes of wheezing, breathlessness, chest tightness, coughing Rare acute cases can be severe enough to cause respiratory failure, death

Answer 72

Chronic inflammatory disorder of airways Subacute state - Inflammation quiet - Inflammatory cells present in airway tissues Acute episodes - Widespread airflow obstruction - Antigen-antibody response - Inflammatory mediators released - Bronchoconstriction, airway edema, impaired mucociliar clearance

Answer 73

``` Allergens Chemical agents in the workplace Respiratory infections Exercise Emotional stress Pharmacologic -N S A I D s, beta-blockers, sulfites ```

Answer 74

Acute or early response - Inflammatory mediators - Activation of inflammatory cells - Stimulation of parasympathetic receptors - Bronchoconstriction and impaired gas exchange Late phase response -4-12 hours after trigger

Answer 75

``` Wheezing Breathlessness Chest tightness Coughing Dyspnea Status asthmaticus -Severe, prolonged asthma -Does not respond to treatment ```

Answer 76

``` History and manifestations Pulmonary function tests (P F T s) Challenge or bronchial provocation tests A B G s Skin tests ```

Answer 77

Disease monitoring - Peak expiratory flow rate (P E F R) - Evaluated by traffic signals Preventative measures - Avoiding allergens, environmental triggers - Eliminating tobacco - Early treatment of respiratory infections

Answer 78

Long-term control - Anti-inflammatory agents - Long-acting bronchodilators - Leukotriene modifiers Quick relief - Short-acting adrenergic stimulants - Anticholinergic drugs - Methylxanthines Routes of administration - Metered-dose inhaler (M D I) - Dry powder inhaler (D P I) - Nebulizer Bronchodilators -Adrenergic stimulants, anticholinergic agents, and methylxanthines In combination with anti-inflammatory Anti-inflammatory agents - Corticosteroids - Cromolyn sodium and nedocromil Leukotriene modifiers - Montelukast, zafirlukast, zileuton - Reduce need for short-acting bronchodilators

Answer 79

Health promotion - Link between smoking, childhood asthma - Smoking cessation

Answer 80

Diagnoses, outcomes, and interventions - Ineffective Airway Clearance- monitor LOC, assess pulse oximetry, assess cough effort and sputum, raise HOB, administer O2 and nebulizer Tx as ordered - Ineffective Breathing Pattern-Assess RR, pattern and breath sounds, vital signs, labs, assist with ADL’s, provide rest between scheduled activities, teach pursed lip breathing and relaxation techniques, Administer O2 and bronchodilators/anti-inflammatories as ordered. - Anxiety-Assess level of anxiety, identify coping skills, provide physical and emotional support, active listening, provide clear instructions, reduce excessive environmental stimuli, relaxation techniques. - Ineffective Therapeutic Regimen Management-Assess level of understanding about treatment and diagnosis, discuss perceptions of illness, identify problems integrating tx plan into lifestyle, provide verbal and written instructions

Answer 81

Also known as C O P D Pathophysiology -Chronic bronchitis and/or emphysema -Characterized by slow progressive obstruction of airways: Resistance to airflow increases Expiration becomes slow or difficult Mismatch between alveolar ventilation and perfusion Impaired gas exchange

Answer 82

Chronic bronchitis - Inhaled irritants cause chronic inflammation - Production of thick mucus - Productive cough lasting 3 or more months in 2 consecutive years - Narrowing of airways - Common recurrent infection

Answer 83

Emphysema - Destruction of the walls of the alveoli - Enlargement of abnormal air spaces - Airway collapse - Loss of alveolar surface area for gas exchange

Answer 84

COPD is classified according to severity, staged from 0 to 4 Productive cough, often in mornings Dyspnea with activity, exercise intolerance Presence of a barrel-shaped chest

Answer 85

``` Fourth leading cause of death in U.S Cigarette smoking Air pollution Occupational exposures Airway infection Familial and genetic factors ```

Answer 86

``` Pulmonary function tests Ventilation-perfusion scanning Serum alpha1-antitrypsin levels A B G s Pulse oximetry C B C with W B C differential Chest x-ray ```

Answer 87

- Immunizations against pneumococcal pneumonia and influenza - Broad-spectrum antibiotics for suspected infection - Bronchodilators- improves airflow and reduce air trapping - Corticosteroids when asthma is component - Alpha1-antitrypsin replacement therapy for those with genetic deficiency

Answer 88

``` Smoking cessation Avoidance of airway irritants and allergens Pulmonary hygiene measures Adequate hydration Pulmonary rehabilitation (P R) Pursed Lip Breathing Regular aerobic exercise, if applicable Oxygen -Long-term oxygen therapy Surgery -Lung transplant -Lung reduction surgery ```

Answer 89

Diagnoses, outcomes, and interventions - Ineffective Airway Clearance- assess respiratory status, rate, cough, secretions, oxygen saturation, I/O, mucous membranes, encourage fluid intake of 2500ml/day, elevate HOB, coughing/deep breathing, suction, provide rest periods, oxygen, expectorants/bronchodilators. - Imbalanced Nutrition: Less Than Body Requirements- assess nutritional status, monitor food intake, provide frequent, small feedings, elevate HOB for meals, provide snacks at bedside, assist with choosing preferred foods, and consult with dietician. - Compromised Family Coping- Assess family interactions and effects of illness on them, identify coping strengths/weaknesses, provide teaching on COPD, encourage expression of feelings and avoid judgment, encourage family participation in care, family care conferences. - Decisional Conflict: Smoking- Assess knowledge and understanding, acknowledge concerns and beliefs, listen nonjudgmentally, encourage expression of feelings, assist with creating plan to quit, provide referrals to outside support personal or groups.